Racial discrimination and racial inequalities in health care are among the most critical current health problems in the United States. Most non-white people, especially African Americans, experience daily discrimination that has a cumulative effect on self-perception (Ford & Airhihenbuwa, 2010). More importantly, racial biases are one of the main reasons why health outcomes for whites and blacks in the United States differ dramatically, regardless of socio-economic status (McMillan Cottom, 2017). Racial discrimination is a perception problem, and by changing the perception of nurses and health workers, governments can save billions of dollars in poorer health outcomes. Changing social determinants is also essential but should not be perceived as a more practical solution. This paper aims to discuss how race disparities affect health indicators like life expectancy and infant and maternal health and mortality in the US healthcare system and suggest how the Critical Race Theory can alter the situation.
Socio-Economic Factors Are Not the Main Reason for Disparities
The most painful awareness of discrimination for African Americans is that they are often considered incompetent by nurses and other health care workers, regardless of social and economic status (McMillan Cottom, 2017). This is an extremely sensitive issue because due to the ignorance and neglect attitude of the health workers, African Americans are at least twice as vulnerable to health problems in all areas of health care. Many studies provide statistics that can provide evidence that the cause of health disparities is not the difference in social determinants of health, as is commonly believed. On the contrary, these inequalities are associated with bias in nurses’ perception, especially nurses who work in areas with better health care, where there is a predominantly white middle-class population (McMillan Cottom, 2017).
African Americans are perceived to be less competent simply because of their skin color, even if they display all the hallmarks of high socioeconomic status and are from the middle class. This situation is unhealthy and unfair, as it negates all the efforts that individuals make to improve their quality of life (McMillan Cottom, 2017). This ignorance and neglect also undermine the public effort to change the social determinants of health for African Americans, who have been under social pressure for decades to improve their socio-economic status.
Scientists note that the issue of racial disparity is particularly evident in maternal mortality nation’s health indicators. Molina & Pace (2017) say that “there are profound racial, ethnic, and socio-economic inequities in women’s risk of dying during or soon after pregnancy” (p. 1705). Scientists define maternal mortality as death during the 42 after delivery due to pregnancy-related causes (Molina & Pace, 2017). They specifically emphasize that the maternal mortality indicators in the US are low compared to low-income countries, with 28 deaths per 100,000 live births, compared with 230 deaths per 100,000 live births (Molina & Pace, 2017).
However, there are particular health disparities within the US. According to the scientists, “low-income women and women from rural areas are more likely to die during pregnancy, and a non-Hispanic black woman is almost three times as likely to die during or shortly after childbirth as a white woman with 56.3 versus 20.3 deaths per 100,000 live births “(Molina & Pace, 2017, p. 1706). The scholars also noticed the general trend of maternal mortality is growing since 1990 and is high compared to Canada, with 11 deaths per 100,000 live births (Molina & Pace, 2017). This statistics means that although the white population in the US receives a middle-class-like treatment, the black population does not benefit from it. In other words, the statistics prove that there are racial disparities related to the treatment of pregnant women in the US. The scientists do not suggest the reasons for such inequality. Still, it should not be considered these are only socio-economic reasons, as implied in the presentation of the statistics.
Other scientists present similar statistics for infant mortality. Singh & Stella (2019) state that “in 2016, black infants had 2.5-2.8 times higher risk of mortality from perinatal conditions, sudden infant death syndrome, influenza/pneumonia, and unintentional injuries, and 1.3 times higher risk of mortality from birth defects compared to white infants” (p. 19). Moreover, in the US, the black people seem to be the group that faces most disparities, even among the racial minorities. The scholars say that “detailed racial/ethnic comparisons show an approximately five-fold difference in infant mortality rates, ranging from a low of 2.3 infant deaths per 1,000 live births for Chinese infants to a high of 8.5 for American Indian/Alaska Natives and 11.2 for black infants” (Singh & Stella, 2019, p. 19).
It is also noted that although there was a dramatic declining trend in infant mortality from 1915 to 2017, both for black and white infants, the black vs. white disparities rose significantly in the 2000s (Singh & Stella, 2019). Therefore, the statistics illustrate the general trends that do exist in US society. There is an urgent need to alter the situation, which can be done through the education of the healthcare practitioners and with the help of direct influence on social determinants. However, it should be considered that the issue of the racial disparity in healthcare is not equal to the problem of social-economic inequality, which is not the only factor that contributes to the statistics.
