What is a lived experience for many Black women is only being talked about by the mainstream in recent weeks. Decades of catalogued data and research shows that the medical industry willfully withholds lifesaving information and treatments from Black women at nearly every engagement throughout their lives. I use the term “willfully” to describe this phenomenon because there is nothing preventing medical professionals from doing their jobs by providing this information.
Despite much research around the medical community’s negligence toward Black women, few viable solutions have coalesced. For instance, since at least 2008, TheBody has been reporting about the consistently disproportionate effect that HIV has on Black women. To no avail, it seems; we are still writing about the same issues that afflicted Black women back then, as if they were brand new today.
Meanwhile, white gay men have had an inverse experience with the virus. During the ’80s, white gay men were the group most visibly impacted by HIV. While that dynamic has shifted over the past 40 years, the attention devoted to white gay men—be it in media representation, medication trials, or resources—has not.
For instance, HIV messaging is still heavily targeted towards gay men instead of Black women. The problem with that omission is that Black women do not realize that they are statistically vulnerable to HIV, even though their doctors know that they are.
Black Women and HIV
Though HIV diagnosis rates have declined across almost all demographics in the U.S., Black women still account for 57% of all new HIV diagnoses among women even though they make up less than 7% of the country’s overall population. One reason for this racial disparity is that doctors consistently fail to speak with Black women about the virus or pre-exposure prophylaxis (PrEP), which protects people from HIV transmission.
In response to TheBody’s recent reporting on PrEP access for Black women, this reporter was contacted by a Black woman who shared details from a conversation she had with her doctor regarding why they had never discussed PrEP. This woman, who asked to remain anonymous, says that she was told, “We usually only offer it to sex workers and people with multiple partners.”
Beyond the loaded judgement baked into that statement, what is most surprising about this exchange is the doctor’s commitment to using an antiquated risk profile, in defiance of current data.
Negligence Is Murder
Risk profiles are created by analyzing existing statistical data as well as information collected through patient questionnaire forms and during in-person observations. Health care professionals use this information to help determine a patient’s vulnerability for developing certain diseases or conditions. While risk profiles can be helpful, their focus on statistics can result in a provider treating metrics rather than the unique, living, breathing person in front of them.
Unless that person is a Black woman, in which case, useful data—statistical or observed—is often ignored. For example, breast cancer is the second leading cause of death among women across the U.S. Black women are still 40% more likely to die from the disease than white women. This, even though Black women are actually less likely to develop breast cancer than white women in the first place.
Numerous studies indicate that this mortality rate is due to late diagnosis and treatment options, which is just an antiseptic way of saying that doctors do not provide Black women with adequate care. This is true beyond cancer, even when income and education are not factors, as evidenced by the deaths of numerous Black women doctors—such as Chaniece Wallace, Susan Moore, and Shalon Irving—and the near deaths of Serena Williams and Beyoncé, while they were giving birth.
Data collected from 2008 to 2012 found that Black women who had graduated college were 2.4 times more likely to suffer from severe complications from childbirth than white women who had not graduated from high school. Keep in mind that the Centers for Disease Control and Prevention’s current mortality rates show that Black women are 243% times more likely to die from pregnancy-related causes than their white counterparts.
Studies have concluded that 60% of these recorded deaths would have been prevented if proper care had been provided in a timely manner.
Medical Racism or Institution-Sanctioned Murder?
Black women consistently face disproportionate mortality and morbidity rates during medical care, even when providers are aware of their statistical vulnerabilities. After years of pointing the finger at medical racism without any improvements in outcomes, one has to consider that this is by design.
Rather than railing against the medical profession for failing to protect Black women, perhaps we should look at it as doing what it was intended to do. Centuries of data support that perspective. What started in the 19th century with J. Marion Sims, the “father of gynecology,” conducting brutal experiments upon enslaved Black women without anesthesia, has become a casual methodology for treating modern-day Black women.
