Confronting Racism in Health Care

Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN


Am Nurs Journal. 2013;8(8) 

Weeks after the acquittal of George Zimmerman in the shooting death of 17-year-old Trayvon Martin, local communities are still holding peaceful demonstrations to show solidarity with Martin's family, and to underscore the message that we have not yet achieved the civil rights and justice envisioned by the Reverend Martin Luther King Jr in his historic speech, "I Have a Dream," on August 28, 1963. Fifty years later, we are reminded of the lingering tensions and discrimination that characterize race relations in this nation.

President Obama, in a surprise unscripted speech on July 19, talked about his personal experiences as an African-American and our history of racial injustices that continue to affect black people. As the country's first black President, his words were historic; they reopened the dialogue about race in America.

What, then, is the responsible conversation about race in health care? More than a third of the US population reported belonging to a racial or ethnic minority group in the 2010 US Census. Disturbingly, however, the Centers for Disease Control and Prevention (CDC) Office of Minority Health and Health Equity find that racial and ethnic populations suffer lower life expectancy, higher infant mortality, and higher rates of disability and preventable diseases than non-minorities. Black Americans bear the most serious burden, according to statistics in the CDC's first Health Disparities and Inequalities Report (2011), which analyzes the factors creating higher disease burden for some populations that rob them of a healthy life. The report calls for immediate action to accelerate efforts at the federal, state, and local levels to shrink gaps in access to care, reduce preventable deaths, and impede the ever-increasing incidence of morbid conditions that threaten a dramatic reduction in quality of life and life expectancy.

Blatant discrimination is no longer rampant in health care, but it is no secret that subtle biases and stereotyping persist. For years, "separate but equal" conditions existed. As a nursing student in the mid-1970s I was deeply disturbed by the socioeconomic segregation that occurred on the obstetrical units of an inner city hospital. Mothers with insurance were placed on a unit with nicely appointed private rooms. The poor, almost all African-American women, were on another unit that had rooms with multiple beds. In the 1990s, I was on a team designing a new clinic building. To my shock and disbelief it was suggested there be two entrances—one for private patients and one for those who were indigent. Fortunately there was no indulgence of this ill-founded request.

Over time, we have implemented protections for patients' rights and embraced the need for cultural diversity but we may have fallen short addressing the same concerns for workers. In February a neonatal ICU registered nurse sued a Michigan hospital for discrimination when it honored a request from a white father to bar African-American nurses from caring for his baby. The hospital honored the request for some period of time before correcting the discriminatory action. The nurse settled the case with payment for emotional stress and harm to her reputation; a second nurse has also sued over the same incident.

Most people prefer to have a caregiver who looks like them, and understands and appreciates their racial, ethnic, and religious beliefs and practices. There are benefits to accommodating race concordance; however, it is not to be misinterpreted as accommodating racial bias as pointed out by Paul-Emile (2012), who studied physicians' rationale for acceding to patients' racial preferences. She points out the complexity of such accommodation and posits there is no moral reason to allow decisions based on racial bias.

The nurse who commits subtle intentional or unintentional racism, reinforces prejudice that leads to disparities in care. Many would say nurses exhibit less racism than other groups. But any racism is still racism and strikes at the core of our professional obligation to protect and care for patients. Hall and Fields (2013) advocate for "positive profiling" to address and prevent racial health disparities and inequities. They suggest nurses can use evidence to remove barriers to care and implement strategies to avoid the potential for subtle racism that results in delays in care, reduced referrals, or suboptimal treatment. They boldly address the difficulty admitting racism exists in our workplaces and care settings, pointing out that the majority of nurses are white, and that racism perpetuated by whites is more prevalent than that of any other people of color.

Health care has no place for hate, anger, stereotypes, discrimination, or marginalization. As uncomfortable as it may seem, talking about how we treat one another, and how we avoid discrimination, is a crucial step toward eroding historic prejudice. It's time to address the subtle racism affecting the health of the very people we have pledged to protect and serve. Let's create a safe environment for the crucial conversation. Racism hurts all of us.