Guide

Strategies towards antiracism in care delivery.

Inclusive Language Illustration

Strategies towards antiracism in care delivery.

Black patients are less likely to receive pain medication based on the assumption that Black people have a higher pain tolerance.

What can you do: 

  • Acknowledge the history and implications biased beliefs had on Black patients to justify violence and unethical medical testing. Historical examples include the Tuskegee Study of Untreated Syphilis and gynecological experiments on enslaved Black women.
  • Provide standardized procedures and practices so that every patient, regardless of race, will receive the same amount of care. Having best practice guides available and following them can ensure more consistent treatment.
  • Practice empathy and compassion towards patients who may exhibit medical mistrust based on prior mistreatment and misunderstanding in health care settings. Good ways to build empathy involve learning about community perspectives and hearing patients share their story.

Racial discrimination is the most commonly reported type of discrimination in health care settings. 

What can you do: 

  • Build trust over time so that patients feel encouraged and safe to disclose their experiences with discrimination. Examples of ways to build trust include using patient-centered talk, having a positive effect during visits and providing longer appointments.
  • Understand that a patient’s race/ethnicity is not a risk factor for discrimination; exposure to discrimination and racism are the risk factors. 
  • Affirm BIPOC patients in acknowledging there is discrimination in health care which negatively impacts their health literacy and provide resources that address discrimination in the clinical setting. Allow patients the opportunity to share previous experiences and to share concerns about the clinician-patient relationship, which include perceived racism, cultural differences, or issues with how care is delivered.

While BIPOC comprise approximately of 33% of the U.S. population, they make up only 14% of students entering medical school.

What can you do:

  • Encourage the recruitment, hiring, retention, and leadership development of BIPOC clinicians. 
  • Know that Black representation and ongoing antiracist allyship matters and can be instrumental to the health literacy of BIPOC patients.

Predominantly Black zip codes are more likely (67%) than other zip codes to lack an adequate number of PCPs.

What can you do: 

  • Link BIPOC patients to case managers to schedule appointments with PCPs and specialists, make reminders, and coordinate transportation. 
  • Collaborate with different stakeholders to form an interdisciplinary team keeping an open dialogue based on the patients’ needs.  
  • Be mindful of the racist structures in place that further marginalize BIPOC patients from achieving their health outcomes. 

Racism is strongly associated with higher rates of anxiety and depression among Asian Americans and the Latino/a/e/x community.

What you can do:

  • Provide translated psycho-educational resources that are both culturally appropriate and accessible to patients. Community-specific health organizations and community groups can be resources for finding more culturally appropriate materials.
  • Model mental health strategies such as mindfulness and breathing exercises to relieve psychological distress for patients experiencing racism, while taking into account cultural norms and coping strategies. 
  • Connect patients to local support networks that hold a shared identity and can help them cope with racism. Examples of these can include local community centers or places of worship.

American Indians and Alaska Natives born today have a lower life expectancy than the United States all races population and continue to die at higher rates than other Americans from preventable illnesses.

What you can do:

  • Incorporate evidence-based, outcome-based, and community-based approaches, treating patients as the expert. Consider including more patient-centered communication and language in treatment.
  • Set achievable goals that are culturally appropriate with a focus on preventative care.  

Things to consider.

01

Since racism is expressed on an individual, structural, historical, and symbolic level, dismantling it will require individual and collective action across multiple communities to create antiracist health care structures.

02

Implementing medical and cultural competence training that includes an awareness of racism and how to address it.

Question to think about:

What choices are you making that reflect antiracism?

References

Cigna. (2021, July). Health disparities: African American/Black population.

Hostetter, M., & Klein, S. (2021, January 14). Understanding and ameliorating medical mistrust among Black Americans. The Commonwealth Fund.

King, C. J., & Redwood, Y. (2016). The health care institution, population health and black lives. Journal of the National Medical Association, 108(2), 131-136.

King, B. (2021, November 30). Faculty confront structural racism in health care. Columbia University Irving Medical Center.

Martin, K. D., Roter, D. L., Beach, M. C., Carson, K. A., & Cooper, L. A. (2013). Physician communication behaviors and trust among black and white patients with hypertension. Medical care, 51(2), 151–157. https://doi.org/10.1097/MLR.0b013e31827632a2

New York, NY: Springer. Lewis-Fernández R (2009). The Cultural Formulation. Transcultural Psychiatry 46: 379–382.

Nong, P., Raj, M., Creary, M., Kardia, S. L., & Platt, J. E. (2020). Patient-reported experiences of discrimination in the US health care system. JAMA Network Open, 3(12), e2029650. doi:10.1001/jamanetworkopen.2020.29650

Rees, M. (2020, September 16). Racism in healthcare: What you need to know. Medical News Today.

Rees, M. (2020, November 4). What is the link between racism and mental health. Medical News Today.

Ross, P. T., Lypson, M. L., Byington, C. L., Sánchez, J. P., Wong, B. M., & Kumagai, A. K. (2020). Learning from the past and working in the present to create an antiracist future for academic medicine. Academic Medicine, 95(12), 1781-1786.

Sabin, J. A. (2020, January 6). How we fail Black patients in pain. Association of American Medical Colleges.

Saint Catherine University. (2021, June 15). Racial discrimination in healthcare: How structural racism affects healthcare.

Smithsonian National Museum of African American History and Culture. (n.d.). Being Antiracist.

Smith, M. (2018, August 1). Native Americans: A crisis in health equity. American Bar Association.

Williams, D. R. (2018). Stress and the mental health of populations of color: Advancing our understanding of race-related stressors. Journal of Health and Social Behavior, 59(4), 466-485.