February 17, 2020

By William Buckley, MD

African Americans have a complicated history with the American healthcare system. While as a nation we deliver among the best care in the world, numerous studies have documented poorer healthcare and health outcomes for black patients in the U.S., but few have asked why or compared racial bias across nations. Natalia Neha Khosla, a second-year student at the University of Chicago Pritzker School of Medicine, wanted to know more and formed a research team to investigate.

Her group’s findings, “A Comparison of Clinicians' Racial Biases in the United States and France,” were published in April 2018 in the journal Social Science & Medicine. The team found that American clinicians rated white patients as significantly more likely to improve and more likely to adhere to recommended treatments than black patients, and to be more personally responsible for their health than black patients. Then they compared the findings to clinicians in France, where healthcare providers didn’t exhibit significant bias toward either race. “Clinicians tended to see black patients as less likely to take responsibility for their health, less likely to follow treatment recommendations and less likely to get better. We need to continue to examine if medical providers have preferences for some groups over others, either implicit or explicit, and how that affects treatment, expectation for patient success, and interactions with patients,” said co-author Sylvia Perry, PhD, an assistant professor of psychology at Northwestern University, who was Khosla’s undergraduate thesis advisor at Yale.

Pair those perceptions with African Americans’ historical encounters with the American healthcare system and there is a perfect storm. Two examples of those encounters are the Tuskegee Syphilis Experiment and the story of Henrietta Lacks. The Tuskegee Syphilis Experiment was an experiment held from 1932-1972 that followed 600 black men in Alabama (about 400 of whom had syphilis) over the course of their lives. The participants believed they were being treated for “bad blood,” and were promised free meals, free healthcare, and free burial insurance. The facilitators refused to tell patients their diagnosis, prescribed placebo medications, and at points, actively denied treatment.

In 1951, Henrietta Lacks visited the hospital complaining of vaginal bleeding. During her examination, a large, malignant cervical tumor was discovered. Without her consent, a sample of cancer cells retrieved during a biopsy were sent to a nearby tissue lab. These cells have been used in everything from studying the human genome to developing the polio vaccine. These stories from recent history have naturally led to a lack of trust in the medical community. Even today, many African Americans continue to receive disparate treatment and a disregard for their medical concerns. I recommend you read the story of tennis champion Serena Williams and her encounter with the healthcare system.

This complexity of bias and distrust leads to the poorer health outcomes that we see today for African Americans. Black infants in the U.S. are more than twice as likely to die than white infants – at 11.3 deaths per 1,000 births. Their mothers are at-risk as well – black mothers die at a rate that is 3.3 times greater than white mothers – at 42.8 deaths per 100,000 live births. While this seems incredibly discouraging, TriHealth’s mission to serve the community and all its patients regardless of race, has been the catalyst to change these numbers for the better. Next week’s cascade will spotlight some of the great things TriHealth is doing to change history for the better.

This is our tragic truth. We need change.
Posted by: Jaime Kist on March 02, 2020
Reply/View Reply

Thank you for the enlightening article. I plan to share with my family who are currently doing their residencies in Emergency Medicine and Family Medicine.
Posted by: Dana Price on February 24, 2020
Reply/View Reply

Thank you. The things you just don't know!!
Posted by: Gregory Davis on February 22, 2020
Reply/View Reply

Thank you!!
Posted by: Pamela Larkins on February 20, 2020
Reply/View Reply

thanks for the info
Posted by: Team Member on February 20, 2020
Reply/View Reply

Thank you for enlightening us and explaining to us the reason for some of the mistrust of healthcare providers and disparity in the African American community.
Posted by: Christina Howard on February 19, 2020
Reply/View Reply

Great info-thank you!
Posted by: Alysia Dasenbrock on February 19, 2020
Reply/View Reply

Thank you!
Posted by: Team Member on February 19, 2020
Reply/View Reply

great info - Thank you for the stimulating thought!!
Posted by: Donna Sadelfeld on February 19, 2020
Reply/View Reply

Thank you Dr. Buckley for such a powerful and enlightening article that I feel should be viewed by all. Thank you
Posted by: Bobbie Henderson on February 19, 2020
Reply/View Reply

Wow, this is sad but informative as well. I hope to see a change in my lifetime. I watched a documentary about the Tuskegee Experiment- that was shameful, to say the least. I will read up on Serena. Thank you for the great article!
Posted by: Tammy Lohrum on February 19, 2020
Reply/View Reply

Thank you Dr Buckley for bringing this very important information to all our attention. I know the Henrietta Lacks story but I had no idea about the Tuskegee Syphilis Experiment. I will share this page with family and friends for sure.
Posted by: Iesha Metcalf on February 19, 2020
Reply/View Reply

Great article, I'll read about Serena, interesting she had trouble as well
Posted by: Shanda Scott on February 19, 2020
Reply/View Reply

Thank you Dr Buckley for the informative article. Working beside you and now reading this article, I would never guess that these biases and distrust exist. I remember taking my medical ethics class and reading about the Tuskegee Experiment and telling my husband about what I read. So encouraged to continue to grow in my own beliefs and biases and change for the better of human kind. Hard topics to discuss equals understanding and empathy.
Posted by: Darla Daniel on February 18, 2020
Reply/View Reply

