After George Floyd’s murder by the hands of four Minneapolis police officers, the impact of systemic racism in American society has become clearer. To spread awareness, many healthcare activists on social media use the #whitecoats4blacklives to show their support for the Black Lives Matter movement and to bring to light the healthcare disparities between white and black patients. In fact, with the COVID-19 Pandemic, Black Americans have a hospitalization rate 4.5 times higher than Non-Hispanic White Americans. These disparities permeate many aspects of healthcare, especially maternal care. Black women have a maternal mortality rate of forty-one deaths per 100,000 live births, compared to White women with thirteen deaths per 100,000 live births . There are many compounding variables for this disparity, whether it being poor insurance coverage over the pregnancy period, lower income levels, or that medical professionals perceive black patients to have a higher pain tolerance than white patients, despite being completely false (1). But one factor that is less discussed, is that American medicine, especially gynecology, was developed directly at the detriment of Black Americans.
Dr J Marion Sims is credited as the father of American Gynecology and is celebrated through statues and praise in medical textbooks. He developed the first treatments for vescovigial fistula, a childbirth complication which leads to continuous urination (2). However, these important treatments have a disturbing history. Sims routinely performed surgeries on black female slaves without anesthesia. These slaves often had dozens of surgeries performed on them before their conditions were cured, leaving them in continuous pain for weeks and pains. Sims perfected his technique on slaves who had no rights, but when Sims moved to New York to continue his research, he used anesthesia on his white female subjects because of the pain these patients felt. Sims’ New York subjects had given informed consent and had more protections and regulations during his research. Sadly, Sims’ abuse of black slaves was unnecessary, as there were many white female test subjects with informed consent that Sims could have chosen. Unfortunately, many slaves had medical techniques tested on them, and it is not surprising that American medical practitioners ignore the pain of black patients with this cruel history (3).
As American healthcare’s legacy of racism carries over to the modern day, it may appear futile to break the systemic cycle that prevents healthcare equities from reaching black patients. There have been some attempts to teach this history and go over healthcare inequalities in medical student curriculum, yet not all colleges have included these classes. The American Association of Medical Colleges (AAMC) has shown its support to include discussions of racism within medical school curriculum (4). Similarly, some argue that programs like Medicaid Expansion or even Medicare for All may help to solve aspects of this problem. Health insurance coverage is much lower for Latino and Black Americans, with 19 percent and 11.5 percent of Hispanic and Black Americans, respectively, being uninsured compared to 7.5 percent of White Americans in 2018. The barriers preventing accessible healthcare can be removed with universal coverage, but enduring systemic racism in hospitals, such as the aforementioned perceptions of differences in pain tolerance between races, could continue to perpetuate inequality. As such, until physicians, medical staff, and government institutions can understand the legacy of racism in modern medicine, patients will continue to face healthcare disparities because of their race and their socio-economic status.
Edited by: Keshav Kailash
Illustrated by: Victoria Xu