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Critical Race Theory: Systemic Racism in Healthcare Kayla C. Hatchett Chamberlain University PHIL 347N: Critical Reasoning Dr. Virginia Micheli October 4, 2023

The issue of systemic racism in healthcare has gained attention within our society, and it creates barriers that affects marginalized communities, and it undermines the idea of equality and justice. Disparities in healthcare found among diverse racial and ethnic groups are not coincidental, instead it reflects systemic racism that has been heavily embedded in rules and regulations. The healthcare system should be treating everyone affiliated with the system equally regardless of their racial background or ethnicity. There are socioeconomic factors that reinforce systemic racism and lead to adverse health outcomes Research shows that racism affects healthcare workers and their patients. Numerous studies express how minorities experience higher rates of chronic diseases, maternal mortality, and they have a lower life expectancy. Supporting Points Research shows that racism affects healthcare workers and their patients. Minorities experience higher rates of chronic diseases, maternal mortality, and lower life expectancy. There are socioeconomic factors that reinforce systemic racism and lead to adverse health outcomes, Disparities in access to healthcare. Implicit bias within healthcare and how it can influence treatment. Opposing view

Individuals should be more responsible for their health. Some can argue that minorities are choosing to have poor lifestyle habits. Racial disparities reflect the patients’ poor lifestyle choices. Bailey, Z. D., Feldman, J. M., & Bassett, M. T. (2021). How Structural Racism Works - Racist Policies as a Root Cause of U.S. Racial Health Inequities. The New England journal of medicine , 384 (8), 768–773. https://doi.org/10.1056/NEJMms2025396 This article discusses how racism can be noticed in laws, rules, and practices which eventually gets embedded in societal norms. The authors discuss redlining which was the act of the government highlighting communities that were composed of black Americans and they labelled them as negative areas and they did not distribute the HOLC loans to those residents. In regard to unequal health care, Samuel Morton, a America scientists influenced white superiority and in the 20 th century there were laws that prohibited miscegenation. This led to the eugenics movement of trying to establish a whiter nation which meant “better” and “more intelligent” (Bailey et al., 2020). The article discusses a situation where a physician tried to diagnose enslaved Africans with a metal illness due to them running way from their cruel living situations as a human slave (Bailey et al., 2020). The physician also argued that the cure for these diagnoses would be whippings, and that black people had another disease that involved “reduced intellectual ability, laziness, and partial insensitivity of the skin” (Bailey et al., 2020). This source was published on February 25, 2021, and it is current. This source is credible and reliable because they all have professional backgrounds in healthcare, they are

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familiar with public health and epidemiology. The authors are experts in their field and this information is research-based and documented as historical facts. I believe this source is credible. This article provides substantial amount of evidence to support my claims because it provides information about the origin of racism in healthcare and how it has developed over time. This source is not “popular” it is a scholarly article that informs that public of the origin of structural racism, how it operates, and why it perpetuates racial health inequities. Hill, L., Artiga, S., & Ranji, U. (2022, November 1). Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them . Kaiser Family Foundation. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal- and-infant-health-current-status-and-efforts-to-address-them/ Howell E. A. (2018). Reducing Disparities in Severe Maternal Morbidity and Mortality. Clinical obstetrics and gynecology , 61 (2), 387–399. https://doi.org/10.1097/GRF.0000000000000349 McFarling, U. L. (2022, February 23). 20 years ago, a landmark report spotlighted systemic racism in medicine. Why has so little changed? STAT. https://www.statnews.com/2022/02/23/landmark-report-systemic-racism-medicine-so-little- has-changed/

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. 3, The Root Causes of Health Inequity. Available from: https://www.ncbi.nlm.nih.gov/books/NBK425845/ Resnik D. B. (2007). Responsibility for health: personal, social, and environmental. Journal of medical ethics , 33 (8), 444–445. https://doi.org/10.1136/jme.2006.017574 This article discusses how lifestyle can influence illnesses and it states how many diseases are lifestyle related. According to the authors lifestyle choices becomes a burden to the costs of healthcare and it would make more “…medical sense to hold individuals morally responsible for their health-related choices” (Resnik, 2007) Overall, this article analyzes that as a society we should encourage personal responsibility when it pertains to a persons’ health. This source is credible as it is supported by the National Institute of Environmental Health Science, National Institutes of Health and there are no views that represents those organizations, so I do not believe there is any bias. The authors are credible as Dr. Resnik is an expert in his field and he has done over 250 peer reviewed articles. The source is outdated it was published in 2007 but I believe most the information still holds true today regarding people being responsible for health.

Sathya, J. V. S. J. H. (2020, July 9). Racism in Health Care Isn’t Always Obvious. Scientific American. https://www.scientificamerican.com/article/racism-in-health-care-isnt-always- obvious/ There are many other social determinants of health and statistics may rightly express a higher amount of the deaths among minorities, but racism may not be fully responsible. However, this article expresses how many providers or workers within healthcare may not realize they are contributing to the racial disparities. In this article, they discuss implicit bias, and this may be the reason why some people do not comprehend racial inequalities within the healthcare system. This source is credible as the author is an associate professor of surgery and nursing, which proves he is an expert on the topic. Systemic racism, a key risk factor for maternal death and illness | NHLBI, NIH. (2021, April 26). Www.nhlbi.nih.gov. https://www.nhlbi.nih.gov/news/2021/systemic-racism-key-risk-factor- maternal-death-and-illness Several studies support the author's claim that black women are three times more likely to die from pregnancy complications than white women. According to the article, African American women die at a rate of 41.7%, and social determinants are often used to justify the alarming statistics. However, racial inequality is present and black women having a higher mortality rate than their counterparts proves that social determinants alone cannot be the primary cause. Vela, M. B., Erondu, A. I., Smith, N. A., Peek, M. E., Woodruff, J. N., & Chin, M. H. (2022). Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs. Annual

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review of public health , 43 , 477–501. https://doi.org/10.1146/annurev-publhealth-052620- 103528 This article discusses health care providers that have negative explicit and implicit biases against minorities. Explicit and implicit biases can influence the health care system and it also affects the patients. The research addresses the importance of raising awareness to implicit and explicit bias and the authors offer a model that displays interventions that “…systemically change structures inside and outside the health system…” (Vela et al., 2022) This source is credible because the authors are experts in this area of study and the disclosure statement states that there were no affiliations, funding, or memberships that affected the “objectivity” of the review. This source was published in 2022, and it is not outdated. This is a scholarly source, and it supports my thesis because it proves my statement of “…implicit bias within healthcare and how it can influence treatment…” and the article demonstrates ways to raise awareness.

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