Health and Healthcare Systems

A brief history of racism in healthcare

A medical staff member works in the Intensive Care Unit (ICU) for coronavirus disease (COVID-19) patients at the Robert Ballanger hospital in Aulnay-sous-Bois near Paris during the outbreak of the coronavirus disease in France, April 29, 2020. Seine-Saint-Denis, a mainly working class and multiracial suburb, was already lacking doctors and resources before the coronavirus crisis and has seen a bigger spike in mortality than neighbouring Paris. But despite being understaffed, teams at Robert Ballanger hospital reorganized to prioritize emergency health and have worked long hours, giving everything to fight the virus. Picture taken April 30, 2020. REUTERS/Gonzalo Fuentes - RC25JG94KZCV

The COVDI-19 pandemic has highlighted racial inequality. Image: REUTERS/Gonzalo Fuentes

Harry Kretchmer
Senior Writer, Forum Agenda
Share:
Our Impact
What's the World Economic Forum doing to accelerate action on Health and Healthcare Systems?
The Big Picture
Explore and monitor how COVID-19 is affecting economies, industries and global issues
A hand holding a looking glass by a lake
Crowdsource Innovation
Get involved with our crowdsourced digital platform to deliver impact at scale
Stay up to date:

COVID-19

  • In the US, UK and elsewhere, COVID-19 is hitting Black and other ethnic minority groups hardest – creating a renewed focus on racism in healthcare.
  • In the 19th century, Black people were seen as ‘racially different’, which was used to justify discrimination.
  • In the 20th century, medical racism became more ‘systemic’, for example with Black people not informed of the true nature of some experiments.
  • Today, medical algorithms are accused of racism and systemic housing inequalities continue to create bad health outcomes.

If you’re Black or Latino in the US, you’re almost twice as likely to die from COVID-19.

That’s according to The New York Times’ analysis of data from America’s Centers for Disease Control and Prevention (CDC). The numbers also reveal that Native Americans are more likely to be hospitalized with the condition than other ethnic groups.

Have you read?

In the UK, it’s a similar story. Official figures show that Black people are 1.9 times more likely to die from COVID-19 than white people. In France, infection rate data is not collected by ethnicity but the trends are believed by some medical experts to be similar.

These patterns are drawing attention to long-standing health inequalities faced by ethnic minority groups. From HIV/AIDS and cancer to prenatal care, and even amputations, research shows Black, indigenous and people of colour (BIPOC) in America and elsewhere are more likely to be affected, and less likely to receive the right treatment.

Implicit bias – when people are unconsciously influenced by prejudices or stereotypes – can play a part in these inequalities. In the US, for example, only 4% of doctors are Black, compared to 13% of the population. Several studies show that doctors can hold negative stereotypes of BIPOC patients without realizing, which can make interactions unpleasant and affect the treatment given.

And in some cases, these inequalities stem from structural or overt racism that goes back decades, or centuries. Here’s how it’s developed.

Jazmine Raygoza's dresser in her room holds the incentive spirometer used to prepare for her Lap-Band surgery in Denver June 18, 2011 along with CD's, hair clips, makeup, hairspray and her cellphone. After trying multiple diets and exercise, Jazmine, 17, decided on the Lap-Band treatment with the encouragement of her mother, who recently had a gastric bypass herself. About 17 percent of American kids and teens are obese, according to the Centers for Disease Control and Prevention. Picture taken June 18, 2011. REUTERS/Rick Wilking (UNITED STATES - Tags: HEALTH SOCIETY) - GM1E76M1DUC01
Spirometers measure lung capacity. In the past their readings were used to justify discrimination based on ‘racial difference’. Image: REUTERS/Rick Wilking

‘Racial difference’

Throughout history, medical racism has often been based on the myth that Black people have different – and inferior – bodies.

Tales of experiments that were done to show it make for grim reading.

Phrenology was one example of this – the belief popular in 19th-century Europe and America that character traits could be read through differently shaped skulls. The idea that Black people were naturally submissive was used by some slave owners to justify their trade.

