Many Black adults, particularly younger women, say they would strongly or somewhat prefer to see a health care provider who shares their racial background for routine visits. However, most older Black women and men say it wouldn’t make a difference to them. Black adults point to a wide range of issues as major reasons for poor health outcomes.
Poor Health Outcomes
As a result, Blacks are sicker and die younger than other Americans. They are more likely to suffer from chronic conditions, such as heart disease, diabetes and asthma, and they have higher rates of premature death from health conditions that could be treated or prevented, such as hypertension, the flu and certain cancers.
These disparities are not random. Many factors contribute to Blacks’ poor health outcomes. But it is important to note that the anti-Black racism that has permeated American society for generations also negatively impacts Blacks’ social determinants of health, which are the environmental and economic conditions that affect a person’s ability to get well.
Moreover, anti-Black racism often plays out in health care settings. A recent study by the Kaiser Family Foundation and Undefeated found that 70% of Black adults believe that people who seek medical care are subject to unfair treatment based on their racial or ethnic background. This distrust of health care professionals is justified. The medical community has a long history of mistreating Blacks, including experiments on enslaved people, forced sterilization of Black women and the Tuskegee syphilis experiment, in which doctors withheld treatment from hundreds of Black men so they could track the progression of the disease.
Across the country, Blacks are taking action to address their distrust of the health care system and work toward more equitable care. For example, in Richmond, Va., where a massive medical system, Virginia Commonwealth University, has a large Black community, the institution has embarked on a host of equity and trust-building initiatives in the neighborhoods, from a health hub to regular “Faith and Facts Friday” Zoom calls between VCU doctors and local Black clergy.
Lack of Access to Health Care
Black people live sicker and die younger than other Americans because of barriers that prevent them from accessing the quality medical care they need. They have higher rates of poverty, poor housing and lead poisoning, higher rates of preterm birth and lower obstetrical outcomes (birth defects, premature infant mortality). And they are more likely to have advanced cancer or other chronic illnesses.
They are also more likely to lack insurance coverage than other adults because of income inequality. The decision by some states not to expand their Medicaid programs disproportionately impacts Black households that have low enough incomes to qualify for coverage under the Affordable Care Act.
Many Black Americans experience mistreatment by health care providers, too. They are more likely than other adults to say they had at least one negative experience with a health care provider, and Black women are more inclined than men to report these experiences.
Younger Black women stand out from their elders in their tendency to say they would prefer to see a Black health care provider for routine care, though the majority of this group still says it wouldn’t make a difference to them. A similar proportion believes the health care system is designed to hold Blacks back a great deal or a fair amount, and nearly half believe medical researchers today experiment on Black people without their knowledge or consent.
Mistrust of Health Care Providers
Black Americans report that they do not trust their health care providers. This can lead to a number of negative outcomes, such as people not adhering to medication or routine screenings and being less willing to participate in medical trials.
In a survey conducted by the Pew Research Center, nearly six-in-ten Black adults said the U.S. system was designed to hold them back “a great deal” or at least a fair amount. This belief was more prevalent among Black women than men.
The poll also found that Black Americans are more likely than other groups to believe that medical experiments that involve black participants happen today. And, more than half say they have been denied tests, medications or treatment that they think they need. These findings are consistent with numerous other studies that show Black patients are often mistreated by their doctors.
Despite the long legacy of medical mistrust, a growing number of hospitals and health systems are making it a priority to address the issue. In a recent episode of our podcast, Clinical Advisor, we spoke with Lynn Todman, vice president of health equity and community partnerships at Corewell Health. Todman has years of leadership and expertise in the areas of urban poverty, social and structural determinants of health, and community development and engagement. She shared her thoughts about how to broach the subject of medical mistrust with patients and how it can be addressed in hospital and community settings.
Racial Disparities in Health Care
Many factors contribute to worse health outcomes and shorter lives for Black Americans. Some of these are structural, such as poverty and lack of affordable housing; others reflect the legacy of past discriminatory policies, including “redlining” in which neighborhoods were classified as high risk and thus excluded from mortgages and other forms of financial access. But a significant number of these problems stem from the interaction between people and the system — that is, how the social and economic conditions that affect health are addressed by health care providers and the institutions that deliver health services.
The vast majority of Black Americans say less access to medical care where they live is a major reason that they have worse health outcomes than other adults in the U.S. – and 22% say it is a minor reason. This includes fewer primary care doctors, trauma centers, pharmacies and COVID-19 vaccination centers near Black communities.
Most Black respondents in the 2021 survey say they would strongly (14%) or somewhat (29%), prefer to see a health care provider who shares their own racial background for routine care. This preference is most pronounced among younger Black women, though the trend is similar across income levels. Some studies have shown that patient-provider racial concordance is associated with improved clinical outcomes and higher rates of preventive visits.
