Health literature pays plenty of lip service to racial disparities. In the last two years, for instance, countless articles have explored how COVID-19 deaths and vaccination rates differ by race—few of them explaining why. But those articles focus on outcomes. At Verywell, we’re asking a different question: What is the entire patient experience like for Black Americans, and how is it different from White Americans?
The biggest difference, according to our survey of 1,000 Black Americans and 1,000 White Americans, has nothing to do with how often people are going to the doctor. Racism against Black Americans is leading to meaningful differences in the quality of their health care, as well as their perceptions of providers.
Of course, systemic racism in the healthcare system is already well-documented. The Centers for Disease Control and Prevention (CDC) indicates that Black Americans are more likely to experience and die from complications of diabetes, high blood pressure, obesity, asthma, and heart disease compared to White Americans.1
Verywell’s Black Health Experience survey gets to the bottom of how, when, and why those outcomes occur. The results show how experiencing racism within the healthcare system impacts the entire health journey, not just the outcome.
Our survey asked respondents about their perceived experiences with racism in the healthcare system. We did not define what constitutes a racist experience.
Same Actions, Different Results
Black and White Americans use health care at nearly identical rates each year. In fact, three out of four total survey respondents reported that they had seen a healthcare provider in the last 12 months, and that they get a physical most years. But their experience of the healthcare system is not the same.
The Black health experience is having to navigate additional hurdles because of your race with the hope of receiving equal treatment. But seeking similar treatment does not automatically equate to receiving treatment that responds to your needs.
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Quality of Care Begins with Trust
Black Americans in our survey report being 10 percentage points less likely to have positive perceptions of doctors than White Americans, and 9 percentage points less likely to have a favorable view of nurses and physicians assistants.
Mistrust of the healthcare system exists among Black Americans partly because of awareness of racism in medicine. Racist beliefs led to once-accepted practices of medical experimentation on Black and enslaved people, as well as the exploitation of Black people for research without their consent.2 The trauma of that type of structural racism being a “normal” part of medicine has echoed through generations—and varying degrees of racism still exist in medicine today.
Mistrust is amplified by lack of representation. Only one in four Black Americans in our survey report seeing a provider that shares their race, and only half of Black respondents said they felt that their last provider was familiar with Black patients.
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While our survey allows us to quantify these sentiments, actual patients can speak to the challenges of looking for care they trust.
For example, Adrienne Hibbert, founder of the website Black Doctors of South Florida, told NPR about her challenges working with a White obstetrician during her pregnancy: “I want someone who understands my background. I want someone who understands the foods that I eat. I want someone who understands my upbringing and things that my grandma used to tell me.”
For Jayla, a patient seeking STI treatment who sat down with CBS News, a lack of representation led to being dismissed—and misdiagnosed—by a provider.
“I have to be the angry loud Black woman making a scene for you to do something...I used to want to avoid that, but when it comes down to my health, I’d rather you be uncomfortable and me not be dead,” she said.
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When Are Racist Experiences Happening?
According to our survey, one in three Black Americans reported experiences of racism while dealing with the healthcare system. Data from the Pew Research Center indicates that 71% of all Black Americans have experienced discrimination in any setting,3 suggesting that our survey may be underrepresenting the full scope of the Black health experience.
Patients Report Racism at the Point of Care
Interpersonal racism occurs between two or more individuals. In the context of the healthcare system, it could be between the patient and a provider or member of the administrative staff. In the case of our survey, more than half (52%) of people who have had racist experiences in a healthcare setting say the appointment itself is where the interaction occurred.
experiences of racism throughout the healthcare journey
Nusha Ashjaee / Verywell
Experiences of interpersonal racism while seeking care puts the patient in a position where there is no ideal outcome. Black Americans often have to choose between enduring racism versus interrupting or stopping treatment completely.
Systemic Racism Is the Bigger Problem
Systemic racism, also called institutional racism, occurs within institutions or systems of power. The reality of systemic racism in the healthcare system can be seen in the policies and procedures laid out by many healthcare institutions, pharmacies, and health insurance companies that exclude Black Americans, even inadvertently.
Despite the fact that 87% of survey respondents say that racist experiences occur interpersonally, when asked whether inequality in the healthcare system is individual or systemic, the majority of Black Americans who report experiencing racism in healthcare say that it's the system as a whole.
This requires systemic solutions.
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At Brigham and Women’s Hospital in Boston, the Department of Medicine’s Health Equity Committee found that Black and Latinx patients with heart failure were more likely to be admitted to a general medicine floor and less likely to receive the specialty cardiology care that White patients with the same diagnosis were receiving.
Moreover, Brigham and Women’s heart failure patients who were discharged from a general medicine floor were more likely to have unplanned hospital readmissions within 30 days, and less likely to receive support in the form of home monitoring and check-in calls.
In an effort to uncover the systemic drivers of these disparities, physicians were surveyed about what influences their decision to admit a patient to a general floor rather than a specialty unit. Their response, reported by The Commonwealth Fund, was that “they perceived White patients to advocate more often and more vigorously for access to specialty cardiology services, and that this impacted their decision-making.”
Although racial bias was happening at the provider level, it took accountability and action from the hospital itself to begin to rectify it.
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The Impact of Racism on Care
Responding to racism in healthcare can force patients to choose between basic respect and continued care. These experiences can lead Black Americans to take actions that impact the care they receive, and ultimately, their health. This could be a contributing factor to disparities in health outcomes.
Our survey participants report responding to racism in healthcare in the following ways:
36% report changing healthcare providers
28% report not making a follow up appointment
28% report delaying making a health decision
Interrupting care has consequences. The 36% of Black Americans who report changing healthcare providers after a racist experience run the risk of delayed care given the current shortage of healthcare providers. One study published by the Association of American Medical Colleges (AAMC) projects that shortages in primary care providers will be between 17,800 and 48,000 physicians by the year 2034.
Provider shortages will only make accessing equitable care more challenging for Black Americans, forcing them to settle for any available provider, rather than matching with a provider who shares their race or is familiar with Black patients.
Avoiding follow up appointments or delaying health decisions can lead to poor outcomes that are so often cited. A 2021 study, for example, looked at medical mistrust, racism, and delays in preventive health screening among African American men. Researchers found that delays in preventive health screening, such as routine check-ups, blood pressure screening and cholesterol screening, were due to reasons other than lack of health insurance or access to care. Patients’ history of perceived racism leading to medical mistrust was the biggest contributing factor to delayed care.4
Black Americans Still Seek Health Care with Hope for the Future
Despite all of the delays in care that Black Americans in our survey face, they continue to seek health care at the same rate as White Americans. Hope for a solution to inequality within the healthcare system is alive among Black Americans. Survey respondents who represent Gen Z are most hopeful, with 75% of them citing they do believe there will be a solution to healthcare inequality in their lifetime.
Today, though, the Black health experience remains a challenge. Racism that affects quality of care, lack of representation, and limited options for Black providers make it difficult for Black Americans to achieve the same levels of care as White Americans. The idea that poor health outcomes for Black Americans are a function of genetics or lack of access to care is false.
The systemic racism that has been infused into the healthcare system for decades makes the health journey an uphill battle, but one that Black Americans are willing to continue to fight—for their health and for their communities.