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African Americans have a dim view of the nation’s health care system, which they see as infected by the same racism they encounter on the job, out shopping, in the classroom or interacting with the police.
A new nationwide poll by The Undefeated and the Kaiser Family Foundation (KFF) found that 7 in 10 African Americans believe that people are treated unfairly based on race or ethnicity when they seek medical care. It’s a feeling born of unequal history and intensified by the coronavirus pandemic, which is disproportionately ravaging Black lives both physically and economically.
The poll, which included interviews with 777 African Americans, is the most comprehensive survey of Black attitudes and experiences with health care since the start of the pandemic. Among the findings:
- About four out of 10 Black adults said they knew someone who has died from the coronavirus, almost double the rate for white people.
- One-third of Black adults and nearly half of Black parents are struggling to pay their bills as a result of the pandemic. Two out of 3 Black parents have either lost jobs or had their incomes interrupted since the pandemic struck in February.
- While a sizable minority of Americans of all races are deeply skeptical of the nation’s byzantine health care system, the feeling is more pronounced in the Black community. Fifty-five percent of African Americans said they distrust it.
- Despite the horrific toll of the pandemic, African Americans are doubtful about the promise of a coronavirus vaccine that public health officials hope to begin deploying in the coming months. Just half of African Americans surveyed said they would be interested in taking a vaccine, even if it were determined to be safe and were provided at no cost. By comparison, 2 in 3 white people said they would definitely or probably get vaccinated, as did 6 in 10 Hispanics. The vast majority of African Americans who said they would not take a coronavirus vaccine did not think that it would be properly tested, distributed fairly or developed with the needs of Black people in mind.
Public health experts called the misgivings around a vaccine an outgrowth of the discrimination many African Americans endure, not only as they attempt to access health care, but also as they go about their daily lives.
“We have a centurieslong legacy in this country of basically Black people, in particular, and other people of color as well, being treated poorly,” said Dr. Lisa A. Cooper, an internist who directs The Johns Hopkins Center for Health Equity. “So why should Black people trust any institution? It has gone on for so long.”
A majority of Black adults, 58 percent, said they had experienced discrimination in just the past year. One in 4 said they were discriminated against dealing with police in traffic and other incidents. Twenty-eight percent said they experienced racial bias on the job, while 40 percent said they were treated unfairly while shopping. One in 5 said they experienced it while seeking health care.
A large majority of Black Americans cited implicit bias as a major factor, both in preventing racial equality and as an obstacle in their own lives. At the same time, 7 in 10 Black respondents who said they were treated unfairly because of their race saw the discrimination as deliberate. (There are large gaps between attitudes of Black and white people over bias and discrimination.)
“They treat Black people different than they do white people when I go to the hospital,” said Eugene Lawrence, 73, a retired waiter who lives in Hartford, Connecticut. “It’s petty, little things. When they call the nurse, they rush to come see the white people. They don’t rush to see the Black people. I think it’s racist. It’s been that way from the beginning in this country, and it is going to be that way to the end.”
The survey found scant trust among African Americans in fundamental American institutions. Only 1 in 4 trusted police to do the right thing for their communities all or most of the time. Less than half trusted local schools.
The poll was taken as the country has been gripped by a monthslong racial reckoning prompted, in part, by the death of George Floyd in May under the knee of a Minneapolis police officer. While a majority of African Americans, 57 percent, are hopeful that the ongoing protest movement and push for racial equality would produce meaningful change, 53 percent of white people expected no meaningful change.
Still, the ongoing disparities have Black people pessimistic about their current standing in American society. Just over four years ago, then-President Barack Obama told Howard University graduates, “If you had to choose a time to be, in the words of Lorraine Hansberry, ‘young, gifted and Black’ in America, you would choose right now.”
The survey, however, found that only 1 in 4 Black men and 1 in 3 Black women agreed that it was a good time to be Black in America. That is a far cry from 2006, when 60 percent of Black men agreed with that statement, or 2011 when 73 percent of Black women thought it was a good time to be Black.
“It’s a challenging time to be Black,” said Eddie Singleton, 76, a retired Army lieutenant colonel who lives in Goldsboro, North Carolina. “Just look at all the things going on, and the tone of the election. We need to get together and get this country headed in the right direction.”
