Race is a social construct, not a medical condition.

This is Race and Medicine, a series dedicated to unearthing the uncomfortable and sometimes life-threatening truth about racism in healthcare. By highlighting the experiences of Black people and honoring their health journeys, we look to a future where medical racism is a thing of the past.

Black people deal with racism in everyday life, even when it comes to health.

Race is inextricably linked to socioeconomic status, which determines access to healthcare and healthcare outcomes.

It’s important to understand the distinction between two facts.

The first is that race is not biological. Race is often confused with ethnicity, when the two are not the same. Race is actually a social construct.

The second is that Black people have particular experiences regarding health due to social determinants like lack of access to healthcare, education, and generational wealth. This is caused by racial injustice — not race.

Conflating these facts leads to myths that prevent Black people from receiving appropriate care.

COVID-19 has exposed and worsened issues of health inequity and the danger of myths about Black patients.

At the start of the pandemic, misinformation and memes circulated that Black people were immune to COVID-19. This was quickly recognized as dangerous and rooted in a long history of systemic racism within the medical field.

In 1792, there was a yellow fever outbreak and it was thought that African Americans were immune.

It happened again with smallpox in the 1870s, which was thought to have no impact on Black people.

Racist ideology and othering of Black people made these myths easy for a white public to swallow, and made it easy for medical professionals to believe that Black people felt less pain than white people.

Then there was the now-infamous Tuskegee Syphilis Study which ran from 1932 to 1972 and caused the death of Black men who were intentionally left without treatment.

These men were robbed of the opportunity for informed consent, and were essentially led to believe they were receiving treatment when they were not. This is one of many examples of doctors treating Black people as fodder for experimentation in the name of science, rather than as real human beings.

These incidents and others like them led to the erosion of trust toward medical professionals in the Black community, which has impacted their access to care.

As a result of this, among other factors, HIV had a disproportional effect on Black communities in the 1980s.

In 2020, as COVID-19 cases in Black people increased, the original myth that they’re immune flipped. Instead, the idea that Black people are predisposed to COVID-19 started to gain traction.

It suggested that higher cases in Black people were due to genetics rather than acknowledging that Black people are at higher risk because they’re more likely to be essential workers and not able to stay at home.

Not only do Black people not have access to the same level of care as white Americans, but they’re not always able to maintain safety precautions like physical distancing, as many are essential workers.

Issues of race aren’t sufficiently explored and addressed in medical schools, and the proliferation of myths about Black people continue.

Medical schools don’t focus on race. It’s implicitly taught that all patients present signs and symptoms in the same way. This isn’t always the case.

There just isn’t enough information on Black patients and their experiences of illnesses.

Dr. Michael Fite, district medical director for One Medical in Atlanta says, “There is a definite and warranted skepticism and mistrust among many Black Americans due to multiple documented instances such as the Tuskegee Syphilis Study, the most well-known of many similar incidences of abuse.”

This means that Black people don’t always receive care. Unfortunately, when they do, the care they receive may be riddled with bias.

“As a consequence of this, there is a dearth of research noted in many areas of medical science as it specifically relates to Black [people] and multiple disease states. The absence of this research may propagate poor health outcomes and disparities,” says Fite.

Gunjan Mhapankar, MD, pediatric resident physician at Children’s Hospital of Eastern Ontario (CHEO) says, “In medical education, we learn primarily on white patients, so medical students have a poor understanding of how common illnesses present in BIPOC [Black, Indigenous People of Color] patients.”

This leads to major oversight in diagnosis of some diseases.

“For example, what does jaundice present like in people with darker skin, or how can we detect pallor in those who are Black?” says Mhapankar.

London-based medical student Malone Mukwende has taken steps to help remedy this widespread issue with his book “Mind the Gap,” a clinical handbook of medical symptoms for Black and brown skin. Still, curriculum like this isn’t required in medical schools — at least not yet.

On top of the lack of education about symptoms for Black people, there are also far too few doctors of color.

Medical students aren’t given sufficient information about the impact of racism on patients’ health outcomes or access to care.

It’s often believed that race and genetics play a stronger role instead of social determinants like medical care and generational wealth, but there are plenty of cons to thinking this way. This idea is being revised slowly in medical theory, but may take decades to trickle down to actual practice.