Black babies are three times more likely to die when their doctors are white instead of Black for no other reason than they are Black and white. Keep in mind that the Association of American Medical Colleges has found that 56.2% of active physicians are white, compared to 5% who are Black.
Analysis of 20 years of published research reveals that Black patients who report pain are 22% less likely than white patients to receive pain medication from their doctors. Fourteen studies focused on pain management in American emergency rooms revealed that compared to white patients, Black patients are 40% less likely to receive medication for acute pain or traumatic injuries such as long bone fractures. All of this is worse for Black women because medical professionals profile them as unreliable reporters.
The net result is that doctors do to Black women what the police do to Black men, except that in place of a gun, doctors murder Black women through medical neglect.
Racism Defies the Hippocratic Oath
That neglect is motivated by structural racism, which is embedded within every aspect of our society, including medical schools. A study from 2016 involving over 222 white medical students and residents found that half of those surveyed believed that Black people were less sensitive to pain than white people.
This incorrect belief has its roots in pseudo-science expounded by leading thinkers—including the physician Samuel A. Cartwright in 1852 and anthropologist Carleton S. Coon in 1962—as a “righteous” excuse for slavery and white supremacy. Though slavery (outside of prison) has been abolished, data shows that their beliefs—that Black people are subhuman and therefore deserve less care—are implemented and held to be true in medical establishments across the nation.
Who is teaching this ideology? Not Black people; they account for 3.6% of all full-time medical school faculty members in the U.S., compared to 63.9% of their white counterparts. This is not to suggest that white teachers encourage their white students to see Black people as less than human, though the failure to stamp out this anti-scientific ideology speaks volumes.
A study conducted by the National Academy of Sciences Institute of Medicine in 2002 found that “U.S. racial and ethnic minorities are less likely to receive even routine medical procedures and experience a lower quality of health services.” Nearly 20 years later, numerous studies affirm that this finding still holds true.
When one of the world’s best-educated professions perpetually fails to adequately treat Black women in defiance of the Hippocratic Oath’s opening creed—“to treat the ill to the best of one's ability”—we are no longer dealing with simple negligence, but an extinction-level threat.
No amount of diversity, anti-racism, or anti-bias training can resolve an issue that has defined the nation’s approach to health care for centuries. And yet the solution to medical racism is obvious. We just have to approach it the same way that police officers process the murder of other police officers: with a vengeance.
Racist care that results in death should be treated like a malignant tumor—removed surgically, aggressively, and decisively—and when possible, with the loss of one’s medical license. Ignore false equivocations between hostile behavior and racism—“Was it racist or just unpleasant?”—and accept that bad behavior usually manifests as racism when racial power dynamics are present and makes for inferior care anyway. Embrace that white people are ill-equipped to recognize racism, just as white doctors consistently fail to provide proper care to Black patients.
Create quarterly and mandatory classes for engaging with Black community patients so that medical students are forced to confront and break through their implicit biases. Teach medical students that upholding racist ideology and implementing racist care will result in zero recommendations, honors, promotions, or graduation.
Outside of punitive measures, doctors Uché Blackstock, M.D., and Oni Blackstock, M.D., recently addressed health equity in an article for The Washington Post that suggested lowering the COVID-19 vaccine age cutoff for Black people in response to the fact that “Black people ages 45 to 54 are seven times more likely to die of COVID-19 than similarly aged White Americans.”
Extraordinary inequities call for radical solutions; otherwise, we will continue to write about these issues for another 20 years. Eliminating medical racism will require more than balancing the scales and punitive consequences, but these course corrections are preferable to waiting for policy makers and legislators to course correct.
While we wait for them to do their jobs, it is essential that we remain educated and alert to the fact that Black women are more than 200% more likely to receive poor care than a white woman, whether they are at risk for a condition or not. For Black women, that means it is time to knock care providers off of their pedestals and to approach them with the spirit of “I deserve better.” Because you do.