Key themes of our survey
- VigorTip surveyed 1,000 black Americans and 1,000 white Americans about their experiences in the US healthcare system.
- While our respondents showed similar rates of health care use across races, Black and White Americans have different experiences with health care.
- Half of Black Americans agree with the statement ‘the health care system is racist’. One in three black Americans report experiencing racism while dealing with the health care system.
- Black Americans are making decisions that interrupt their care, such as finding new providers or delaying follow-up appointments, because of racist health experiences.
Racial disparities are heavily rhetorically promoted in the health literature. For example, in the past two years, countless articles have explored how COVID-19 mortality and vaccination rates vary by race—and few of them explain why. But these articles focus on results. At VigorTip, we ask a different question: What is the overall patient experience like for black Americans, and how does it differ from white Americans?
According to our survey of 1,000 black Americans and 1,000 white Americans, the biggest difference has nothing to do with how often people go to the doctor. Racism against black Americans is causing significant disparities in the quality of their healthcare and how they perceive providers.
Of course, systemic racism in the healthcare system is well documented. Black Americans are more likely than white Americans to die from complications such as diabetes, high blood pressure, obesity, asthma and heart disease, according to the Centers for Disease Control and Prevention (CDC).
VigorTip’s Black Health Experience Survey provides insight into how, when and why these outcomes occur. The results show how experiencing racism in the healthcare system affects the entire health journey, not just outcomes.
Our survey asked respondents about their views on racism in the healthcare system. We do not define what a racist experience is.
Same action, different result
Black and white Americans use health care at nearly the same rate each year. In fact, three-quarters of survey respondents reported that they had seen a healthcare provider in the past 12 months and that they had a physical exam in most years. But they don’t have the same experience with the health care system.
Black health experiences have to overcome additional hurdles because of your race, hoping to be treated equally. But seeking similar treatment does not automatically equate to receiving treatment that meets your needs.
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Quality of care starts with trust
In our survey, black Americans had a 10-point lower positive opinion of doctors than white Americans, and a 9-point lower favorable opinion of nurses and physician assistants.
Black Americans have distrust of the health care system in part because of a sense of racism in medicine. Racist beliefs led to the once-accepted practice of medical experiments on blacks and enslaved people, as well as the exploitation of blacks for research without their consent. The trauma of this structural racism as a “normal” part of medicine has resonated across generations – and there are still varying degrees of racism in medicine today.
Lack of representation fuels mistrust. In our survey report, only a quarter of black Americans saw a provider of their race, and only half of black respondents said they thought their last provider was familiar with black patients.
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While our survey allowed us to quantify these emotions, actual patients can talk about the challenges of finding care they trust.
For example, Adrienne Hibbert, founder of the South Florida Black Doctors website, told NPR about the challenges she faced working with a white obstetrician during pregnancy: “I want someone who understands my background. I want someone who understands what I eat. I want someone who understands my upbringing and what my grandmother used to tell me.”
For Jayla, a patient seeking treatment for STIs who spoke to CBS News, the lack of representation led to dismissal from providers and misdiagnosis.
“I have to be an angry black woman to do something for you…I used to want to avoid this, but when it comes to my health, I’d rather you be uncomfortable than die,” she said.
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When does the experience of racism happen?
According to our survey, one in three black Americans reported experiences of racism when dealing with the health care system. According to the Pew Research Center, 71% of black Americans have experienced discrimination in any setting, suggests that our survey may be underestimating the full extent of the black health experience.
Patients report racism at the point of care
Interpersonal racism occurs between two or more people. In the context of a healthcare system, it might be between the patient and the provider or administrator. In our survey, more than half (52%) of those who had an experience with racism in a health care setting said dating itself is where the interaction takes place.
When seeking care, experiences of interpersonal racism put patients in situations where there is no desired outcome. Black Americans often have to choose between enduring racism and interrupting or stopping treatment altogether.
Systemic racism is the bigger problem
Systemic racism, also known as institutional racism, occurs in institutions or systems of power. The reality of systemic racism in the health care system can be seen in the policies and procedures established by many medical institutions, pharmacies and health insurance companies that exclude black Americans, even if unintentionally.
Although 87% of survey respondents said their experiences of racism occurred in interpersonal interactions, when asked whether inequalities in the healthcare system were personal or systemic, the majority reported experiencing racism in healthcare of Black Americans say it’s the whole system.
This requires a systemic solution.
American Medical Association declares racism a ‘public health threat’
At Brigham and Women’s Hospital in Boston, the Department of Medicine’s Health Equity Commission found that black and Latino patients with heart failure were more likely to be admitted to general internal medicine and were less likely to be admitted to general internal medicine than white patients with the same disease. May receive a diagnosis of specialist cardiology nursing care being received.
In addition, Brigham and Women heart failure patients discharged from general medicine were more likely to have unexpected readmission within 30 days and were less likely to receive support in the form of home monitoring and registration calls.
To uncover the systemic drivers of these differences, physicians were surveyed to understand what influenced their decision to admit patients to general floors rather than specialist wards. The Commonwealth Fund reported that their response was that “they believed that white patients were more frequently and actively advocating for access to specialist cardiology services, which influenced their decision-making.”
Despite racial bias at the provider level, the hospital itself took accountability and action to begin correcting it.
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The impact of racism on nursing
Tackling racism in health care can force patients to choose between basic respect and continued care. These experiences can guide Black Americans into actions that affect the care they receive, and ultimately, their health. This may be a factor in differences in health outcomes.
Our survey participants reported responding to racism in healthcare by:
- 36% report changing healthcare providers
- 28% reported no follow-up appointments
- 28% report delays in making health decisions
Interrupting care has consequences. Given the current shortage of healthcare providers, 36% of Black Americans who report switching healthcare providers after a racist experience risk delaying care. According to a study published by the Association of American Medical Colleges (AAMC), the shortage of primary care providers will be between 17,800 and 48,000 by 2034.
Provider shortages will only make it more challenging for Black Americans to access equitable care, forcing them to settle for whatever provider is available rather than match them with providers of their race or familiarity with black patients.
Avoiding follow-up appointments or delaying health decisions can lead to oft-cited adverse outcomes. For example, a 2021 study looks at medical mistrust, racism, and preventive health check-up delays among African-American men. The researchers found that delays in preventive health screenings such as routine check-ups, blood pressure screenings and cholesterol screenings were due to factors such as lack of health insurance or access to health care. A patient’s history of medical distrust due to racial discrimination was the biggest factor behind delays in care.
Black Americans still seek healthcare with hope for the future
Despite all the delays in health care faced by black Americans in our survey, they continue to seek health care at the same rate as white Americans. Hope for addressing inequalities within the health care system remains among black Americans. Survey respondents representing Gen Z were the most promising, with 75% saying they truly believe there will be a solution to healthcare inequities in their lifetime.
Today, however, the black health experience remains a challenge. Racism affecting the quality of care, lack of representation, and limited choices of black providers make it difficult for Black Americans to access the same level of care as white Americans. It is wrong to think that poor health in black Americans is a function of heredity or lack of medical care.
The systemic racism that has been infused into the health care system for decades makes the journey to health an uphill battle, but Black Americans are willing to keep fighting for their health and their communities.
From January 19, 2022 to January 24, 2022, VigorTip conducted a survey of more than 2,000 black and white Americans over the age of 18. The survey was conducted online with a self-administered questionnaire to an opt-in panel of respondents from the market research vendor. Using U.S. Census (2019 ACS) estimates as a baseline, quotas are used to ensure national representation by generation, gender, and region within each racial group.
Detailed sample size: N=1,010 Black Americans, N=1,006 White Americans