A recent Institute of Medicine report on health disparities, came to the conclusion that when you control for factors like education, income, and social status—nonwhites still received worse care than whites in the American health care system. Race really matters when you try and get health care in the United States.
Whites looked at this report and said ”How can this be?” African Americans looked at the report and said “Why are you surprised?” Whites said,”Tthe number must be wrong. It must be poverty that accounts for disparities.” Hispanics just looked at the report and said “Duh, tell me something I didn’t know.” Whites said, “If this report is right it must be us and not the minorities who have to change.” Asians looked at the report and said, “Yup. That is right.”
The truth is –if you are unlike someone you make judgments about that someone. You reach into the culture and pull out of it only what you know. TV, Internet, Movies supply us with the experiences we need to understand people different than us. And we assume TV makes up for direct experiences.
From this perspective it makes sense that we will use stereotypes-even the best of health care providers do this. I have seen these stereotypes play out in a number of ways:
- A black woman who questions a doctors is considered argumentative and unreasonable
- A Hispanic woman really understands the language more than she is letting on so we don’t need to translate well
- Asian men are all healthy and knowledgeable and will not have emotions.
It is subtle, very subtle.
These ideas shape the health care in this country. They pervade health care and create disparities. We do many things to address the border of this issue—promote health literacy, establish health liaison offices, train on cultural diversity but we avoid the most central issue. The people who in power, the health care providers have to admit they have prejudices and are controlled them. Sometimes we are driven by the fear of admitting we have prejudices.
Yes. I know. Many of you are saying wait—poverty is a big cause of disparity. I am not prejudiced, or I control my stereotypes. To all that I say, it is hard to admit you are prejudiced. I think the only way to begin to understand the pervasiveness of prejudice when you are a victim of a stereotype. Then you begin, and I say only begin, to understand.
As a nurse and a good nurse I think, who is male. I have been asked numerous times “Aren’t you smart enough to be a doctor?”. I was surprised at how many people had these stereotypes and how frequently I encountered them. One day I asked myself “If a person thinks I am not smart enough to be a doctor, how does that affect the way they treat me?” On many occasions, I could think of no other explanations for the way I was treated except prejudice. The benefit from this insight is that I try, not perfectly, but I do try, to listen when a person of color speaks. I try and not interrupt. I try and listen to their story all the way through. I often fail at this but I am then reminded that stereotypes die very slowly because race really matters.