There is also the statistics that present how both social-economic and race issue impact health outcomes. Dwyer-Lindgren et al. (2017) say that “socio-economic and race/ethnicity factors, behavioral and metabolic risk factors, and health care factors explained 60%, 74%, and 27% of the county-level variation in life expectancy, respectively; combined, these factors explained 74% of this variation” (p. 1003). The statistics are eloquent, but still, there is a need to distinguish and separate the influences of racial and socio-economic factors since the problems of poverty and related difficulties do not explain the differences in the quality of health care received.
Critical Race Theory
Racial discrimination exists not only in the real life of society but also in science. Ford & Airhihenbuwa (2010) note that “the notion of racial groupings was introduced in Carolus Linnaeus’s Natural History in 1735 and subsequently advanced by many others; both Linnaeus’s concept of race and the subsequent racial groupings devalued and degraded those classified as non-European” (p. 31). The scholars explain that Linnaeus’s classification was later used as a basis for racial policies in the US and many other countries. Moreover, the ideas of ‘scientifically proven’ racial inequality was adopted by scholars and today still constitute scientific knowledge, including in medicine. Therefore, Ford & Airhihenbuwa (2010) developed the Critical Race Theory to enhance the analysis of disparities using four basic features of race consciousness, contemporary orientation, centering in the margins rather than in the mainstream, and praxis (or theory-informed action). The scientists proved the actuality of the four features by applying them in the analysis of the race-related indicators of HIV testing in the US.
This theory can as well be applied to analyze the maternal mortality rates, due to several reasons. Firstly, in the example of the HIV-testing, the scholars proved that race consciousness is necessary to understand and take into account the factor of racial prejudice, in contrast to the colorblindness approach implying that non-racial factors (for example, income) fundamentally explain the allegedly racial phenomena (Ford & Airhihenbuwa, 2010). Secondly, the contemporary orientation should be used, which emphasizes the widest spread of everyday racism. Thirdly, the centering in margins approach should be utilized, which suggests analyzing the situations from the perspective of the marginalized group, not from the general public’s view. Finally, implementing the praxis or theory-informed action means that marginalized groups should be informed and educated to self-analyze their actions and decisions in the process of the study since such an approach is more humane and effective.
Therefore, scholars should apply the Critical Race Theory when analyzing race issues or race-related statistics. This, of course, does not mean that the programs addressing the social health determinants should be ended. Thornton et al. (2016) present an exhaustive list of programs aimed to reduce the social disparities among the non-white races. They mention the programs aimed at education in early childhood, urban planning and community development, housing, income supplements, and employment.
Thus, it was discussed how race disparities affect health indicators. The application of the Critical Race Theory was suggested to alter the situation. Most often, the race-related biases against African Americans cannot be eliminated by socio-economic factors. Moreover, the disparities are integrated into the scientific knowledge, and often the researchers use the outdated race-degrading approaches without knowing it. The Critical Race Theory suggests integrating the new attitudes to race-related issues into scientific knowledge.
Dwyer-Lindgren, L., Bertozzi-Villa, A., Stubbs, R. W., Morozoff, C., Mackenbach, J. P., van Lenthe, F. J., & Murray, C. J. (2017). Inequalities in life expectancy among US counties, 1980 to 2014: temporal trends and key drivers. JAMA Internal Medicine, 177(7), 1003-1011.
Ford, C. L., & Airhihenbuwa, C. O. (2010). Critical race theory, race equity, and public health: toward antiracism praxis. American Journal of Public Health, 100(S1), 30-35.
McMillan Cottom, T. (2019). “I was pregnant and in crisis. All the doctors and nurses saw was an incompetent black woman.” Time. Web.
Molina, R. L., & Pace, L. E. (2017). A renewed focus on maternal health in the United States. The New England Journal of Medicine, 377(18), 1705-1707.
Singh, G. K., & Stella, M. Y. (2019). Infant mortality in the United States, 1915-2017: large social inequalities have persisted for over a century. International Journal of Maternal and Child Health and AIDS, 8(1), 19.
Thornton, R. L., Glover, C. M., Cené, C. W., Glik, D. C., Henderson, J. A., & Williams, D. R. (2016). Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Affairs, 35(8), 1416-1423.