On the 50th anniversary of the historic “March on Washington for Jobs and Freedom,’’ America has become a safer, more opportune society for all. But various critical disparities still exist for Black Americans, specifically in terms of the poorer quality of their health care and higher mortality rates compared to White Americans. While the reasons behind these racial health disparities are numerous and complex, I think a vital part of the solution lies in replicating the bravery and determinism of the freedom marchers.
Despite the societal and institutional factors that contribute to health disparities, I believe that Black Americans must be far more engaged in prioritizing, highlighting, and advocating for their own well-being, and ultimately for their community’s well-being.
Racial health care inequities certainly stem from institutional problems such as a lack of health insurance, paucity of clinics and staff in low income neighborhoods, and a sordid history of racial malpractice. One of the worst examples was the Tuskegee experiment, where black men were secretly denied a diagnosis and treatment for syphilis so that they could be used as “lab rats’’ for studying the disease.
But these inequities are also caused by more subtle human prejudices: researchers have consistently found that doctors’ cultural biases influence the amount of attention they give to a patient, how they understand and interpret symptoms, and how they make a diagnosis and plan treatment.
More challenging to study, however, are hurdles unconsciously put in place by black patients themselves when they devalue their own health problems, sometimes due to a phenomenon called internalized racial oppression. This stems from self-blaming and minimizing various struggles when experiencing racial discrimination. It can limit patients’ abilities to feel empowered enough to advocate for their own best interests. Often they worry that their doctors will label them difficult or argumentative, which they fear may potentially lead to even less attention to their health needs.
For example, Black Americans seek routine and preventive care at significantly lower rates than White Americans, often waiting until the symptoms are unbearable and difficult to treat. Their lack of trust in the American health care system may cause them to delay seeking care, but many also believe — often unconsciously — that their suffering has less value and is not a big deal. Black women, for example, are more likely to die of breast cancer than White women because they’re sicker when they’re first diagnosed, often due to delays in seeking treatment; they may opt instead to suffer through increasing fatigue and discomfort, which are initial symptoms of cancer. Heart failure rates are much higher in Black Americans because so many skip screening tests and yearly physicals that could detect heart problems much earlier. Moreover, those with internalized racial oppression may minimize serious heart symptoms such as chest pain or overwhelming fatigue that may cause others to seek out medical care.
Despite being a Harvard-trained clinical psychologist, I’ve had recent encounters with physicians where I’ve felt dismissed, rushed, or ignored. I have no way of knowing whether the negligent treatment I received was due to the color of my skin, but my heart always skips a beat when these moments occur. Perhaps this reaction exposes my fears of being misunderstood or further dismissed if I speak up.
In reflecting on today’s anniversary, I want to urge all Black Americans to harness the will of those brave marchers and bring our health concerns to center stage. My advice to Black Americans – and patients of all races — is the following:
1. Understand that your health concerns are important and that believing they’re trivial may stem from unconsciously devaluing yourself.
2. Tell your doctor if you’re feeling that your concerns aren’t being addressed. Ask if you can have a little extra time to explain your symptoms or ask questions about your diagnosis and treatment.
3. Feel emboldened enough to express fears you have about treatment plans your doctor suggests and express your ideas of what recovery and a healthy outcome looks like. In essence, tell your doctor your “dreams’’ for a long, healthy life.
4. If you still feel ignored, take full control of your health care by changing doctors, seeking a second, third, fourth opinion if necessary. You can also seek the assistance of the patient advocate; many Boston hospitals now have such specialists on staff.
5. Recognize that your body and mind deserve to be nourished and maintained properly. This means feeding yourself healthy foods, getting rest and exercise, and acknowledging when you experience physical and emotional discomfort.
Just as the “March on Washington’’ catalyzed legal eradication of certain civil rights inequities, conquering any internalized racial oppression can help the black community overcome health disparities to ensure a longer life and better health.
Monica O’Neal is a clinical psychologist who practices in the Back Bay. O’Neal can be reached at [email protected].