Skip to main content

Healthcare, Fear, Discrimination, and Racism

  • Chapter
  • First Online:
The Trauma of Racism

Abstract

This chapter explores the relationship between racial discrimination, racism, stereotype threat, and health disparities and the role of fear in shaping attitudes of health providers and clinicians.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 34.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 44.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 49.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Alhusen, J. L., Bower, K. M., Epstein, E., & Sharps, P. (2016). Racial discrimination and adverse birth outcomes: An integrative review. Journal of Midwifery & Women’s Health, 61(6), 707–720. https://doi.org/10.1111/jmwh.12490.

    Article  Google Scholar 

  • Anderson, K. O., Green, C. R., & Payne, R. (2009). Racial and ethnic disparities in pain: Causes and consequences of unequal care. The Journal of Pain, 10(12), 1187–1204.

    Article  Google Scholar 

  • Attanasio, L. B., & Hardeman, R. R. (2019). Declined care and discrimination during the childbirth hospitalization. Social Science & Medicine, 232, 270–277., ISSN 0277-9536. https://doi.org/10.1016/j.socscimed.2019.05.008.

    Article  Google Scholar 

  • Blumenthal, D., Abrams, M., & Nuzum, R. (2015). The affordable care act at 5 years. The New England Journal of Medicine, 372(25), 2451–2458.

    Article  Google Scholar 

  • Brawley, O. W. (2002). Disaggregating the effects of race and poverty on breast cancer outcomes. Journal of the National Cancer Institute, 94(7), 471–473.

    Article  Google Scholar 

  • Brewer, L. P. C., Carson, K. A., Williams, D. R., Allen, A., Jones, C. P., & Cooper, L. A. (2013). Association of Race Consciousness with the patient–physician relationship, medication adherence, and blood pressure in urban primary care patients. American Journal of Hypertension, 26(11), 1346–1352. https://doi.org/10.1093/ajh/hpt116.

    Article  PubMed  PubMed Central  Google Scholar 

  • Buchmueller, T. C., Levinson, Z. M., Levy, H. G., & Wolfe, B. L. (2016). Effect of the affordable care act on racial and ethnic disparities in health insurance coverage. American Journal of Public Health, 106(8), 1416–1421. https://doi.org/10.2105/AJPH.2016.303155.

    Article  PubMed  PubMed Central  Google Scholar 

  • Centers for Disease Control and Prevention. Infographic: Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. Retrieved from https://www.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-related-deaths/infographic.html on January 28, 2021.

  • Chamberlain, J. M., Joseph, J. G., Patel, K. M., & Pollack, M. M. (2007). Differences in severity-adjusted pediatric hospitalization rates are associated with race/ethnicity. Pediatrics, 119(6), e1319–e1324.

    Article  Google Scholar 

  • Chapman, E. N., Kaatz, A., & Carnes, M. (2013). Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. Journal of General Internal Medicine, 28(11), 1504–1510. https://doi.org/10.1007/s11606-013-2441-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chen, I., Kurz, J., Pasanen, M., Faselis, C., Panda, M., Staton, L. J., & Cykert, S. (2005). Racial differences in opioid use for chronic nonmalignant pain. Journal of General Internal Medicine, 20(7), 593–598.

    Article  Google Scholar 

  • Chen, J., Vargas-Bustamante, A., Mortense, K., & Ortega, A. N. (2016). Racial and ethnic disparities in health care access and utilization under the affordable care act. Medical Care, 54(2), 140–146. https://doi.org/10.1097/MLR.00000000000000467.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chevarley, F., & White, E. (1997). Recent trends in breast cancer mortality among white and black US women. American Journal of Public Health, 87(5), 775–781.

    Article  Google Scholar 

  • Chu, K. C., Tarone, R. E., & Brawley, O. W. (1999). Breast cancer trends of black women compared with white women. Archives of Family Medicine, 8(6), 521–528.

    Article  Google Scholar 

  • Cintron, A., & Morrison, R. S. (2006). Pain and ethnicity in the United States: A systematic review. Journal of Palliative Medicine, 9(6), 1454–1473.

    Article  Google Scholar 

  • Collins, J. W., Jr., Herman, A. A., & David, R. J. (1997). Very low birthweight infants and income incongruity among African American and White parents in Chicago. American Journal of Public Health, 87, 414–417.

    Article  Google Scholar 

  • Contrada, R. J., & Ashmore, R. D. (2001). Gary MLet al. Measures of ethnicity-related stress: Psychometric properties, ethnic group differences, and associations with well-being. Journal of Applied Social Psychology, 31(9), 1775–1820.

    Article  Google Scholar 

  • Cook, B. L., Hou, S. S.-Y., Lee-Tauler, S. Y., Progovac, A. M., Samson, F., & Sanchez, M. J. (2019). A review of mental health and mental health care disparities research: 2011-2014. Medical Care Research and Review, 76(6), 683–710. https://doi.org/10.1177/1077558718780592.

