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Representation Matters: It Will Save Lives

April 15, 2019

maternal rates of death by racial identity

Take your time to breathe in those statistics.  A black British mother is statistically more than twice as likely to die in childbirth or shortly after than the nearest racially identified group.  That terrifies me, and I am not within the racial group most at risk, I’m three below.  I also have no children nor do I intend to, which puts me at no risk.

Just as in any other social system, healthcare is imbued with racial disparity; in representation of medical staff, hierarchy and management, and in treatment of patients.  The difference in this case is that it endangers lives and as seen above, leads to death of those already discriminated against in so many other ways.

There are many reasons for the above statistic, not least is the fact there are medical conditions which are statistically more likely to present in particular subgroups; for example, those of African, Caribbean, Middle Eastern, Eastern Mediterranean and Asian heritage are more likely to suffer with sickle cell anaemia.  In the UK, patients are almost always of African or Caribbean heritage.

However, that is a statistical diagnostic prevalence, and not what I am talking about.  I am talking about the different ways in which racial bias in treatment can lead to undiagnosed illness and in the most extreme cases death of patients.  There is a gender aspect to this also, in the way women are mistrusted with regard to information about and complaints regarding their health and their treatment.  This is true both in mental and physical health.

A study published in 2008 found that children of Black or Hispanic/Latino heritage are more likely to be diagnosed with behavioural psychological conditions, whereas those of white heritage are more likely to be diagnosed with depression or substance abuse issues. Those of black heritage are also far more likely to be hospitalised as a result of those diagnoses.  The study concluded in part by stating:

“Findings from our analyses show that race/ethnicity is associated with specific diagnostic and disposition decisions in this PES, suggesting that race may affect diagnosis and disposition decision-making in pediatric PES.”

This correlated with the results of an early study of adults delineated on racial identity lines.

Other studies have found differences in diagnosis of and treatment for prostate cancer for those of different racial backgrounds with those of Black heritage being diagnosed at a far later stage than White patients.  Further studies have shown that pain management and treatment of chronic pain is different according to racial group, with Black people more likely to be seen negatively and either mistreated or not treated at all, or to be viewed with suspicion, i.e. the expectation of addiction issues and of the patient trying to get pain medication for this reason rather than for pain.

Implicit bias in healthcare professionals is not a new concept but it is still not being addressed and it is killing people.

Representation of those of different racial backgrounds is one way of addressing the matter, but that does not fully address implicit bias as we are ALL susceptible to this indoctrination no matter what racial identity we are privileged or unprivileged to present.  This is why women support sexism and misogyny, why Black people can uphold and perpetuate racial discrimination, why disabled people can exhibit discriminatory attitudes towards other disabled people, and so on.

However, representation is a massive step towards changing attitudes.  It starts with education at the youngest level, and requires a fully integrated policy of change.  I believe we need over-representation at first, with affirmative action to remove any implicit bias in the initial stages of study and employment and create the visual representation of those in deemed minority groups in all levels of healthcare work.  We need a deliberate policy of equality education at all stages of medical teachings, with emphasis on implicit bias and the dangers this poses to treatment and this means representation in the minority groups in teaching positions as well.  We also need an effective and proactive complaints system in place which supports those who are discriminated against.

I have made a complaint against a GP for his conduct towards me, and specifically for making racist comments whilst I was discussing a form of treatment.  He seemed to expect my implicit support as I am a white person.  The result of my complaint was that I was taken off his register and will never have to speak with him again, and he was given specific training with regard to his attitudes.  He still treats, he still sees patients.  I live in a borough which is very racially integrated (According to the 2011 census, of a population of 275,885, 53% identify as white and 47% identify as BAME).  I have no idea if he still holds racist views, or how he treats his patients.  The complaint went no further.  All I can hope is that he learned not to racially stereotype at all.

racism-apathy feesI am pleased to note my local healthcare trust has completed a study in this area and seeks to implement the findings.   This is a great step, and should be built upon; and I await the further study citing how effective such actions have been.

People are dying NOW.  It is up to all of us to fight for equality and if you are white-identifying and are not doing so, you are part of the problem.  It should not be in your name, either.

From → Ideology, political

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