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Race & Racism: Effects of Racism

SEMINAL STUDY

4.2

4.1 // Race & Racism: Case and Introduction

4.3 // Race & Racism: Recommendations

4 RACE & RACISM

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Conflict Statement

The authors have no conflicts of interest.

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Objectives

Describe how race and racism affects Emergency Medicine care directly between provider and patient.
Describe how racial bias and microaggressions affect Emergency Medicine at the training, hospital, and healthcare system level–minimizing diversity of the healthcare workforce.
Describe how race and racism interacts with other social determinants of health, affecting Emergency Medicine care at the societal level.

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Effects of Racism at the Bedside

Provider bias

Pain management

Heart Failure Risk Score

Kidney Transplantation

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Effects of Racism at the Hospital/Healthcare System Level

Access to care based on demographics

Hospitals with fewer resources

ED overcrowding

Unequal implementation of evidence-based care

Unequal health outcomes

Delayed delivery of life-saving therapeutic interventions

Moderate to high stress in healthcare workers

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Effects of Racism at the Societal Level

Disparities in utilization associated with poor outpatient management of chronic conditions

Perpetuation of discriminatory beliefs, values and distribution of resources

Inhumane treatment of people of color in medical research leading to distrust for minoritized communities of the healthcare system

Disproportionate impact of infectious disease in minoritized communities

Maladaptive patterns of interactions with the healthcare system (Ex. delayed EMS activation)

Societal Level

Throughout US history, the belief that Black people are fundamentally and biologically different was championed by physicians, scientists and slave owners alike to justify inhumane treatment in medical research.

unequal access to health care infrastructure and services

Racial and ethnic disparities are also evidenced as a disproportionate burden of infectious disease in Black, Latino, and Native American communities. African Americans account for about 13% of the US population, yet represent almost half of new AIDS diagnoses.

More recently, African American, Latinx, and Native American populations represented a disproportionately higher incidence of COVID-19 infections compared to the White population; and higher morbidity and mortality based on population per capita

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Effects of Racism at the Societal Level

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Assessment

Name one effect of racism at the bedside.
Name two effects of limited resources in minority serving healthcare institutions.
Name two infectious diseases associated with disparities in minoritized communities.

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Answer Key

Name one effect of racism at the bedside.

Any of the following were given as examples: Provider bias, Pain management, Heart Failure Risk Score, Kidney Transplantation

Name two effects of limited resources in minority serving healthcare institutions.

Racial minorities more frequently receive care in lower performing hospitals
ED overcrowding and unequal implementation of evidence-based care

Name two infectious diseases associated with disparities in minoritized communities.

COVID
HIV/ AIDS

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References

Kaltiso SO, Seitz RM, Zdradzinski MJ, Moran TP, Heron S, Robertson J, Lall MD. The impact of racism on emergency health care workers. Acad Emerg Med. 2021 Sep;28(9):974-981. doi: 10.1111/acem.14347. Epub 2021 Aug 6. PMID: 34358387.

Vyas DA, Eisenstein LG, Jones DS. Hidden in Plain Sight - Reconsidering the Use of Race Correction in Clinical Algorithms. N Engl J Med. 2020 Aug 27;383(9):874-882. doi: 10.1056/NEJMms2004740. Epub 2020 Jun 17. PMID: 32853499.

Doran KM, Raven MC, Alter HJ, Dalawari P. Social Emergency Medicine : Principles and Practice. Springer; 2021. Accessed December 11, 2022. https://search-ebscohost-com.foyer.swmed.edu/login.aspx?direct=true&db=cat06326a&AN=tsw.1350038&site=eds-live&scope=site

Control CfD, Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2018 (Updated). HIV Surveill Rep. 2020;31:1–119.

Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and Racial/Ethnic Disparities. JAMA. 2020;323(24):2466–2467.

van Dorn A, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. Lancet (London, England). 2020;395(10232):1243.

Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017 Apr 8;389(10077):1453-1463. doi: 10.1016/S0140-6736(17)30569-X. PMID: 28402827.

Aaron SP, Gazaway SB, Harrell ER, Elk R. Disparities and Racism Experienced Among Older African Americans Nearing End of Life. Curr Geriatr Rep. 2021;10(4):157-166. doi: 10.1007/s13670-021-00366-6. Epub 2021 Dec 14. PMID: 34956825; PMCID: PMC8685164.

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Credits

Marquita Norman, MD, MBA

Ava Pierce, MD

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SEMINAL STUDY

Race & Racism: Recommendations

4.3

5.1 // Culturally Informed Care

5.2 // Limited English Proficiency

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