How a Textbook Page Single-Handedly Encourages Racial Stereotyping in Healthcare
By: Project Hbe
Tags: Health, Racism, Education, Diversity, Social Justice

How a Textbook Page Single-Handedly Encourages Racial Stereotyping in Healthcare

Why your zip code is more important than your genetic code

Source: Nursing: A Concept-Based Approach to Learning, pg. 161

Take a look at the image above, read it carefully, and consider where it’s from. You can probably suspect that page comes right out of a textbook used in healthcare education.

While we would like to believe our healthcare system and providers are not biased, both implicit and explicit circumstances of discrimination still exists.

A recent study assessed the utility of an algorithm equating health-risk and cost. While African American patients were found to have similar risk levels to White patients, the African Americans were found to still be much sicker.

At a sampled high-risk group, African Americans were found to have 26.3% more chronic illnesses compared to the White individuals within the same group.

Because the algorithm attempts to use cost as a core factor of health, much less is spent on the treatment of African Americans in the same level of need, and an implicit racial bias is introduced.

The data presented focuses on a typical algorithm used in many large hospitals and facilities, and it shows the growing need for attention given to these hidden biases.

While I may not be able to see your initial reaction to this image, let’s think about what it means for us, both as patients and as members of the community.

Advancing cultural sensitivity in healthcare

With an increased richness in racial, cultural, and religious diversity, healthcare schools adopted a systematic approach to teach their students how to treat those from different backgrounds.

Thus, a page like the one shown above was written. It was distributed in hopes of helping students learn the different aspects surrounding one’s culture, and leverage that understanding as a way to facilitate treatment modalities.

While the intention is well and all, many harmful implications stem from having this published in a textbook. First and foremost, facts and observations are mutually exclusive. When we make claims about the nature of the real world, we establish certain facts which then trickle down to future students.

The descriptions provided in the image are clearly based on racial stereotypes. It runs the massive risk of offending patients if physicians treating them are jumping to conclusions about their beliefs.

The teachings in the textbook can potentially manifest into a physician or a nurse refusing to offer pain medication to Jews or Hispanics. Rather than being culturally sensitive, it is passively harmful.

If a patient tells us he is in pain, and we have access to medications that can help him, should we ignore him or not offer him treatment simply because he’s a “Catholic Hispanic?”

Cultural sensitivity as a form of ignorance

Cultural sensitivity is like ordering a non-meat dish when going out to eat with a vegetarian friend. However, skewed cultural sensitivity in healthcare that influences the physician’s choices can ultimately have life-or-death implications.

A textbook and non-proven data are by no means good ways to encourage cultural sensitivity. Rather than attempting to promote sensitivity, what we really need is to train future healthcare professionals to be culturally competent.

Competent healthcare providers can be trained through the exposure to and experience with individuals from different backgrounds. Here are some possible ways to instill this within healthcare education:

Establish mandatory community service in medical school, nursing school, PA school, etc. Community engagement encourages active participation with locals from various backgrounds, often with ones that differ from our own. Empower cross-border, cross-cultural community service. For example, if students come from a predominantly white state, then they should travel to a state near the border to gain experience working with potential Hispanic communities. As a California resident, this is definitely one population set I’ve had a lot of exposure to over the years. Create seminars or workshops involving speakers, advocates, or those who first-handedly suffer from inequalities. Returning to the conference I mentioned in the beginning, we invited a speaker who had personally faced medical prejudice based on race/ethnicity. Shared experiences and stories are a humanistic way of connecting with those around us. Much has changed over the years with cultural competency overcoming the barriers brought forth by racial stereotyping. The examples I listed above were just a few of the many experiences I’ve had or seen with my colleagues. My hope is that everyone entering the healthcare field takes away the value and need for understanding the backgrounds of others.

Where you live affects how you are

When all is said and done, the broadest implications of this textbook page point to a term known as the Social Determinants of Health — conditions ranging from social or economic inequalities that result in health injustices.

Race and culture are determined socially rather than biologically. Essentially, our zip code is more important than our genetic code.

Studies have shown the correlation between the quality-and-length of life compared to the living locations of individuals. In some circumstances across America, there can be a twenty-year average life expectancy difference between cities that are only miles away from each other.

Breastfeeding rates, as well, are shown to have a direct correlation with the race and income of the mother associated with her environment.

An additional study by researchers at Harvard Medical School have shown that 145 of the 560 diseases examined were “modestly influenced by socio-economic status derived by zip code.”

Here are some reasons your zip code matters:

If you live in a culturally polarized neighborhood, the language barrier will prevent you from receiving appropriate access to healthcare

If you go to school in a poor district, you lack the education needed for informed health decisions

If you live in a food desert, you lack access to healthy eating options or grocery stores — instead you’ll resort to primarily fast food for sustenance

If you live in an area with a low physician to patient ratio, there are more barriers to receiving care

We often associate our diseases with genetics or family history — diabetes is a classic example. Yet the onset of such conditions is more, in part, influenced by social factors, such as the environment.

The textbook image failed to consider how socioeconomic status is one of the biggest social determinants that creates health disparities. We need to take a holistic approach to patient care by recognizing both biological and social factors.