Fite notes that Black people are often seen as monolithic and monocultural. Mhapankar adds that there’s no formal education on racism and its impact.

“Race is talked about broadly in medical school as a social determinant of health along with education, housing, poverty, etc., but racism and how that impacts the lives of people that experience it is not addressed,” she says.

Anti-racism training is critical so that physicians are not only made aware of their biases, but can become allies and actively advocate for their patients.

“This is often perceived as something outside of the scope of medicine, and the burden of responsibility falls to BIPOC learners,” says Mhapankar.

She’s currently working with a colleague to design an anti-racism curriculum for the pediatric resident body at CHEO.

Some healthcare professionals assume that Black people are dishonest about their medical histories.

“History-taking is designed to obtain key clinical information which may consist of current symptoms, personal medical history, and pertinent social and family history,” says Fite.

He notes that this information is critical to the diagnosis and treatment of the patient, but the implicit bias of the interviewer can obstruct the process.

“There is the untruth that Black patients are less likely to give a true picture of their medical condition and may have ulterior motives when seeking care,” Fite says.

He also points to “small, but significant” factors such as colloquialisms and other dialects common in Black communities. A lack of awareness or empathy around the way others speak can lead to subtle bias as well as miscommunication.

Fite recalled a visit to a hospital emergency room when he was a child.

“I had a pretty bad asthma attack and was unable to breathe. This older white male doctor told me I was hyperventilating and I should just slow down my breathing. He gave me a paper bag as if I was having a panic attack rather than treating me as an asthmatic patient,” says Fite.

This experience made Fite want to be a doctor. He didn’t want to have to rely on a healthcare system he couldn’t trust, so he entered the field to improve it.

“I want to make it better for the next kid like me that goes to the ER scared, so they can be taken seriously, because it could be a life or death situation,” Fite says.

Mhapankar points out just how pervasive the myth of Black people’s high tolerance for pain is in medicine, citing a 2016 study. In the study, about 50 percent of the 418 medical students believed at least one myth about race.

“[This] included that Black people’s nerve endings are less sensitive than white people’s and Black people’s skin is thicker than white people’s,” Mhapankar says.

This factors into the care provided to Black people who experience pain. They’re often denied pain medication.

One of the most common myths is that Black people come to healthcare facilities in order to get medication. They’re seen as “addicts,” often leading to substandard treatment for pain.

“Pain is significantly undertreated in Black patients compared to white patients,” says Mhapankar.

A study of almost 1 million children with appendicitis in the United States showed that Black children are less likely to receive any pain medication for moderate pain. According to the study, they’re also less likely to receive opioids for severe pain.

“Oftentimes, the complaints of pain among Black patients seem to be filtered through a prism of pain medication-seeking and histrionics by medical professionals, causing patients to not be taken seriously by their physicians and as a consequence, to not receive the appropriate care,” Fite says.

He referenced Serena Williams’ experience having to advocate for herself as she experienced a pulmonary embolism — a blood clot in the lungs — during childbirth.

Fite, a graduate of one of two historically Black medical colleges, Meharry Medical College, says he was well-prepared for the rigors of medicine and dealing with institutionalized racism.

Mhapankar says that there’s a need for more diversity and, specifically, more representation for Black people in institutions.

“In my Western University graduating class of 171 doctors, there was only one Black student,” she noted.

In addition, she emphasized that diversity curricula need to be formalized and funded within institutions with BIPOC participating at all decision-making levels.

Medical schools need to make it clear that race is a social construct. While there are differences in the ways disease presents, we all have the same basic human biology.

Still, funding, research, and treatment disparities need to be addressed in cases like sickle cell disease, which more commonly affects Black people, and cystic fibrosis, which more commonly affects white people. This would help us understand where these discrepancies come from.

Mhapankar notes it’s also important for white students to recognize disparities around them, demand accountability from people in positions of power, and actively work to learn and unlearn with empathy and humility.

Above all, believing the experiences, pains, and concerns of Black patients is essential for these medical myths to change.

When Black people are believed, they receive adequate care. They trust their healthcare providers. They aren’t afraid to seek treatment.

These factors mean Black people get the healthcare they deserve.

Alicia A. Wallace is a queer Black feminist, women’s human rights defender, and writer. She’s passionate about social justice and community building. She enjoys cooking, baking, gardening, traveling, and talking to everyone and no one at the same time on Twitter.