    Article  PubMed  Google Scholar 

  • Corrigan, P. W., & Watson, A. C. (2007). The stigma of psychiatric disorders and the gender, ethnicity, and education of the perceiver. Community Mental Health Journal, 43, 439–458.

    Article  Google Scholar 

  • Cunningham, W. A., Johnson, M. K., Rave, C. L., Gatenby, J., Gore, J. C., & Banaji, M. R. (2004). Separable neural components in the processing of black and white faces. Psychological Science, 12, 806–813.

    Article  Google Scholar 

  • Davis, A. M., Vinci, L. M., Okwuosa, T. M., Chase, A. R., & Huang, E. S. (2007). Cardiovascular health disparities: A systematic review of health care interventions. Medical Care Research and Review: MCRR, 64(5 Suppl), 29S–100S. https://doi.org/10.1177/1077558707305416.

    Article  PubMed  Google Scholar 

  • Dobscha, S. K., Soleck, G. D., Dickinson, K. C., Burgess, D. J., Lasarev, M. R., Lee, E. S., & McFarland, B. H. (2009). Associations between race and ethnicity and treatment for chronic pain in the VA. The Journal of Pain, 10, 1078–1087. https://doi.org/10.1016/j.jpain.2009.04.018.

    Article  PubMed  Google Scholar 

  • Dominguez, T. P., Dunkel-Schetter, C., Glynn, L. M., Hobel, C., & Sandman, C. A. (2008). Racial differences in birth outcomes: The role of general, pregnancy, and racism stress. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 27(2), 194–203. https://doi.org/10.1037/0278-6133.27.2.194.

    Article  Google Scholar 

  • Dressler, W. W. (1990). Lifestyle, stress, and blood pressure in a southern black community. Psychosomatic Medicine, 52(2), 182–198.

    Article  Google Scholar 

  • Eack, S. M., & Newhill, C. E. (2012). Racial disparities in mental health outcomes after psychiatric hospital discharge among individuals with severe mental illness. Social Work Research, 36(1), 41–52. https://doi.org/10.1093/swr/svs014.

    Article  PubMed  PubMed Central  Google Scholar 

  • Eack, S., Newhill, C., & Watson, A. (2012). Effects Of Severe Mental Illness Education on MSW Student Attitudes about Schizophrenia. Journal of Social Work Education, 48(3), 425–438. Retrieved May 13, 2021, from http://www.jstor.org/stable/41705876.

  • Esnaola, N. F., & Ford, M. E. (2012). Racial differences and disparities in cancer care and outcomes: where’s the rub? Surgical Oncology Clinics of North America, 21(3), 417–viii. https://doi.org/10.1016/j.soc.2012.03.012.

    Article  PubMed Central  Google Scholar 

  • Eylem, O., de Wit, L., van Straten, A., et al. (2020). Stigma for common mental disorders in racial minorities and majorities a systematic review and meta-analysis. BMC Public Health, 20, 879. https://doi.org/10.1186/s12889-020-08964-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ezenwa, M. O., & Fleming, M. F. (2012). Racial disparities in pain Management in Primary Care. Journal of Health Disparities Research and Practice, 5(3), 12–26.

    PubMed  PubMed Central  Google Scholar 

  • FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fox, A. B., Taverna, A. C., Earnshaw, V. A., & Vogt, D. (2018). Conceptualizing and measuring mental illness stigma: The mental illness stigma framework and critical review of measures. Stigma Health, 3, 348–376.

    Article  Google Scholar 

  • Gara et al., (2018). A naturalistic study of racial disparities in diagnoses at an outpatient behavioral health clinic. Psychiatric Services, 10 Dec 2018. https://doi.org/10.1176/appi.ps.201800223.

  • Goyal, M. K., Kuppermann, N., Cleary, S. D., Teach, S. J., & Chamberlain, J. M. (2015). Racial disparities in pain Management of Children with Appendicitis in emergency departments. JAMA Pediatrics, 169(11), 996–1002. https://doi.org/10.1001/jamapediatrics.2015.1915.

    Article  PubMed  PubMed Central  Google Scholar 

  • Graham, G. (2015). Disparities in cardiovascular disease risk in the United States. Current Cardiology Reviews, 11(3), 238–245. https://doi.org/10.2174/1573403x11666141122220003.

    Article  PubMed  PubMed Central  Google Scholar 

  • Green, C. R., Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S., Fillingim, R. B., Kalauokalani, D. A., Lasch, K. E., Myers, C., Tait, R. C., Todd, K. H., & Vallerand, A. H. (2003). The unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain Medicine, 4, 277–294. https://doi.org/10.1046/j.1526-4637.2003.03034.x.

