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CUNY Queens College *
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Course
555
Subject
Medicine
Date
Feb 20, 2024
Type
docx
Pages
6
Uploaded by shuaifeng1989113
1.
How does racial discrimination and bias contribute to disparities in health care? How did Linda Villarosa's thinking about racial disparities in health care shift over time? How did her opinions on systemic bias change while witnessing her father’s treatment for colon cancer and dementia?
R
acial discrimination and bias could contribute to issues in health care in several ways. First, black patients are less likely to receive appropriate diagnoses, treatment, and pain relief compared to white patients, even when income and insurance coverage are equal. Second, there is a lack of
diversity among health care providers, with few black doctors and nurses.
This can lead to cultural misunderstandings and lack of trust from black patients. In addition, the health care system does not adequately address social factors like poverty, lack of education, and environmental risks that
disproportionately affect black communities.
Linda Villarosa's thinking shifted from blaming problems on lack of education and self-care among poor Black communities, to recognizing racism's role. Originally, she thought health disparities resulted from poverty and lack of education among poor black communities. She advocated self-help and education as solutions. Later, seeing her college-
educated father mistreated made her realize middle-class black people also face discrimination in health care. It wasn't just about poverty. Over time, especially when reporting on maternal/infant mortality, she came to
understand how systemic racism and bias lead to unequal treatment and drive health disparities.
Witnessing her father's poor treatment showed discrimination firsthand. It contradicted her earlier views and opened her eyes to bias even against educated, middle-class black patients. This was a turning point in recognizing systemic issues.
2.
How does the history of medicine in the U.S. demonstrate that its roots are in slavery? How is this reflected today in how Black people are treated, how
their pain is managed, and how they receive care? What can be done to reconcile this history within health care?
The history of medicine in the U.S. has roots in slavery in several ways.
During slavery, racist pseudoscience claimed Black people were physically and mentally inferior to whites. This justified cruel medical experiments on slaves without anesthesia or consent. Slavery-era doctors like Sims performed painful, unethical experiments on enslaved black women to test medical procedures. Beliefs like Black people having higher pain tolerance continued into modern medicine, affecting how Black patients' pain is managed. Studies show Black patients get less pain relief. Mistreatment and coercion of Black patients has continued, like forced sterilization of the Relf sisters in the 1970s. This echoes the lack of consent during slavery. Distrust of medicine among Black Americans stems partly from this historical mistreatment by the medical system.
Several ways could be done to reconcile this history within health care. Medical schools must teach about past medical racism and prevent outdated racial beliefs from affecting care. Providers should acknowledge this history and its present impact as they work to build trust with Black patients. Diversity
efforts should aim for greater Black representation among health providers and leaders. Providers must listen to Black patients' perspectives and complaints of discrimination. An anti-racist, patient-centered approach focused on closing disparities can work to overcome this legacy. Ongoing reform is needed.
3.
How were residents of Walnut Cove in Stokes County, North Carolina harmed
by Duke Energy? Why were the county’s poor and Black residents disproportionately harmed? How was Danielle Bailey harmed? How did local activists battle for better living conditions? Why are activists of color, like Danielle and her neighbors, often left out of the environmental movement?
Residents of Walnut Cove were harmed in several ways by Duke Energy. Toxic coal ash with dangerous levels of chemicals was dumped in ponds and landfills, contaminating water and soil. This caused health issues like cancer. In 2014, a coal ash pond spilled over 40,000 tons into a local lake
and river, further spreading toxins. Pollution from the plant contributed to poor
air quality and respiratory disease.
Poor and Black residents were disproportionately harmed. The plant was located in their community, subjecting them to the worst impacts. This environmental injustice follows historical patterns. Pollution from the coal ash lowered property values, making it hard for residents to move. The lack of political and economic power of this community allowed the plant's damage to
go unchecked.
Danielle Bailey, a Black resident, developed aggressive brain cancer at
age 35. She believes toxins from the plant and coal ash caused her illness. She was forced to move away for her health.
Local activists battled for the better living situation in multiple ways. First, they organized groups like Appalachian Voices to pressure Duke Energy to clean up the coal ash. Second, they spread awareness of the health impacts, like Danielle did by speaking up about her cancer treatments. Third, they advocate for impacted residents like Danielle.
Activists of color are often excluded because of multiple reasons. First, mainstream environmental groups fail to recognize environmental justice issues in marginalized communities. Second, Lack of resources and influence
can limit activism in poor, minority areas. Third, stories of activists like Danielle often go untold in the broader movement. Finally, centering and supporting the leadership of impacted residents like Danielle is key to addressing environmental racism.
4.
How is Black mental health care affected by racist stereotypes, assumptions, and stigma? What are some of the vulnerabilities that arise from untreated mental illness? What effect does this have on Black men? Children? Teenagers?
Racist stereotypes, assumptions, and stigma negatively impact Black mental health care in several ways. Black patients are less likely to seek treatment due to mistrust of the system and wanting to avoid being seen as "crazy." Providers are more likely to misdiagnose or underestimate symptoms in Black patients based on false beliefs like Black people being "stronger." Black psychiatric patients face greater risk of being involuntarily committed or
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overmedicated due to bias. Lack of providers from similar backgrounds hampers communication and understanding.
Untreated mental illness leaves Black Americans vulnerable to Worse physical health outcomes, since mental and physical health are linked. Higher
rates of suicide, especially among Black youth. Increased risk of incarceration
when untreated conditions lead to behaviors criminalized by society. Homelessness and poverty result from inability to hold jobs or care for oneself.
