How White People Can Help Fight Systemic Racism in Health Care
I’m the only White kid in my family. Understand, me saying that does not give me some kind of get-out-of-racism-free card, just a different lens on growing up White than the one you may have had. Being the youngest in a family with two Brown siblings made me aware of my whiteness earlier than some. It made my whiteness overt when for most White people, it isn’t.
That’s part of what privilege is — the invisibility of the advantages our skin color confers. If you had the ability to see it, it wouldn’t be so insidious, so pernicious, and so hard to acknowledge. It is, by definition, unseen and unconscious advantage based on skin color. White privilege means I can trust I won’t be followed when I’m walking around a store, that band-aids will match my skin tone, and that I am not afraid for my safety when I get pulled over by the cops. It means I get a higher wage, preferential treatment, and assumed competence, among other things. But the thing I want to draw attention to today is how it impacts illness.
The stress-disease connection has been well documented. Many of us had the start of our diseases during a time of stress in our lives. Perhaps it was an accident, illness, or injury that triggered our chronic illness, or maybe we were going through a difficult time in our life like a job transition or divorce. Stress can ignite disease in the body. My rheumatologist says that many autoimmune diseases have a genetic predisposition but require a triggering event to initiate the disease. Even if you aren’t someone whose disease began with a stressful event, stress exacerbates our illnesses. Every doctor’s advice about chronic illness begins with “reduce the stress in your life.” Stress is like gasoline on the fire of chronic disease.
So, with that as the context, consider the impact of race on chronic illness. Think about the toll that the daily stress racism and oppression puts on Black, Indigenous, and people of color’s (BIPOC) bodies. In 2013, The National Institutes of Health reported that people of color were “1.5 to 2 times more likely to have a chronic illness than their White counterparts.” One-and-a-half to two times – that is a stark and shocking number.
The impact of race on health has been studied and well documented over the years and the data is bleak. From lower quality of health care, to increased mortality rates, BIPOC are overlooked in our systems, have less access, worse health outcomes and greater mortality. And is it any wonder? When navigating a society that “abolished” slavery but perpetuated systems, attitudes and structures that have continued to disadvantage BIPOC, the burden of stress they carry is disproportionate to their White counterparts.
The disenfranchised, in any society, do not become empowered simply by deciding they want to become empowered. Women did not get the right to vote because they suddenly decided they wanted it and gained the power to do it. They got the right to vote because through their activism, they convinced enough husbands, brothers, fathers and sons to support them. The same principle holds for every other “ism” in our society.
We don’t overcome this by ignoring it. BIPOC will not gain equality in health outcomes (or other systems) by deciding they want it — if that were true, it would have happened long ago. Meaningful change happens when enough of us in the majority begin to acknowledge the structural inequities and start making and expecting those changes.
I know this is problematic on many levels. For those of us who are White, we were likely raised to think it is impolite to talk about race. This singular impediment, our lack of fluency leads to a multitude of difficulties — from lack of skill, to embarrassment and fear, to the bigger problem of thinking of ourselves as “unraced,” or because we didn’t start the problem, not seeing how we play a role in the problem or the solution. Well, this pattern hasn’t been serving us, and it is time to push through our discomfort. Our non-White counterparts don’t have the luxury of not talking about race or being conscious of how the world views them. Racist things are happening to them every day and in order to keep their children safe, they must talk about race — in the car, on the walk home, at the dinner table, all the time. It is time for us White folks to learn these skills.
In order for things like health outcomes to change for BIPOC, many things will have to shift over a long period of time (i.e. the long-term contributions that the stress of racism contributes to the development of chronic illness.) However, that doesn’t mean that there’s nothing we can do. Acting now can make change in the lives of individuals today and work towards systems change for generations to come.
1) We must increase our skill, comfort, knowledge, and understanding of White supremacy and White privilege. Much of this work needs to be done within our families, churches, and friendship circles, with other White people.
2) As we educate ourselves about issues of power and privilege and initiate conversations about those subjects, we will begin to become more confident and comfortable. It is common to feel defensive and awkward.
3) The only way we improve a skill is to practice. When someone shows us a thinking error or when we’ve made a mistake, we must accept and learn from it. It’s so easy to allow embarrassment to stop us in our tracks. This is part of the reason this work has not already been done. Yes, it is awkward. Yes, it is uncomfortable — but it is also overdue. Until we start to change our patterns of behavior, there is no hope for statistics like the one about disease and race to change.
4) Initiate conversations with your doctors about the disparate numbers for BIPOC patients. We cannot change what we do not acknowledge. There might be some engaging dialogues that you could open up by expressing your surprise with your physician, asking them why they think it’s true, what can be done, what their office is doing to support BIPOC patients etc.
5) Offer to support your BIPOC friends and family around their health conditions. If you have the energy and availability to offer to support your loved ones in medical settings, talk to them about what meaningful support would look like. It’s likely they’ve had racist experiences interacting with the medical establishment that have left them feeling ineffective or shut out. Ask them about it and listen to their experiences. Ask if there are ways you can support them in getting the care and access they need. This is not about co-opting the experience, but about supporting and joining in ways that feel useful to your friend or family member to change a situation for the better.
It begins with us. As our nation is in turmoil over the murder of George Floyd (and others), as we think about what it means for us personally, or what it means for us with chronic illness, (who may not be able to go out and protest) there are things we can do. We can learn about our privilege. We can initiate uncomfortable conversations. We can begin to become allies or continue to become better allies. We can make room for voices that are historically unheard or disenfranchised. We can question our assumptions. We can change what we watch, listen to, and read to reflect a more diverse and broad set of perspectives. And this is just a start.
What change are you committed to making?
“Just Medicine: A Cure for Racial Inequality in America,” Dayna Bowen Matthew
“Black Man in a White Coat: A Doctor’s Reflections on Medicine and Race,” Damon Tweedy, M.D.
Ta-Nehisi Coates’ article, The Case for Reparations
Van Jones’ article, Black People ‘Loot’ Food…White People ‘Find’ Food
“The New Jim Crow,” Michelle Alexander
“Between the World and Me,” Ta-Nehisi Coates
“White Fragility,” Robin DiAngelo
“Me and White Supremacy,” Layla F. Saad
“Witnessing Whiteness,” Shelly Tochluk
“So You Want to Talk About Race,” Ijeoma Oluo
Read more on Annette’s blog.
Getty photo by Monkey Business Images.