As demonstrators have taken to the streets across the country to protest police violence and systemic racism, the nation’s attention has been directed to the stark disparities that continue to separate Black and white people in nearly every walk of American life.
African Americans are more likely than white folks to be arrested. Once arrested, they are more likely to be convicted. One in 3 Black men born in 2001 can expect to go to prison in their lives, as opposed to 1 in 17 white men.
At $188,200, the net worth of a typical white family was nearly eight times greater than that of a Black family in 2019. A typical Black worker earns $805 a week, according to the U.S. Department of Labor, which is 79 percent of the median white wage of $1,017 a week.
Gaping racial disparities also characterize American health outcomes, which experts call a consequence of other social inequities. Black people suffer more frequently than white people from diabetes, obesity, high blood pressure, maternal mortality and infant mortality. In 2017, 12.6 percent of Black children had asthma, compared with 7.7 percent of white children. Overall life expectancy for Black people is 75.5 years, 3.4 years shorter than it is for white folks.
Asked to name the biggest driver of those disparities, Dr. Leo Moore, a public health physician in Los Angeles, offered a one-word answer: racism. “Redlining, pollution, the fact that we have fewer parks and recreational activities in our neighborhoods. Our schools not receiving as much funding, all plays a role,” he said. “And racism and white supremacy is at the root of it all.”
Those disparities are compounded by the differences in the health care received by Black and white people, the survey found. One in 5 Black adults said they have been “personally treated unfairly” in the past year when trying to get health care for themselves or a family member because of their race. (COVID-19 unveils an America that always sees itself in Black and white.)
Verlisa Taylor, 49, an IT project manager who lives in Waldorf, Maryland, has been helping to manage the care of both her cancer-stricken brother and her mother, who has suffered a stroke and other ailments.
In each case, she has been dissatisfied. Her brother, Thomas Mason, 60, was diagnosed with throat cancer in 2007. When he was treated, she always suspected something was off, and she frequently felt cut out of the decision-making.
That notion was confirmed last year when cancer returned, and the doctors this time said it probably was a result of excessive radiation during his first round of treatment. She often believes that if they were wealthy, or perhaps white instead of Black, that would not have happened.
“You can never know, but when all of your doctors are white, you can come to the conclusion that is about race,” she said.
She gets the same feeling when she goes to the doctor with her 78-year-old mother, Shirley Taylor, who, among other things, suffers from chronic stomach problems. “When she goes to the doctor, it is always, ‘Take this medication,’ ” she said. “It seems like there is never any conversation or dialogue to try to get at what might be the underlying problem.”
Black Americans were more likely than white people to cite specific negative encounters with the health care system, including feeling that providers didn’t believe they were telling the truth, being refused a treatment or test they thought was necessary, and being denied pain medication.
It is a feeling Camellia Moses Okpodu, dean of the college of arts and sciences at Xavier University of Louisiana in New Orleans, knows personally. Two years ago, she received a frantic call: her 88-year-old mother had been stricken with a ruptured aneurysm in Wilmington, North Carolina. She hopped into her car for the nearly 900-mile drive to be by her mother’s side. When she got there, she was stunned by the attitude of her mother’s doctors. At first, they were reluctant to perform the surgery that she believed offered the best chance to save her life.
“They kept saying she was 88 years old,” recalled Okpodu, a biochemist. “Yes, she was 88. But she had never lost consciousness, was not in terrible health or had some extenuating circumstance that would not allow her to withstand the operation. It was like they were looking at some actuarial table and not at my mother.”
The doctors relented once Okpodu insisted that her mother undergo surgery. The procedure proved to be successful. She said her mother is now 90 and going strong. “I wonder what the outcome would have been had I not been there to advocate for her,” Okpodu said. “Would she have died?”
Looking back, “I can’t say what is in their hearts,” Okpodu said. “I just know it was some horrible decision-making seeming based on some sort of table they had. I just think it was ignorance.
A legacy of discrimination
Black people were used as medical research subjects during slavery. It was long before medical ethics developed as a discipline and “Black bodies often found their way to dissecting tables, operating amphitheaters, classroom or bedside demonstrations, and experimental facilities,” according to a 1982 paper (PDF) by Todd L. Savitt, a professor at East Carolina University’s College of Medicine.