In America, black and Latino communities have suffered from higher coronavirus death rates than white groups.
In America, black and Latino communities have suffered from higher coronavirus death rates than white groups. Image: NY Times

The spirometer, a common medical device in use around the world today, also tells a story of racial difference. It measures lung capacity, and was used during the American Civil War to study the bodies of Union soldiers. Doctors incorrectly concluded Black soldiers had inferior bodies because white soldiers had a higher lung capacity.

Even today, spirometers are usually “race corrected”. Researchers say that history shows this practice could represent an implicit bias, discrimination, and racism, and masks economic and environmental factors.

The 'Tuskegee Study of Untreated Syphilis in the Negro Male' used 600 Black men. Image: CDC

Deception and misinformation

Black people were used unwittingly in early 20th-century medical experiments. One of the worst examples is the Tuskegee study.

In 1932, US government researchers recruited 600 poor Black men in Alabama for a syphilis study. “Free Blood Test; Free Treatment” said the advert. Except the 399 in the group who had syphilis were never treated – they were just observed until they died. But neither they, nor their families, were ever told about this.

Discover

What's the World Economic Forum doing about diversity, equity and inclusion?

The injustice had a long history: it wasn’t until 1972, when the study was exposed, that it was finally shut down.

Taken without consent

American history provides another famous example of experimentation without consent.

In 1951, Henrietta Lacks, a 30-year-old African American woman, was diagnosed in hospital with an aggressive form of cervical cancer. She was killed by the disease, but the cancer cells lived on.

They were cultured on a mass scale, becoming known as the “HeLa” cell line. These “immortal” cells were critical to medical breakthroughs, including the polio vaccine, cancer treatments and IVF. They have even been into space – and you can still buy them today.

But they were taken without her, or her family’s, knowledge or consent. So was this medical racism?

On one hand, the 1950s was a time when it was common not to ask family members for their consent, whatever their race. But that wasn’t the only occasion. “In the 1970s, when scientists went back to her children to do research on them – that's the moment I think race played a significant role,” Lacks’ biographer, Rebecca Skloot, tells National Geographic.

Loading...

Digital discrimination

In 20th-century history, one of the big trends in medicine globally has been the use of computers to manage healthcare. But medical software can be racist.

In 2019, an algorithm that helps manage healthcare for 200 million people in the US was found to systematically discriminate against Black people. According to research published in the journal Science, people who self-identified as Black were given lower risk scores by the computer than white counterparts, leading to fewer referrals for medical care.

The computer appeared to give fewer referrals to Black people because their care costs – on average – were less over a year than for white patients (despite the Black patients being sicker).

Loading...

That might be because Black people have lower levels of trust in health-care systems, an example of “systemic racism” – where whole systems are loaded against particular groups, unknowingly or not. The researchers also suggested that direct racial discrimination by healthcare providers could play a part.

In recent years, systematic discrimination has become better understood as a powerful force around the world that traps people on lower incomes in unhealthier places –- for example, in more polluted neighbourhoods, breathing dirtier air.

Yet clearly, as COVID-19 shows, systemic racism – and other forms of discrimination – continue to be powerful, and deadly.

Loading...
Loading...
Don't miss any update on this topic

Create a free account and access your personalized content collection with our latest publications and analyses.

Sign up for free

License and Republishing

World Economic Forum articles may be republished in accordance with the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Public License, and in accordance with our Terms of Use.

The views expressed in this article are those of the author alone and not the World Economic Forum.

Share:
World Economic Forum logo
Global Agenda

The Agenda Weekly

A weekly update of the most important issues driving the global agenda

Subscribe today

You can unsubscribe at any time using the link in our emails. For more details, review our privacy policy.

Scientists make pancreatic cancer discovery, and other top health stories to read

Shyam Bishen

July 17, 2024

About Us

Events

Media

Partners & Members

  • Sign in
  • Join Us

Language Editions

Privacy Policy & Terms of Service

© 2024 World Economic Forum