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Blog, Health disparities, Health equity

Deadly Discrimination

by Suzanne Bohan
February 9, 2014
David Williams, a Harvard University professor with an expertise on the health effects of racism.

David Williams, a Harvard University professor with an expertise on the health effects of racism.

Beware of the small slights in life. Over a lifetime they add up to major loss of health, physical and mental, warns David R. Williams, a professor of public health, sociology and African and African-American studies at Harvard University.

For decades Williams has studied the connection between racism and diminished health. Recently his work percolated up in the news as he’s giving a few talks this week, at the invitation of Canadian health experts eager to close the gap between black and white populations there.

Worldwide, life expectancies are all strongly linked to socioeconomic status – job rank, income and education level. Minority populations typically end up on the lower end of the spectrum, and many nations are working to reduce those life span differences, which reach up to 20 years.

Between 1990 and 2008, the United States began making headway in its quest end the difference, with the most educated blacks gaining 6.7 years in life expectancy. But they still lag in lifespan behind their white counterparts, and Williams points to racism, or what he calls “microaggressions,” as the key hidden factor.

To quantify the effects of racism, Williams developed three statistical tools: The Major Experiences of Discrimination, Everyday Discrimination, and Heightened Vigilance scales.

Everyday discrimination, Williams found, extracts the greatest toll. Black Americans often report poor service in retail outlets or being followed as though they’ll shoplift, being passed over for important positions or promotions, and less attentive treatment from health care professionals, among countless slights. (The Tumblr site, http://microaggressions.tumblr.com, has numerous first-hand examples.)

Among the health ramifications: Greater risk of developing heart disease, depression, and premature delivery, as well as the buildup of abdominal fat, itself linked to diabetes, high blood pressure, and stroke.

Awareness starts the cure, Williams asserts. In a recent article in the (Halifax) Chronicle Herald, he advised pausing before subconsciously categorizing somebody based on the most common traits used to discriminate — race, gender and age. Instead, he suggested making a conscious effort to focus on the person as a unique individual.

1)   Harvard prof coming to HRM for talks on racism’s effect on health; The Chronicle Herald, Clare Mellor, staff reporter. February 7, 2014.

Suzanne Bohan

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Health, Health disparities

What’s your social rank? Status can influence welcome into a doctor’s office

by Suzanne Bohan
February 27, 2013
Dr. Stephen Hwang is a general internal medicine physician at St. Michael’s Hospital and researcher in its Centre for Research on Inner City Health. He wrote a new study assessing discrimination in doctors’ offices on socioeconomic status.

Dr. Stephen Hwang is a general internal medicine physician at St. Michael’s Hospital and researcher in its Centre for Research on Inner City Health. He wrote a new study assessing discrimination in doctors’ offices on socioeconomic status.

Family physicians’ offices in Toronto more frequently rebuffed people of low socio-economic status seeking first appointments, even when there is no economic incentive to do so, a new study found. All Canadians have universal, publicly-funded health insurance.

In 2011, researchers called nearly 400 family practice offices seeking a first appointment,

posing as either a newly-transferred bank employee or a welfare recipient. In both cases, the researchers told the receptionists that they had either no health problems or that they had diabetes or low back pain. The pseudo-bank workers were able to secure an appointment 23 percent of the time, compared with 14 percent for the lower-status pseudo-welfare recipient – 50 percent better odds of getting in for the higher status caller.

“This impairs access to primary care, and we don’t think this is acceptable,” said Dr. Stephen Hwang, a physician with St. Michael’s Hospital in Toronto in a statement.

The study was published online Monday in the Canadian Medical Association Journal.

In a Feb. 27 article in the Toronto Star by Theresa Boyle, Hwang was quoted as saying, “The most likely explanation is that people working in doctors’ offices may be unconsciously biased against people of low socioeconomic status.” He added that it was the physicians’ staff that demonstrated a reluctance to schedule lower-status patients, not the physician. So it could have reflected staff bias, or could have been due to the physician providing direction to staff on new patient acceptance, Hwang said.

“I’ve always been struck by the fact that many of my patients who are marginalized say that they have been treated poorly by health-care providers in the past, simply because of their position in society,” Hwang said in the article.

I’m posting this news on a Canadian study to cultivate more empathy for what happens to people lower on the socioeconomic ladder in the United States, where the reimbursements for their care is almost always lower than for wealthier patients given the hodgepodge of medical coverage options.  I’ve heard first-hand peoples’ reluctance to schedule a visit to a doctor, because they fear being treated disrespectfully.

TAKEAWAY: This study is a wake-up call for doctors (and patients) to remain vigilant for hidden biases – which compromises treatment.

—

Boyle, Theresa. “Doctors appear more likely to take on wealthier patients, study finds,” Toronto Star, Feb. 27, 2013.

 

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