While calculations and statistics can estimate the life expectancy of the population as a whole or for any individual, the only definite conclusion that has arisen from the seemingly endless desire to know when life will end is that death is impending and inevitable. There are clear correlations between certain decisions made throughout life, such as smoking or daily exercise, and the age at which an individual dies, but recent research has shown that other factors, specifically those that lie outside of the realm of one’s control, can have an even more profound impact on life expectancy. Evolving into increasingly more hidden forms to evade any attempts to fully disclose and eliminate its influence in every aspect of daily life, racial discrimination has persisted for centuries, and continues to serve as an integral part of the system through which people of color receive inadequate health care. The implicit racial bias of physicians and geographic segregation, either when experienced alone or in conjunction with one another, contribute to this inferior medical care and have detrimental effects on the health and wellbeing of people of color, culminating in increased mortality rates among this population.
Unclothed, uncertain, and uncomfortable, when in the presence of a physician, whose aura of confidence and superior knowledge seems to immediately criticize any and all lifestyle decisions, a patient undoubtedly feels vulnerable. This is further amplified by the racially biased undertones that can be heard in the speech and actions directed towards patients of color. Despite the enormous amount of trust that patients place in the gloved hands of a physician to diagnose their conditions, assuage their fears and pursue their eventual well-being, beyond the white coat and professional composure often lies a concealed bias against people of color (Chapman et al. 1505). In a study conducted by the University of Colorado, almost none of the 210 clinicians surveyed admitted to displaying overt racial discrimination during medical practice. The research, however, also estimated that, “two-thirds of participating primary care clinicians showed some implicit ethnic/racial bias that favored whites, even as they rejected explicit expressions of bias” (Blair et al. 44). Regardless of whether or not the providers acknowledge their prejudicial opinions, they unconsciously demonstrate their judgment through poor communication and threatening body language, which can severely impede the relationship between the physician and the patient (Hall et al. e72). The provider-patient interactions between individuals of different races tends to lead to a subconscious desire of the physician to assert dominance over the patient through aggressive and domineering body language, a lack of collaboration and conversation and an overall decrease in total interaction time (Hall et al. e72). Although these actions may not be obvious to the medical professionals themselves, people of color, who have been exposed to multiple instances of microaggressions similar to these for their entire lives, recognize the oppression. As a result, the amount of trust that they bestow upon their doctors gradually decreases until they permanently refuse to seek medical advice, consequently allowing their health to decline. It is not difficult to find research concluding that, “minority patients are sicker and more likely to die than whites from a wide range of diseases and illnesses” (“African American Health,” Matthew 1). While there may be some truth in this statistic, for diseases that people of color are genetically predisposed to have, there is little explanation for the increased mortality rates from these readily treatable conditions other than inequitable health care on the basis of race.
The fear of feeling invalidated and intimidated, and thus avoiding contact with providers does contribute to the discrepancy in quality of health when comparing patients of various races. Even in the circumstances in which the patients regularly visit their physicians, however, they often receive inadequate treatment that significantly deteriorates their health. It is estimated that, “83,570 minority patients die annually due to health care disparities,” and whether the patients are delaying office visits as their health declines, or the physicians are suggesting, “fewer angiographies, bypass surgeries, organ transplants, cancer tests and resections, less access to pain treatment, rehabilitative services, asthma remedies, and nearly every other form of medical care,” the extreme increase in mortality can no longer be assumed to be unassociated with race (Matthew 1). The tendency of health care providers to avoid prescribing preventative screening or certain medications to patients of color was surmised by a systematic review completed by members of the Schools of Social Work and Psychology at the University of North Carolina to be a result of the physician-held perception that African American patients are less intelligent than their white counterparts, and therefore are less likely to comply with and fully understand treatment regimens (Hall et al. e61). This highly inaccurate allegation along with the other false assumptions made by physicians, including the stereotype that patients of color are more likely to have obesity-related conditions, such as hypertension and diabetes, and are more likely to have unprotected sex, leading to sexually transmitted infections and HIV/AIDS, contribute to both the malpractice by physicians and the patient’s disdain for medical offices (Hall et al. e61). As anticipated, these assumptions do not go undetected by patients of color, a fact that is confirmed by a study that compared physicians’ scores on the Implicit Association Test and patients’ ratings of “interpersonal treatment, communication, trust, and contextual knowledge” on the Primary Care Assessment Survey (Blair et al. 45). Overall, the research concluded that, “the stronger the clinicians’ implicit preference for whites over blacks, the lower their black patients rated them” (Blair et al. 46-47). People of color are not oblivious to the microaggressions that they encounter in the field of medicine, and the negative impact of this hostility is devastating to the psychological health of patients. Implicit bias can lead to decreased socialization and life satisfaction and increased symptoms of depression, all of which increase the risk of suicide and lead to stress that causes premature mortality (Hall et al. e72). Regardless of whether patient receives substandard medical care in the form of insufficient treatment plans or refuses to return to the physician due to intimidation, the current state of racial bias in the medical field is diminishing patients’ health and increasing mortality rates for people of color.