That kind of medical exploitation (which sometimes included white people, too) continued for more than a century. Most famously, the Tuskegee syphilis study began in 1932 with the goal of tracking the damage the disease does to the human body. Without informed consent, the study enrolled 600 Black men, including 399 who had syphilis. The men were told they were being treated for “bad blood,” but they did not receive any treatment for their illness — not even after penicillin was found to cure syphilis in the mid-1940s. The study did not end until it was exposed to the press in 1972, and has gone down as one of the nation’s most egregious examples of medical racism.
But disparate treatment did not end there. Researchers have documented many ways that Black patients are treated differently from white patients. In 2002, the Institute of Medicine’s groundbreaking report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, found higher rates of diseases, including diabetes, heart disease, hypertension and HIV, among Black and other people of color. Yet, minority patients were less likely to receive critical medical interventions such as bypass surgery or antiretroviral therapy. At the same time, people of color were more likely to receive extremely invasive treatments, such as amputations.
Different treatment contributed to mistrust, which only compounded medical problems, the report found. “Minority patients are more likely to refuse recommended services, adhere poorly to treatment regimens and delay seeking care,” it concluded. The report helped move the issue of racial disparities in health care into the mainstream of medical thinking. But rooting out the disparities, which are tightly bound to the nation’s other social inequities, remains a problem.
The Undefeated/KFF survey found that Black people tended to have much more confidence in doctors than they do in the overall health care system, with its impenetrable billing models, slow-moving waiting rooms and multitude of insurance plans. Yet, Black patients had much less confidence in doctors and local hospitals than white folks.
In her own research, Cooper has found that doctors have poorer communication with Black patients than white ones. Doctors tended to dominate visits with Black patients by talking, rather than listening and connecting with patients, she found. With white patients, the conversation more often flowed two ways. The result is that Black patients often are reluctant to share whatever ails them and, more often than white patients, leave doctor’s visits feeling unheard.
“Physicians tend to dominate the conversations when they are seeing African American patients,” Cooper said. “African American patients get to ask fewer questions, they get less opportunity to explain themselves or to offer their opinions or their preferences.”
She also found that communication improves when Black patients see Black doctors. Other researchers have documented a host of benefits when Black doctors see Black patients. They include more shared decision-making, improved medication adherence and better patient perception of treatment decisions.
But in a nation where just 45,000 of the more than 900,000 physicians are Black, that is not always possible. A quarter of Black respondents said they’ve never seen a doctor who is Black. Doctors of all races can do an effective job treating Black patients, and while the survey found that 24 percent of Black adults would prefer to see a Black doctor, most said their doctor’s race did not matter.
Cooper said research like hers is slowly changing how doctors think about their profession. Once concerned mostly with the hard sciences such as biology, she said more physicians are becoming open to ideas springing from the social sciences and are mindful of how best to communicate with patients and understand the many forces that may be impacting their health.
In Los Angeles, Moore said he is careful not to lecture his patients, even when he disagrees with their choices. In recent weeks, he has been encouraging patients to take the flu vaccine and to be ready for the coronavirus vaccine once it is ready and proven safe. But some patients don’t want to hear it. They insist the vaccine will be unsafe, or that they previously contracted the flu from a vaccine. (Half of Black adults say they won’t take a coronavirus vaccine.)
“I try to explain that you cannot get the flu from the vaccine, that you are being exposed to the antigen within that virus,” Moore said. “So you’re being exposed to particles that will help you create antibodies and in that process, you might have some cold symptoms, but it is not the flu.”
Moore acknowledges that he is not always convincing. So he looks for other ways to educate. He is active on Instagram, and he has launched a YouTube show called The Practical M.D., in which he uses short videos to share information in plain language about health and self-care.
“I was taught early on about patient autonomy. So, the importance of telling my patients the risks and benefits and letting them make the best choice for themselves,” he said. “We as providers have to accept that sometimes what a patient views as their best choice would not be the choice that I would choose, but it’s the best choice for them at that time. And we accept that and move on, but continue to have conversations about it to ensure that they’re the best informed to continue to make the best decisions for themselves.”