An inventory of racism in health care

Racism manifests itself in different ways in the health care system. But there is a lack of reliable numbers and data. An inventory of colonial assumptions, misdiagnosis and lack of sensitivity in medical education.

In 2021, a research team commissioned by the German Federal Anti-Discrimination Agency presented the research project Diskriminierungsrisiken und Diskriminierungsschutz im Gesundheitswesen (Discrimination Risks and Discrimination Protection in Health Care). The result: Discrimination risks exist both in access to and in the use of health care. Discrimination such as racism manifests itself not only in the form of discriminatory behaviour on the part of medical staff, but much more in the form of institutional practices and processes that favour unequal treatment of patient groups.

Racism in healthcare is multi-faceted and affects people on many levels. Sometimes racism is directed at health care workers, sometimes at patients, and sometimes racism costs lives when it prevents diseases from being detected early and treated properly.

In Germany, however, there is hardly any research on the topic. Due to a lack of data, the debate is often one-sided, and institutional practices and structural inequalities stay unaddressed. It is therefore worth taking a look at the USA, Canada and the UK, where there are far more reliable figures.

Institutional racism in medicine

According to the Human Rights Watch study „We Need Access“ in conjunction with the “Southern Rural Black Women’s Initiative of Economic and Social Justice”, Black women are diagnosed with cervical cancer much later than white women. They are also more likely to die from it, although cervical cancer is preventable and highly treatable if caught early enough. In the U.S. state of Georgia, Black women are twice as likely to die from cancer as white women. This is, for example, because they are less likely to be screened for cervical cancer, less likely to be informed about preventive measures, or less likely to have their pain taken seriously.

Although cervical cancer is preventable in most cases, institutional racism, or factors such as socioeconomic background, ensure the opposite. This excludes BIPoC from the health care system and cuts them off from important information and services that can be crucial to life and death.

In Germany, too, accusations of racism in the health care system are piling up, primarily as a result of the corona pandemic. The proportion of foreign nationals among all deaths increased during the pandemic at an above-average rate. Between January and August 2021, 4500 foreign nationals died – more than in 2019 during the same period.

Causes of the increased mortality could include on average poorer housing and working conditions, limited access to healthy nutrition, and more frequent use of public transportation. But again, there is a lack of data that could validly reflect structural discrimination.

A short history lesson – colonial-historical assumptions

People with a history of migration and flight often receiving inadequate medical care is also due to a research and knowledge gap in medicine. Many pathologies such as skin rashes, neurodermatitis or Lyme disease are difficult to recognise for the untrained eye on dark skin – which is due to the fact that corresponding textbooks predominantly refer to white patients. In 2020, Malone Mukwende, a Black medical student from the UK, published the textbook „Mind the Gap“, where symptoms are shown on different skin colours to counteract this problem.

In addition, there are still colonial-historical presumptions that need to be dismantled. Other studies from the USA, for example, show that heart attacks in Black women are more often overlooked and therefore only treated half as often. In Great Britain, it was found that the mortality of Black mothers due to birth complications is five times higher than that of white mothers.

An intersectional perspective is needed

What is striking: Black women are particularly often affected. This is due to a combination of anti-Black racism and sexism, which has its roots in colonial times. In order to trivialise slavery, Black bodies were said to be more physically capable. This is still evident today in the stereotype of the „strong Black woman“, who is supposed to be more resistant and allegedly less sensitive to pain.

The so-called „southerner’s syndrome“ (morbus bosporus) is also still widespread today. According to this, patients whose origin is assumed to be Mediterranean are said to have an exaggerated sensitivity to pain and an exaggerated expression of pain, although it has been known for a long time that people perceive pain individually and independently of gender and origin. Black people often report being confronted with stereotypes by medical professionel or not being taken seriously with their complaints.

The result: trust in the health care system is declining. This can lead to those affected visiting medical facilities less often – and thus their health is increasingly at risk.

This article was also published in German.