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Monday, May 20, 2024

To combat health disparities experienced by Black individuals, increased diversity in healthcare is necessary

This Black History Month, the Editorial Board commends the many Black physicians leading more equitable healthcare 

The theme of Black History Month this year is “Black Health and Wellness,” which invites us to recognize and celebrate the many distinguished Black physicians, scholars and leaders in the healthcare and wellness industries — but also to recognize and begin to redress the many ways in which the U.S. health system still fails Black populations. 

The Centers for Disease Control and Prevention data shows that Black Americans are more likely than white Americans to face health disparities, and studies show that unconscious racial biases are linked to lower quality medical care. This can be seen especially clearly in pre and postnatal care. Black women are less likely to be recommended treatments and medical advice for prenatal symptoms, and they are more likely to develop prenatal hypertension disorders, theoretically in part due to “unmeasured comorbidities” that could be a result of poorer health care. 

Black women are almost four times more likely to die during childbirth than white women, a stark disparity that has not decreased in over a decade. According to the BBC, this can be attributed in part to healthcare providers making microaggressions against and disregarding concerns of Black patients, as well as higher percentages of Black patients feeling unsafe and being denied pain relief while receiving prenatal care. We recognize that not all people who give birth identify as women, but it is unclear whether people who do not identify as women were included in the above studies.

Racial bias is also seen in medical training and research. Graphics in medical textbooks often show predominantly lighter skin tones and underrepresent darker skin tones. A 2018 study of four major human anatomy textbooks found that only 4.5% of images showed dark skin tones, based on tone parameters coded by the researchers. When healthcare professionals are trained based on these textbooks, they might recognize certain physical symptoms only on specific skin tones, leading to racial bias when treating patients. Additionally, certain physical symptoms that signal the need for further workup or diagnosis manifest differently across skin tones. Since most of the images showed lighter skin tones, patients with darker skin tones might be put at higher risk for late diagnosis and poor outcomes, specifically in colon, breast, skin and cervical cancers. 

Lack of race-related health research and diversity in clinical trial participants might also contribute to the disproportionate rate of health disparities between Black and white populations in the U.S. UC Davis just completed a study on the differences in gut microbiomes of white and Black women and how those differences can be linked to differing rates of diabetes — the first of its kind. Such knowledge about how race can impact health is important, as it helps healthcare professionals better understand what issues might be more prevalent in their patients and adjust their care accordingly. Especially because of the existing disparity between quality of healthcare services that white and Black populations receive, more studies like this, which assess the ways race intersects with likelihood of certain medical conditions, are imperative to better treatment for Black patients. 

Both more targeted trials that might help identify differing rates of health disparities between Black and white individuals, like the UC Davis study mentioned above, and more diverse representation in all clinical trials, are crucial to improve healthcare for Black people. The combination of systemic racial bias in the medical field and a lack of diversity in training materials and clinical trial representation needs to be addressed further. 

While UC Davis researchers are making strides to improve these issues through their research and course offerings — like SPH 113 (Health Disparities in the U.S.) — a lot more work is needed. More courses should discuss equity and care disparities in the medical field, more diverse textbooks need to be created and utilized and more research needs to prioritize proportional representation. 

It is necessary to take time during Black History Month to examine where we are still falling short, but it is also vital to recognize Black excellence and the massive strides that Black communities have made in medicine. As of this January, the rate of Black first-year medical students is up 21% from 2020 levels, a record increase. Additionally, many Black physicians are leading important fields of research and study, like UC Davis Health’s Dr. David Cooke, whose research focuses on diversity and representation in cardiothoracic care, and Dr. Candace Price, whose most recent work identified the differences in Black and white womens’ gut microbiome.  

Written by: The Editorial Board


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