    Article  PubMed  Google Scholar 

  • Gross, C. P., Smith, B. D., Wolf, E., & Andersen, M. (2008). Racial disparities in cancer therapy: Did the gap narrow between 1992 and 2002? Cancer, 112(4), 900–908. https://doi.org/10.1002/cncr.23228.

    Article  PubMed  PubMed Central  Google Scholar 

  • Haider, A. H., et al. (2011). Association of unconscious race and social class bias with vignette-based clinical assessments by medical students. Journal of the American Medical Association, 306(9), 942–951.

    PubMed  Google Scholar 

  • Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E., Day, S. H., & Coyne-Beasley, T. (2015). Implicit racial/ethnic Bias among health care professionals and its influence on health care outcomes: A systematic review. American Journal of Public Health, 105(12), e60–e76. https://doi.org/10.2105/AJPH.2015.302903.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hardeman, R. R., Karbeah, J.’. M., Almanza, J., & Kozhimannil, K. B. (2020). Roots community birth center: A culturally-centered care model for improving value and equity in childbirth. Healthcare, 8(1), 100367., ISSN 2213-0764. https://doi.org/10.1016/j.hjdsi.2019.100367.

    Article  PubMed  Google Scholar 

  • Harrell, J. P., Hall, S., & Taliaferro, J. (2003). Physiological responses to racism and discrimination: An assessment of the evidence. American Journal of Public Health, 93(2), 243–248.

    Article  Google Scholar 

  • Health Insurance Coverage in the United States: 2018, U.S. Census Bureau, November 2019., https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-267.pdf.

  • Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America, 113(16), 4296–4301. https://doi.org/10.1073/pnas.1516047113.

    Article  PubMed  PubMed Central  Google Scholar 

  • Institute of Medicine, Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2003). Unequal treatments: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press.

    Google Scholar 

  • Kirby, J. B., & Kaneda, T. (2010). Unhealthy and uninsured: Exploring racial differences in health and health insurance coverage using a life table approach. Demography, 47, 1035–1051.

    Article  Google Scholar 

  • Kposowa, A. J., & Tsunokai, G. T. (2002). Searching for relief: Racial differences in treatment of patients with back pain. Race and Society, 5, 193–223. https://doi.org/10.1016/j.racsoc.2004.01.004.

    Article  Google Scholar 

  • Krieger, N., Smith, K., Naishadham, D., Hartman, C., & Barbeau, E. M. (2005). Experiences of discrimination: Validity and reliability of a self-report measure for population health research on racism and health. Social Science and Medicine, 61, 1576–1596.

    Article  Google Scholar 

  • Lieberman, M. D., Hariri, A., Jarcho, J. M., Eisenberger, N. I., & Bookheimer, S. Y. (2005). An fMRI investigation of race-related amygdala activity in African-American and Caucasian-American individuals. Nature Neuroscience, 6, 720–722.

    Article  Google Scholar 

  • Lillie-Blanton, M., & Hoffman, C. (2005). The role of health insurance coverage in reducing racial/ethnic disparities in health care. Health Aff (Millwood), 24(2), 398–408.

    Article  Google Scholar 

  • Manchikanti, L., Helm Ii, S., Benyamin, R. M., & Hirsch, J. A. (2017). A critical analysis of Obamacare: Affordable care or insurance for many and coverage for few? Pain Physician, 20(3), 111–138. PMID: 28339427.

    Article  Google Scholar 

  • Mayberry, R., Boone, L., Kaiser, H. J. (2002). Racial/Ethnic Differences in Cardiac Care: The Weight of the Evidence. Family Foundation.

    Google Scholar 

  • McEwen, B. S. (1998). Protective and damaging effects of stress mediators. The New England Journal of Medicine, 338, 171–179.

    Article  Google Scholar 

  • McEwen, B. S. (2000). Allostasis and allostatic load: Implications for neuropsychopharmacology. Neuropsychopharmacology, 22, 108–124.

    Article  Google Scholar 

  • McEwen, B. S. (2002). Protective and damaging effects of stress mediators: The good and bad sides of the response to stress. Metabolism, 51(6 Suppl. 1), 2–4.

    Article  Google Scholar 

  • McEwen, B. S. (2004). Protection and damage from acute and chronic stress, allostasis and allo-static load overload and relevance to the pathophysiology of psychiatric disorders. Annals of the New York Academy of Sciences, 1032, 1–7.

    Article  Google Scholar 

  • McEwen, B. S., & Stellar, E. (1993). Stress and the individual: Mechanisms leading to disease. Archives of Internal Medicine, 153, 2093–2101.

    Article  Google Scholar 

  • Mensah, G. A., & Brown, D. W. (2007). An overview of cardiovascular disease burden in the United States. Health Affairs (Millwood), 26(1), 38–48.

