June 12, 2017

Addressing the Health Disparities experienced by African American Women.

I remember sitting in the auditorium at Harvard Medical School and seeing, what I considered, a startling statistic.

The infant mortality rate for African Americans was worse than that of Jamaican babies and also double the rate of their white counterparts. That statistic, which I remember more than 20 years later, had a significant impact on my mind as an American citizen, born in New York, and raised in Jamaica.

While, on the one hand, I was pleased that Jamaica had relatively good statistics for a developing country, I could not understand that this first world country, with all the modern facilities, would have such a disparity in the care of its citizens.

Over the years, I often heard the same answers.

It was due to socio-economic factors. But, then I learned that a disparity in health between black women and white women remains even when this is accounted for. And, this does not tell the entire story, because poverty was definitely a factor in Jamaica too.

I heard other explanations, which were unsatisfactory.

Recently I listened to two TED talks, which discussed the effects of racism on the health of African Americans. It was an “aha” moment for me because finally there was another piece of the puzzle—perhaps the most important piece.

It was not necessarily about direct acts of racism but sometimes-subtle, unconscious bias or implicit bias such as not giving the patient as much attention as she deserves due to her race, or making race-based assumptions about her. It is about social structures that have been in place for years that continue to discriminate against African Americans. It was the way an African American pregnant woman might be treated on a day-to-day basis.

Unfortunately, I have observed this implicit bias in professional settings throughout my career.

Recently I heard about a case of substandard care that a relative received when she was in labor in New York State, despite the fact that she was a black professional and the doctor was a black male. She was turned back from admission at her registered hospital because the on-call doctor refused to take her concerns about being in labor seriously. She barely missed delivering her baby enroute returning to the hospital. The incident also led to a prolonged hospitalization for her newborn.

The thing is, you can hold this implicit bias even if you are a victim of the same bias yourself; meaning a black person can have implicit bias against black people. Unfortunately,  the root is the same. It is still racism because of the inundation of negative stereotypes of black people in America as a whole.

African American women are also more likely to die in childbirth, almost four times more likely, according to recent statistics. A substantial gap in the infant mortality rates still remains. My relative was lucky, both she and her child ultimately did well. Many are not so fortunate.

I recently read the tragic story of Kira Dixon Johnson, an apparently healthy woman, who died from hemorrhagic shock hours after a Cesarean section. As an obstetrician, I am not naïve to the fact that this tragedy could occur even under the care of an excellent physician. Unfortunately, the sad reality in this country is that her death may have occurred because of her race.

African American women are also more likely to die from cervical cancer (perhaps the only cancer that can largely be prevented by screening and I am not talking early detection, I do mean prevented). Black women are also more likely to die from breast cancer. These disparities are only the tip of the iceberg. The list goes on.

However I believe there is something that can help. Over the past four years I have studied Lifestyle Medicine and learned, through research, that adopting lifestyle factors can improve the health of individuals. These factors can be applied regardless of race and regardless of any limitations of our health care system. These include a healthy diet, exercise, meditation and mindfulness, and healthy relationships.

Let’s start with mindfulness.

Suppose we were all mindful of the fact that we have biases, we need not pretend they don’t exist and we don’t ignore them. So, if we are doctors or other health care professionals taking care of patients, we force ourselves to step back and ensure we are delivering the best care to this person—regardless of their race. It may even mean discussing the patient’s care with a colleague without mentioning race to maintain objectivity. It is not only our job, it is our responsibility and if it means trying extra hard, so be it.

As a doctor taking care of patients for over 20 years, I know that not every patient is easy. It is not only a matter of handling complicated medical care but also personalities.

However, I learned something else early in my career. I was doing a rotation in neurology and I was taking care of a difficult elderly male patient. He tried my patience and my senior resident noticed my difficulties. He reminded me of something that stuck with me: “Remember he is sick.”

Our patients are sick when they come to us. Even a healthy pregnant woman is in a state that increases her risk of dying. In addition, African American patients could be distrustful of the healthcare system. Any brief study of history and even present day could provide ample reasons for the distrust. Let’s not, as healthcare professionals, give them more reasons.

We, as patients, need to do our part. Recognize that as black women in America we should do what we can to motivate ourselves and others to adopt a healthier lifestyle.

I have often heard that time and money are barriers to living a healthier lifestyle and I would be naïve to pretend that they are not factor. But gym memberships or equipment are not necessary to exercise and it is possible to prepare healthy, tasty, economical meals in 30 minutes. Good relationships and social support are integral to health but, fortunately, socializing and social support, especially through church, are already an important part of the African American culture.

However, we need to pay attention to the quality of our relationships and only maintain those that are positive for us and be prepared to cut those that are not. This applies to both intimate and platonic relationships. We can also use proven strategies such as meditation and prayer to help alleviate unhealthy stress.

Should the disparity be our concern if we are not black, or women, or African American? I leave that for your own conscience to decide.

I have no illusion that racism or the issues with the healthcare system will be solved overnight, nor does this give government permission to abdicate its responsibility of providing social support and healthcare to its vulnerable citizens.

But, this is an opportunity, an opportunity to support ourselves and each other, where our government has failed us, by using tools we already have at our disposal to diminish the racial disparities and improve the health of our nation overall.


Author: Dr. Monique Rainford 
Image: Aaron H/Flickr
Editor: Lieselle Davidson

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