Black History Month offers an opportunity to recognise the history, accomplishments, and contributions of Black people, while also addressing the ongoing challenges the community faces. I want to explore here some of the challenges that Black people encounter within the healthcare system, to encourage discussions and promote actionable steps toward building a healthcare system that recognises and accommodates the unique needs of Black individuals.
Health disparities and inequities
Black individuals often face higher rates of chronic diseases such as hypertension, diabetes, and cardiovascular disease, which can result in serious complications if not properly managed. In addition, they also experience higher cancer mortality rates, particularly for prostate cancer in men and breast cancer in women, primarily due to delayed screenings, limited access to early detection services, and barriers to timely treatment.
These disparities arise from genetic, environmental, and socioeconomic factors. For example, certain genetic variants linked to insulin resistance are more common in Black populations, raising the risk of type 2 diabetes (Himanshu et al, 2020). Environmental factors include limited access to healthcare, fewer medical facilities in Black communities, lack of insurance, and the effects of systemic racism and bias. Socioeconomic challenges also play a major role, as black individuals are more likely to experience poverty, unemployment, and lower levels of education, all of which impact their ability to access high-quality health care.
Systemic racism and bias
One of the underlying causes of systemic racism and bias is the inadequate training that health professionals receive in diagnosing and assessing conditions in Black patients. A major issue is that medical textbooks and educational resources predominantly showcase images of conditions featuring lighter skin tones. This creates difficulties for health professionals in accurately diagnosing conditions that present differently on darker skin, such as rashes, bruising, or cyanosis. For instance, skin conditions such as eczema or psoriasis may look different on darker skin, often resulting in misdiagnoses or missed symptoms.
Another problem is the underrepresentation of Black populations in medical research and clinical trials. Historically, studies have primarily focused on white populations, leading to gaps in knowledge about how medications and treatments impact Black individuals. As a result, treatments may be less effective or cause unexpected side effects.
Moreover, health professionals may unconsciously hold biases, viewing Black individuals as more tolerant of pain. This stereotype is rooted in outdated beliefs that wrongly suggest Black individuals have physiological differences, such as thicker skin or fewer nerve endings, making them less sensitive to pain. These biases lead to inadequate pain management and delayed treatment for Black patients. Added to this, medical devices such as pulse oximeters often provide inaccurate readings for individuals with darker skin tones, or spirometry data may be interpreted differently in Black patients than white patients (Jamali et al, 2022).
Lack of representation and cultural competency gaps
Research has demonstrated that many health professionals lack the cultural competency necessary to understand and meet the specific needs of Black individuals. This can lead to miscommunication, unsuitable treatment plans, and lower patient engagement. Without an understanding of cultural and social contexts, health professionals may struggle to address the unique challenges Black individuals encounter, such as varying dietary requirements, stressors, and health beliefs.
The underrepresentation of Black health professionals can exacerbate feelings of isolation among Black individuals, who might feel more at ease with providers who share their racial or cultural background. The lack of representation can hinder Black individuals' sense of being understood, leading to the perception that healthcare systems are not tailored to their needs.
This issue is especially prominent in mental health, where Black men in the UK are significantly more likely to be sectioned under the Mental Health Act compared with their white counterparts. Research indicates that Black men are up to four times more likely to face sectioning. This disparity is often attributed to a lack of cultural competency within mental health services. Healthcare providers may misinterpret or misunderstand the behaviour and communication styles of Black men, leading to misdiagnosis. Systemic biases and stereotypes, such as the belief that Black men are more aggressive or dangerous, can also contribute to their higher rates of involuntary detention (Ouro-Gnao, 2022).
This is also highlighted in the ‘No One's Listening’ report from the All-Party Parliamentary Group on Sickle Cell and Thalassaemia (2021) highlighting the need to enhance cultural competency in health care, especially for conditions such as sickle cell disease, where increased awareness is crucial for ensuring timely and appropriate treatment.
The way forward
Addressing healthcare disparities affecting Black individuals is essential for building a more equitable system. Advocates such Joe Bervell, who focuses on racial disparities and biases in healthcare, and Malone Mukwende, a medical student and founder of Black and Brown Skin, play a crucial role in this effort. Mukwende's clinical handbook, Mind the Gap, available online and used by over 400000 people, highlights how diseases manifest on Black and Brown skin (https://www.blackandbrownskin.co.uk/mindthegap). By tackling these systemic issues, we can work towards a healthcare environment that truly understands and meets the diverse needs of Black patients, ensuring timely, appropriate, and effective treatment for all.