The University of Kentucky Public Relations and Strategic Communications Office publishes a weekly health column that news outlets can use and republish. R. Kip Guy, Ph.D., dean of the University of Kentucky College of Pharmacy, writes this week’s column.
LEXINGTON, KY (February 27, 2023) – To commemorate Black History Month in 2023, I wanted to spend some time learning about the harmful influence that cultural stereotypes about Black people have on the health care services that our institutions deliver to Black people. I wanted to think about how the medical system regards Black and white individuals as distinct groups, and how it can be tied to cultural beliefs. To ensure that my conclusions were founded on well-established facts, I limited my research to peer-reviewed medical or scientific high-impact publications.
The basic finding is that since we have incorporated cultural myths about Black people into our protocols, rules, and training, health care delivery in the United States frequently gives lesser access, worse quality treatment, and less compassionate care to Black people. Several examples include blood pressure control, weight management, laboratory testing, medical device creation, and pregnancy risk management. So, to keep things simple, I’ll focus on one of the most important: pain management.
Chamberlain and colleagues, for example, looked examined racial disparities in pain treatment for over 940,000 children diagnosed with appendicitis in emergency rooms in the United States between 2003 and 2010 in a cross-sectional research (JAMA Pediatr, 2015, 169(11) 996-1002). What they discovered was startling: black children are ten times more likely than white children to have all analgesia withheld by the treatment team while experiencing moderate discomfort. Black children are five times less likely than white children to receive painkillers when they describe acute pain. This is just one example of how the system gives Black people less access and less compassionate treatment. More research with comparable outcomes may be found for pain management, as well as all of the other categories I listed.
The question that quickly arises is, why is this the case? Why do our guidelines, developed by involved and concerned clinical clinicians who wish to offer the best treatment possible to everyone, have this unintended consequence?
To consider this, I turned to one of many studies, a paper by Oliver and colleagues that examined pain assessment and treatment choice for Black people by 400 white medical students and residents in the United States, as well as whether their held false beliefs about biological differences between Black people and white people influenced their choices (Proc. Natl. Acad. Sci. USA, 2016, 113(16) 4296-4301). Oliver discovered that half of the medical trainees held and endorsed false beliefs about biological differences between Black and white people, and that those who held false beliefs were more likely to rate Black people’s pain as lower than white people’s, and were less likely to prescribe appropriate analgesia.
Patients’ pain treatment is a reflection of how we treat individuals. Pain is a personal symptom that can have a significant impact on a person’s well-being but is difficult to quantify externally. A person’s lived experience defines suffering almost entirely, and in order to comprehend another’s agony, we must listen and believe that they will give us the truth. How we deal with another person’s grief is an intimate act that is entwined with our identity and perspective of that individual. This is true regardless of whether we evaluate their bodily or mental suffering. I encourage you to attempt to listen more honestly to the lived experience of individuals around you, to consider how your own experience influences how you listen to and evaluate what they say. It is critical to identify the areas where our health-care institutions routinely fail to listen and respond correctly.
Erin Balsa is a highly skilled and knowledgeable health journalist with a passion for educating the public on important health and wellness topics. With extensive experience in both traditional and digital media, Erin has established herself as a trusted voice in the field.