Thank you Dr Buckley I saw a special on PBS abut Henrietta Lacks and her families struggle for recognition. It was almost unbelievable. Truly educational.
Posted by: Pamela Baird on February 18, 2020
Reply/View Reply

I truly enjoyed this reading and coming from a lower income family growing up and now working in the medical field I have seen and understand the struggles that come with it. African Americans that are in poverty do not have the money for healthier foods or time to excercise. Most black people seek treatment to late due to lack of insurance or having to work lots of hours leaving little time for self care.
Posted by: Tyler Gwinn on February 18, 2020
Reply/View Reply

I truly enjoyed this reading and coming from a lower income family growing up and now working in the medical field I have seen and understand the struggles that come with it. African Americans that are in poverty do not have the money for healthier foods or time to excercise. Most black people seek treatment to late due to lack of insurance or having to work lots of hours leaving little time for self care.
Posted by: Tyler Gwinn on February 18, 2020
Reply/View Reply

WOW...….Thank you, Dr. Buckley. I will truly read about Serena Williams.
Posted by: Debra Hunt on February 18, 2020
Reply/View Reply

Thank you Dr. Buckley for this very informative article. It is very hard to imagine that this attitude is present within healthcare. We are all human beings and as such should all be treated equally. Kathleen Hayden
Posted by: Kathleen Hayden on February 18, 2020
Reply/View Reply

Great starting point to shed light on the disparities within healthcare especially in regard to the healthcare of people of color. Education and communication is key to creating a change.
Posted by: Micaiah Yhisrael on February 18, 2020
Reply/View Reply

Thank you Dr. Buckley for shedding light on this issue. It's devastating to read in today's society we continue to have such disparity in healthcare. I am encouraged TriHealth is taking steps in bringing awareness, developing plan of action and continued training in conscious/unconscious biases.
Posted by: Robin Melton on February 18, 2020
Reply/View Reply

Dr/ Buckley, Thank you for this informative article, even though it makes you want to cry and some of the things we humans do to one another. Very proud to be a part of a team that cares about treating EVERYONE!
Posted by: Cynthia Shelton on February 18, 2020
Reply/View Reply

Thank you Dr. Buckley. I truly appreciate your guidance and voice for equitable care in the Maternal Child space. Helping us to better uncover our blind spots so we can design care that is customized to meet all of our human family
Posted by: Michael Marcotte on February 18, 2020
Reply/View Reply

I do appreciate the content of this article and thank you for your efforts in keeping us aware there is still more work to do in order to bridge the racial divide.
Posted by: Teresa Martin on February 18, 2020
Reply/View Reply

Thank you sharing this informative article - it inspires me to want to serve and bless everyone more - grateful for the commitment of TriHealth to lead the way in getting health care right for all people all the time.
Posted by: MichaelJeff Hill on February 18, 2020
Reply/View Reply

For all of us in healthcare the article is a surprise. I think the goal is to treat all people as we would like to be treated.
Posted by: Rosetta Popp on February 18, 2020
Reply/View Reply

Thank you for sharing some history on the black community. This is important to the organization and the black community.
Posted by: Tonya Horton on February 18, 2020
Reply/View Reply

Thank you, Dr. Buckley. We know we can do better and that's why TriHealth is committed to this journey. All of our patients deserve THE best care, always!
Posted by: Emily Seitz-Pawlak on February 18, 2020
Reply/View Reply

Great article.
Posted by: Ingrid Chapman on February 18, 2020
Reply/View Reply

This is not TriHealth. My sister has a mass on her pancreatic duct. She has been to Cleveland Clinic twice. She is now experiencing pain again and her PCP here in Cincinnati wants her to go back to the physician at Cleveland Clinic. My sister has been trying since October 2019 to get an appointment and/or at least have a conversation with the physician. Her staff keeps telling her that the doctor is out. Since October 2019? Come on! Time is of the essence. What are we supposed to think?
Posted by: Barbara Coulter on February 18, 2020
Reply/View Reply

This issue has been a personal crusade for over 40 years, since my father died of a misdiagnosis of a cold, when it was lung cancer. The physical makeup of African Americans make it necessary for a more through diagnosis rather than the usual mainstream treatment. Why do Black Males have a higher rate of Prostrate cancer more than White Males? Don't answer the question, just think about it and investigate!
Posted by: Brian Moragne on February 18, 2020
Reply/View Reply

Thanks Bill for being the light for all of us. Keep pushing us forward by helping us to learn from the past.
Posted by: Pamela Coyle-Toerner on February 18, 2020
Reply/View Reply

Interesting - thanks for sharing this information......
Posted by: Sharon Ross on February 18, 2020
Reply/View Reply

Socially, the belief & faith in the healthcare system is so tainted that there's not many Blacks who haven't heard a family plead "don't let them cut on me!" or "I don't trust them, all they want is my money!" The noted examples are not even the tip of the ice burg and I appreciate the fact that these such biases are being brought to light and more importantly, some are trying to correct this behavior.
Posted by: Team Member on February 17, 2020
Reply/View Reply