It is almost guaranteed that some degree of racial segregation exists in all of the 297 major cities in the United States with population of 100,000 inhabitants or more (“2010 Census”). That is, every region in the city does not contain a ratio of white people to black people that is representative of the city’s population as a whole. Despite the overwhelming indications that geographic isolation on the basis of race exists, many city officials do not directly experience the difficulties of social and economic inequalities and fail to recognize the severity of the issue and its impact on the health of people of color. Recent research has indicated that “health is embedded in the social conditions under which groups live and work,” suggesting that the series of interrelated racial inequalities originating from the racial wealth gap can severely harm the wellbeing of people of color (Collins and Williams 496). Economic inequality forces people of color to live in historically impoverished neighborhoods due to an inability to afford the ever-rising cost of living in affluent communities that contain superior resources, such as medical facilities. The houses in within the segregated neighborhoods are pathogens to health, as they are not likely to be inspected on a regular basis and are often found near deserted factories and landfills, thereby exposing the inhabitants to environmental toxins (Williams 183). These hazardous living conditions, which are forced upon people of color due to the racial wealth gap, are breeding grounds for diseases that ultimately cause a decrease in health and life expectancy.
Regardless of the incongruity that is present between medical facilities in historically black neighborhoods and those in historically white neighborhoods, discrepancies in yearly salary alone is directly related to mortality rates. By acknowledging the presence and severity of the racial wealth gap in America and realizing that African American families earn on average 59 cents for every dollar earned by white families, it can be extrapolated that because “higher income [is] associated with greater longevity,” the life expectancy of people of color is less than that of white individuals (Williams 181, Chetty et al. E1). In analyzing the expected age of death, the men in the top one percent of the nation-wide income bracket were estimated to live an average of 14.6 years longer than the men in the bottom one percent. A similar correlation was found in the comparison of the women at opposite ends of the salary distribution, where an increase in income equated to a 10.1 year gain in life expectancy (Chetty et al. E4). Despite recognition of these findings in multiple studies, the issue has only worsened in recent years as the life expectancy of the top five percent has increased by three years, a gain comparable to that of eliminating all cancer deaths, while the bottom five percent experienced no change (Chetty et al. E13). Although the study, completed by the American Medical Association, did not directly examine the cause of this variation, it did theorize, similarly to other previously mentioned articles, that inequalities in medical care and poor living conditions could contribute to the discrepancy in longevity (Chetty et al. E14). Another theory, developed by a past University at Buffalo professor, Ruqaiijah Yearby, suggests that, “access to health care in the United States has been rationed for decades based on a person’s ability to pay. This system of rationing, which serves as a means to allocate scarce resources, has led to an untold number of deaths” (Yearby 78-79). One specific example of the morbid effects of healthcare rationing was the death of a twelve-year-old boy from a toothache that escalated into a brain infection. A condition that was initially solvable with an eighty-dollar tooth extraction ended in a two-hundred and fifty thousand hospital bill and a death certificate, because the family could not locate a dentist that would accept their insurance (Yearby 77). The story of Deamonte Driver is not, however, an isolated incident, considering the fact that, due to economic and employment inequality, people of color are more likely to be uninsured, and, “uninsured adult patients in general have a 25% greater mortality rate than insured adults for all medical conditions” (Jehle qtd. In Yearby 84). In conjunction with one another, the racial wealth gap and the disproportionate allocation of medical resources have resulted in the deaths of thousands of people of color each year, and the mortality rates will continue to rise until the entrapping cycle of poverty is broken.
Despite the widespread research that indicates it is solely the people of color whose health is harmed by the hidden forms of racism, other studies suggest that racial oppression is detrimental to all individuals regardless of whether or not they experience the persecution directly. In a study conducted at the University of Pennsylvania that examined the relationship between community-wide racism and the health of the inhabitants, it was concluded that “whites and blacks living in communities with higher levels of racial prejudice were at an elevated risk of mortality, independent of individual and community sociodemographic characteristics and individually held racist beliefs” (Lee et al. 2349). Although the data from this study states that racism, in terms of its impact on health, does not discriminate between the oppressors and the oppressed, numerous other studies have drawn remarkably contrasting conclusions. In a study conducted throughout the ten largest cities in America, an increase in the index of dissimilarity, a measurement comparing the severity of the unequal population distribution of various races, caused, not only, an increase in mortality for both black adults and infants, but also a significant decrease in mortality of white adults and infants (Collins and Williams 501-502). Due to the prevalence of statistics that indicate the effects of racial bias in medicine and community-wide prejudice most significantly impact people of color, as opposed to all individuals, it can be concluded that the findings that suggest otherwise were unintentionally influenced by other factors, such as income inequality.
Rooted in over two centuries injustice, the issue of racism, in all of its hidden forms, has no simple solution, but its associated discriminations, specifically those affecting the health of people of color, are plausibly addressed. As author of Just Medicine: A Cure for Racial Inequality in American Healthcare, Dayna Matthew, suggests, the only solution is legislation that penalizes for actions of implicit bias, since, “political efforts at universalizing access, regulatory efforts at enforcing cultural competency, and private efforts at ‘doing the right thing’ have all failed” (Matthew 5). In order to structure laws that will most strictly address the issue, more research has to be completed that will identify the forces that directly cause both societal and individual racial bias (Williams 185). While solving the issue of racism as a whole is daunting and impractical in the current state of the nation, it is reasonable that research and legislation can eliminate its impact in the field of medicine and increase the longevity of people of color for decades to come.
Death is inevitable, but increased mortality rates for certain individuals solely on the basis of race and race-related oppressions, such as the racial wealth gap and geographic segregation should not be. The intimidating presence of physicians whose subconscious racial bias generates a fear of medical facilities and the economic inequality that forces people of color into hazardous living conditions causes increased mortality rates and decreased quality of life. It is only with legislation specifically targeting implicit racism that the relationship between longevity and race will disappear, allowing people of color to live long enough to experience the necessary advancements in the equality of all races in all realms of life.