We know countless ways that racism harms our nation’s health. What may not be widely understood is the racism that isn’t seen can be the most destructive.

Public health experts discussed unequal treatment in health access, quality and care in an APHA webinar yesterday. Photo by APHA

Public health experts discussed unequal treatment in health access, quality and care in an APHA webinar yesterday. Click to view this webinar in its entirety. Photo by APHA

As public health leaders discussed yesterday in part three of APHA’s webinar series, “The Impact of Racism on the Health and Well-Being of the Nation,” people of color face countless health crises —like high rates of uninsurance, inability to get treatment and lower quality of care — in spite of the Affordable Care Act and the historic steps the law took to explicitly create health equity. Speakers showed how biases, though often unconscious, have resulted in health injustices.

“These are difficult things to talk about, but they’re critical for us to talk about,” APHA Past President and social justice advocate Linda Rae Murray said. “They impact everyone in our society no matter what their race is.”

The numbers are staggering. According to National Collaborative for Health Equity Executive Director Brian Smedley, 34 percent of Latinos report having no regular source of health care, compared to 15 percent of whites. And blacks experience worse access to care than whites in 10 of 21 measures observed in the National Healthcare Quality and Disparities Report 2014 — and none better.

The problem may include doctors, according to Mayo Clinic School of Medicine Professor Michelle van Ryn, even if they don’t realize it. She said that implicit or unconscious bias affects how clinicians ask questions, make diagnostic decisions, manage symptoms, offer treatment, refer to specialty care and even predict patient trust, satisfaction and adherence to their recommendations.

But van Ryn also said that these are fixable problems, both on organizational and personal levels.

“We need to be much more effective at using images and values and emotions,” she said. “The strongest evidence for change in implicit biases is to increase exposure to counter-stereotypes.”

Murray said that structural racism, defined here by the Aspen Institute, is seen in our health care workforce with fewer clinicians from underrepresented groups, a lack of cultural competence and language barriers for too many Americans. The effects can even lead to harmful, unfounded and even racist scientific theories that have longstanding impact medical practice; for example, in 1852 E.M. Pendleton wrote in The Charleston Medical Journal and Review of an “unnatural tendency of the African female to destroy her offspring.”

But the problem isn’t just black and white. Murray said that despite all the good the ACA has created, its exclusion of undocumented groups exacerbates health disparities and contributes to structural racism by taking “a basic fundamental right, and by law, we exclude groups of people simply because of their legal status in terms of immigration.” She added that structural racism includes high education costs, voting restrictions and residential segregation, which all lead to mental and physical health differences between races.

“We will not realize the American dream until we directly address these structural factors.”

This webinar can now be viewed in its entirety. Check out APHA’s Racism and Health webinar page for the recording, along with part one on “naming and addressing racism” and part two on “race, place and preventing violence.”