Read Part 1 of this blog series here.

For major policy change on any issue to occur, we must examine the root causes and how this country’s history has shaped our current systems and institutions. Unfortunately, when we look back on our nation’s history we see that our institutions and systems have been built on and have been tarnished by racism. This is especially true for our nation’s health care system. 

Per the Centers for Disease Control and Prevention (CDC), the centuries of racism in the United States has created a profound negative impact on communities of color. American Academy of Family Physicians (AAFP) notes that “systemic racism works by categorizing people based on their race, color, ethnicity, and culture.” Resources and societal goods are then allocated to certain groups of people in a way that puts some in a position of privilege without merit and allow others to be oppressed. The AAFP also notes that “racism has been institutionalized in a way that permits the establishment of patterns, procedures, practices and policies within organizations that consistently penalizes and exploits people because of their race, color, culture or ethnic origin.” 

In addition to institutionalized racism, BIPOC (Black, Indigenous, and people of color) communities also face interpersonal racism, discrimination, and implicit and explicit bias in their interactions with healthcare professionals. 

• Interpersonal Racism refers to the persistence of racial prejudice that undermines the relationship between a physician and patient. 
• Discrimination in healthcare settings is the process of limiting patient’s ability to access care and the appropriate level of treatment on the basis of race, gender, ability, socioeconomic status and the many other intersecting identities that the patient may hold. It can include dismissing a patient’s symptoms or health concerns, offering different treatment based on a patient’s type of insurance, or not providing care in the patients’ preferred choice of language.
• Explicit Bias refers to the awareness of prejudices and attitudes for certain groups of people. It is having the conscious knowledge of your personal positive and negative feelings towards different groups of people. Explicit bias may be displayed through overtly racist statements or microaggressions. 
• Implicit Bias refers to our subconscious thoughts, perceptions, feelings, attitudes, and stereotypes about certain groups of people that have developed based on our prior influences, interactions, and imprints on our lives. 

Per the Arkansas Minority Health Commission’s Racial and Ethnic Health Disparity Study, significantly higher percentages of Blacks and Hispanics reported being victims of discrimination while getting healthcare compared to their White counterparts. These experiences, coupled with the historic exploitation of the Black community, have created a growing mistrust for medical professionals.

The pervasive racism, discrimination, and bias within our healthcare system and society has created numerous negative outcomes and disparities for Black women and BIPOC communities as a whole. In this country, Black Americans have higher rates of cancer, diabetes, childhood obesity, and heart disease linked to lack of economic resources, limited healthcare access and delay in treatment. Also, compared to their White counterparts, Black Americans die prematurely from numerous diseases including diabetes, hypertension, strokes, and COVID-19. 

In Arkansas, heart disease is the number one killer for all women, with Black women disproportionately affected. Between 2011-2015, the death rate among Black people was 261.2 compared to the rate for White people at 215.2. For that same timeframe, the heart disease mortality rate for Black women was 209.1 compared to 171.1 for White women. For Black Arkansans, the rate of diabetes was 18.7% compared to 13.3% for White Arkansans. Also, from 2011-2015, the age-adjusted diabetes mortality rate for Black women in Arkansas was 45.2 per 100,000 compared to 17.9 for White women. In 2018, Black women in Arkansas were 2.2 times as likely to die from pregnancy-related causes than White non-Hispanic women. 

These are just a few examples of how Black women in Arkansas have been impacted negatively due to systemic racisms’ hold on the healthcare system. 

The alarming rates of disparities present major challenges in efforts to dismantle systems that work to the detriment of health care access and quality for BIPOC communities. But there are changes that can be implemented to create a more equitable  and engaging healthcare system for Black women and BIPOC communities. Elected officials, state agencies, community leaders, and healthcare providers have the opportunity to work together to eradicate disparities that disproportionately impact people of color. Arkansas can adopt the following policy strategies and recommendations  to reverse health care disparities for Black women.

• Address historic and present-day racism’s impact on the social determinants of health by creating policies with an intentional racial equity lens
• Expand and maintain access to quality and affordable health coverage through continuous expansion of Medicaid benefits
• Expand access to trusted community health care providers by increasing the number of culturally competent and relevant health care providers
• Improve rural communities’ access to providers that specialize in women’s health
• Improve the quality of care that addresses the needs of Black women through cultural humility and implicit bias training for all health professionals
• Increase the use of patient-centered delivery models that focus on relationship development and quality of care
• More carefully collect data regarding race and ethnicity in health care settings

This country has a long-standing history and present-day relationship with racism, to the detriment of Black women. Systemic racism and biases in health care systems have long resulted in inequitable and sometimes fatal health outcomes for Black women. To ensure that all Arkansans can live healthy, positive lives, we need to create policies to address the disparate health outcomes for Black women. 

As a state, we have to both recognize this history and the current disparities and take action to directly eliminate these racial biases. To best treat health inequities, we must first understand where the inequities lie. To do this, we need more high-quality, disaggregated data that shows differences in outcomes across race, gender, and other intersectional factors.