In American Health Care, Prejudice Is Deadly

(Bloomberg Opinion) -- The Covid-19 pandemic has exposed many longstanding injustices, economic and social, that make life unduly perilous for Black Americans. There’s one that deserves more attention, and that is personal for me: How physicians treat patients very differently, depending on race.

I’m a highly educated man living in one of the world’s richest nations, so you might assume that I enjoy better-than-average care. Yet it took me years of persistence and unnecessary suffering to get a digestive illness diagnosed. It turns out I’m not alone: Evidence suggests that doctors often don’t take seriously the complaints of Black patients. Such prejudice has deadly consequences, and stands in the way of efforts to address health disparities.

Ever since people have been able to measure it, there has been a large gap between Black and White mortality in the U.S. Even before then, in antebellum America, enslaved Black people were significantly shorter. This was due in part to inadequate diets, and in part to the treatment of pregnant slaves, who were forced to work to within a week of giving birth and placed back in the fields only a few weeks after. As a result, enslaved Black women gave birth to some of the smallest babies ever observed.

After the end of chattel slavery, the mortality gap narrowed. Public sanitation, medical care, treatments for infectious diseases, and improved living standards increased longevity for everyone, even if some of the benefits to Black people were unintended. Yet as of 2010, the gap was still 5 years — and that was due in part to a largely opioid-related increase in White mortality. This persistent disparity presents a major challenge to health researchers and policy makers.

Many see increasing access to medical care — through insurance or community health centers, for example — as a solution. But it depends on the kind of care Black people get when they show up.

Unfortunately, since the beginning of formalized medical training in the U.S., the profession has viewed Black bodies as inherently different from White ones. Black people went from being seen as more immune to diseases like cholera to being seen as a “dying race” not worthy of medical care. Black Civil War veterans were no more likely to report pain or aches, but they were more than twice as likely to be “doubted” by their physicians, more than three times as likely to be accused of “exaggerating” their illness and 15 times more likely to be described as “ignorant.” This resulted in higher mortality rates, and in lower pensions because disabilities were inadequately assessed.

Such prejudices endure today. Recent research suggests that doctors assess the pain and treatment of Black people differently, prescribing fewer pain medications and offering fewer treatments, surgical and otherwise, relative to their White counterparts. In other words, physicians simply do not believe their Black patients, whose health suffers as a result.

Historical bias has even become embedded in medical systems. Consider government benefit assessments for people with Chronic Obstructive Pulmonary Disease — which includes emphysema, chronic bronchitis and non-reversible asthma, and is one of the leading causes of disability. Doctors use a machine called a spirometer to measure breathlessness, comparing lung capacity to a baseline. The baseline for Black patients is assumed to be lower, based on a study from 1869. So Black people with the same diagnostic scores as their White counterparts are not classified as disabled. Yes, you read that right: Disability diagnoses today are based on assumptions about Black lung capacity from more than 150 years ago.

To truly end racial mortality gaps, health care must be unbiased. This requires educating doctors about the dangers of prejudice, and changing systems that perpetuate and amplify it. Another solution would be to encourage more Black people to study medicine and become physicians. Research has demonstrated that Black doctors improve the health outcomes of their patients — one new study shows that Black newborns are much more likely to survive if their physician is Black as opposed to White. (It’s difficult to know whether this has to do with White doctors harming Black patients or Black doctors treating them more effectively.)

Sadly, this is not a new struggle. Addressing discrimination and disparities in health care has long been part of the civil rights agenda. Solving the problems of physician bias and persistent gaps in outcomes cannot be merely an academic pursuit, or a discussion topic among policy wonks. My life, and the lives of my family and friends, literally depend on it.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Trevon Logan is a professor of economics at the Ohio State University and a research associate at the National Bureau of Economic Research.

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