    Article  Google Scholar 

  • Miller, N. A., Kirk, A., Kaiser, M. J., & Glos, L. (2014). The relation between health insurance and health care disparities among adults with disabilities. American Journal of Public Health, 104(3), e85–e93. https://doi.org/10.2105/AJPH.2013.301478.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mossey, J. M. (2011). Defining racial and ethnic disparities in pain management. Clinical Orthopaedics and Related Research, 469(7), 1859–1870. https://doi.org/10.1007/s11999-011-1770-9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Natale, J. E., Joseph, J. G., Rogers, A. J., et al. (2012). PECARN (Pediatric Emergency Care Applied Research Network). Cranial computed tomography use among children with minor blunt head trauma: Association with race/ethnicity. Archives of Pediatrics & Adolescent Medicine, 166(8), 732–737.

    Article  Google Scholar 

  • National Cancer Institute, NIH. Cancer Stat Facts: Cancer of Any Site. Retrieved from https://seer.cancer.gov/statfacts/html/all.html on January 30, 2021. Last updated on November 17, 2020.

    Google Scholar 

  • Phelps, E. A., Cannistraci, C. J., & Cunningham, W. A. (2003). Intact performance on an indirect measure of race bias following amygdala damage. Neuropsychologia, 41, 203–208.

    Article  Google Scholar 

  • Reisman, M. (2015). The affordable care act, five years later: Policies, Progress, and politics. P & T : A Peer-Reviewed Journal for Formulary Management, 40(9), 575–600.

    Google Scholar 

  • Rosenthal, L., & Lobel, M. (2011). Explaining racial disparities in adverse birth outcomes: Unique sources of stress for black American women. Social Science & Medicine, 72(6), 977–983. ISSN 0277-9536. https://doi.org/10.1016/j.socscimed.2011.01.013.

    Article  Google Scholar 

  • Sabin JA, Rivara FP, Greenwald AG. Physician implicit attitudes and stereotypes about race and quality of medical care. Medical Care 2008;46(7):678–685. doi:https://doi.org/10.1097/MLR.0b013e3181653d58.

    Article  PubMed  Google Scholar 

  • Saftlas, A. F., Koonin, L. M., & Atrash, H. K. (2000). Racial disparity in pregnancy-related mortality associated with livebirth: Can established risk factors explain it? American Journal of Epidemiology, 152(5), 413–419. https://doi.org/10.1093/aje/152.5.413.

    Article  PubMed  Google Scholar 

  • Sawyer, P. J., Major, B., Casad, B. J., Townsend, S. S., & Mendes, W. B. (2012). Discrimination and the stress response: Psychological and physiological consequences of anticipating prejudice in interethnic interactions. American Journal of Public Health, 102(5), 1020–1026. https://doi.org/10.2105/AJPH.2011.300620.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shavers, V. L., & Brown, M. L. (2002). Racial and ethnic disparities in the receipt of Cancer treatment. JNCI: Journal of the National Cancer Institute, 94(5), 334–357. https://doi.org/10.1093/jnci/94.5.334.

    Article  PubMed  Google Scholar 

  • Siegel, R., Ward, E., Brawley, O., & Jemal, A. (2011). Cancer statistics, 2011: The impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA: a Cancer Journal for Clinicians, 61(4), 212–236.

    Google Scholar 

  • Sohn, H. (2017). Racial and ethnic disparities in health insurance coverage: Dynamics of gaining and losing coverage over the life-course. Population Research and Policy Review, 36(2), 181–201. https://doi.org/10.1007/s11113-016-9416-y.

    Article  PubMed  Google Scholar 

  • Sommers, B. D., Buchmueller, T., Decker, S. L., Carey, C., & Kronick, R. (2013). The affordable care act has led to significant gains in health insurance and access to care for young adults. Health Aff (Millwood), 32(1), 165–174.

    Article  Google Scholar 

  • Trawalter, S., & Hoffman, K. M. (2015). Got pain? Racial bias in perceptions of pain. Social and Personality Psychology Compass, 9(3), 146–157.

    Article  Google Scholar 

  • Wallace, M. E., et al. (2015). Joint effects of structural racism and income inequality on small-for-gestational-age birth. American Journal Public Health.

    Google Scholar 

  • Washington, H. A. (2006). Medical apartheid: The dark history of medical experimentation on black Americans from colonial times to the present. New York: Doubleday.

    Google Scholar 

  • Wyatt, S. B., Williams, D. R., Calvin, R., Henderson, F. C., Walker, E. R., & Winters, K. (2003). Racism and cardiovascular disease in African Americans. The American Journal of the Medical Sciences, 325(6), 315–331.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Moreland-Capuia, A. (2021). Healthcare, Fear, Discrimination, and Racism. In: The Trauma of Racism. Springer, Cham. https://doi.org/10.1007/978-3-030-73436-7_8

Download citation

Publish with us

Policies and ethics