Black men with mental illness face additional stigma and are more often seen as "dangerous." Black children and teens are viewed as adults, so their symptoms may be dismissed rather than treated appropriately. Overall, racist biases in the system exacerbate suffering and risk for Black Americans with mental health conditions. Greater cultural competence and awareness is needed to provide equal, compassionate care.
5.
Why is mental illness often treated as a crime? How does this criminalization disproportionately impact Black people? Why is drug use criminalized in the United States? What alternatives exist or should be created?
There are a few key reasons why mental illness is often treated as a crime in the US, disproportionately impacting Black people. The US lacks adequate mental health facilities and treatment options, especially in lower-income areas. This means
people with severe mental illness often end up in jail instead of getting medical care.
Mental illness is stigmatized and misunderstood in society. People are often afraid of
those with mental illnesses, associating them with violence or erratic behavior. This leads to excessive policing and criminalization, rather than care and support. Racist stereotypes paint Black people, especially Black men, as more dangerous, violent, and less rational. This makes police and judges more likely to see mental illness in Black people as criminal rather than medical.
The criminalization of drug use and harsh sentencing for drug offenses has greatly increased incarceration rates, disproportionately for Black people. Many with addiction/substance abuse issues need treatment, not jail time. Drug use is criminalized due to historical association of certain drugs with marginalized groups, Moral opposition to intoxication or altering consciousness, Conflation of drug addiction with crime rather than treating it as a disease, and Political incentives to take a "tough on crime" stance.
Potential alternatives should be created. More mental health and addiction treatment facilities should be established, especially in underserved areas Police training should be provided on interacting with mentally ill individuals and de-
escalation Decriminalization of drug use and increased access to treatment instead of incarceration Restorative justice approaches that get to root causes rather than punitive measures. Community-based interventions like crisis response teams to deal with mental health emergencies instead of police. Addressing stigma and lack of cultural competency around mental health in Black communities. Overall, a public health-focused approach is needed rather than over-criminalization. This requires tackling systemic racism, investing in care and resources, and rethinking how we view and treat mental illness and drug issues in society.
6.
Why is the mortality rate for Black babies influenced by the race of their doctor? Why do you think the mortality rate for white babies is largely unaffected by the doctor’s race? How can programs, such as Perinatal Quality
Collaboratives, improve hospital practices? What are some of the limitations of these programs?
Some research has shown that Black newborns have higher mortality rates when cared for by non-Black physicians compared to Black physicians. Some potential reasons for this, such as, Implicit racial biases may affect non-
Black doctors' treatment decisions for Black patients. Communication barriers due to lack of cultural understanding. Dismissal or underestimation of Black patients' concerns. Less effort to build trust and have empathy for Black patients.
In contrast, white newborns have similar mortality rates regardless of physician race. This is likely because of multiple factors. Most doctors are white, so white babies are accustomed to being treated by white doctors. Doctors of all races provide equitable care to white patients due to absence of
racial bias. White patients may be viewed as the "norm" while Black patients are seen as "other."
Perinatal Quality Collaboratives can help hospitals adopt best practices
to reduce disparities, like Implementing implicit bias training for providers, creating protocols to better listen to minority patients' concerns, Standardizing
treatment guidelines to prevent unequal care.
However, there are some limitations. Participation is voluntary, so not all hospitals join. They don't address broader societal-level factors that influence disparities. Progress depends on hospitals dedicating resources to
improvement. Programs may lack diversity, failing to include community stakeholders. While helpful, these initiatives alone cannot eliminate entrenched systemic biases. Sustained efforts on multiple fronts are needed.
7.
How did the COVID-19 pandemic demonstrate that epidemics do discriminate
based on race? How did you witness patterns of
marginalization, bias, and inequality during the pandemic? Why do the conditions of social and physical environments—also known as social determinants of health—have an outsized influence on health outcomes?
The COVID-19 pandemic clearly demonstrated that epidemics can and do discriminate based on race, despite claims early on that the virus was an "equalizer". The racial disparities in COVID-19 cases, hospitalizations, and deaths resulted from long-standing patterns of marginalization, bias, and inequality in society.
Some examples I witnessed. Higher exposure risks for essential workers who were disproportionately minorities and low-income due to inability to work from home. This resulted from occupational segregation. Lower access to COVID-19 testing and timely healthcare in minority communities due to lack of facilities, transportation issues, and bias in provision of services. Greater severity of COVID-19 cases among minorities because of higher rates of underlying conditions like diabetes, hypertension, etc. These underlying conditions stem from poverty, barriers to healthcare access, and the damaging effects of discrimination.
Distrust of public health guidance and vaccine hesitancy among minorities because of histories of racism and unethical treatment in medicine.
In essence, the social determinants of health - the conditions of our environments shaped by systemic inequities - had an outsized influence on COVID-19 outcomes. Factors like housing, occupation, transportation, access to healthcare, wealth gaps, and
trust in institutions are all shaped by systemic racism. This racism led to higher environmental risks and vulnerabilities that caused more severe COVID-19 impacts on minorities. The pandemic laid bare these pre-existing inequities. To effectively manage epidemics, we have to address the root marginalization and inequalities that shape environmental risks and access to healthcare. Epidemics don't just affect individuals - they reveal where society has failed communities.
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