Medical care and racism: this is your war on drugs
An article caught my eye this morning: Whites more likely to get ER narcotics.
Emergency room doctors are prescribing strong narcotics more often to patients who complain of pain, but minorities are less likely to get them than whites, a new study finds. Even for the severe pain of kidney stones, minorities were prescribed narcotics such as oxycodone and morphine less frequently than whites.
More quotes, and a rant follow after the fold.Another excerpt:
The analysis of more than 150,000 emergency room visits over 13 years found differences in prescribing by race and ethnicity in both urban and rural hospitals, in all U.S. regions and for every type of pain.
When talking about racism, it’s easy to reduce it to the simplistic: to assume that everyone’s racist to some degree and that while whites can act racist towards blacks, sometimes blacks are racist against whites as well. So let’s get that out of the way first, by distinguishing between “small r” racism, which is personal racism: “I don’t think I’d ever want to date a black man.” “I lock my doors in that neighborhood.”
While problematic, occasional personal individual racism is not nearly as damaging as large-scale (“big R”) institutional Racism, which is just intensely dangerous and is implemented nearly universally to the detriment of non-whites.
But this personal and institutional racism can easily intersect. Back to the article again:
…Linda Simoni-Wastila of the University of Maryland, Baltimore, School of Pharmacy said the race gap finding may reveal some doctors’ suspicions that minority patients could be drug abusers lying about pain to get narcotics.
The irony, she said, is that blacks are the least likely group to abuse prescription drugs. Hispanics are becoming as likely as whites to abuse prescription opioids and stimulants, according to her research…
So let’s look at this again: small r racism, in which Doctors attitudes and personal views about race, are influencing their behavior on an institutional level.
Now here’s the interesting part: these Doctors don’t get these attitudes in a vacuum. They don’t have research showing them that blacks are more likely to abuse prescription drugs. They probably don’t even have personal experience suggesting it. Most, probably, are unaware that they even hold these attitudes.
They probably got this attitude from… who can tell me? Yes, you in the back?
They got this attitude from the War on Drugs.
They developed personal opinions about race from institutional Racism.
Now: we can spend time arguing about medical policy, approaches to closing the gap, etc. Those are good things. The article I posted suggests that stricter protocols for pain medication may help. I don’t argue with that, and don’t know enough about medicine to speak to it well. My interest here is about the broader issue of race & racism to springboard this as context for it.
So what do we do when we recognize that our institutions have some fundamentally racist aspects to it? The war on drugs has well-established roots in racism (see here as well). That war on drugs had bled into other institutions: the medical profession, as posted earlier is one example, but others include basic employment discrimination:
…Approximately 5,000 resumes were sent for positions in sales, administrative support, clerical services, and customer service. Jobs ranged from a cashier at a store to the manager of sales at a large firm.
The catch was that the authors manipulated the perception of race via the name of each applicant, with comparable credentials for each racial group. Each resume was randomly assigned either a very white-sounding name (Emily Walsh, Brendan Baker) or a very African-American-sounding name (Lakisha Washington, Jamal Jones).
…applicants with white-sounding names are 50 percent more likely to get called for an initial interview than applicants with African-American-sounding names. Applicants with white names need to send about 10 resumes to get one callback, whereas applicants with African-American names need to send about 15 resumes to achieve the same result.
In addition, race greatly affects how much applicants benefit from having more experience and credentials. White job applicants with higher-quality resumes received 30 percent more callbacks than whites with lower-quality resumes. Having a higher-quality resume has a much smaller impact on African-American applicants, who experienced only 9 percent more callbacks for the same improvement in their credentials. This disparity suggests that in the current state of the labor market, African-Americans may not have strong individual incentives to build better resumes.
Well at least our school systems are equitable, right? Everyone gets equal opportunity at that level, so they can work hard and find better jobs, even if it’s a bit of a hurdle, right? Not so much so. Per Jonathon Kozol:
Many Americans who live far from our major cities and who have no firsthand knowledge of the realities to be found in urban public schools seem to have the rather vague and general impression that the great extremes of racial isolation that were matters of grave national significance some thirty-five or forty years ago have gradually but steadily diminished in more recent years. The truth, unhappily, is that the trend, for well over a decade now, has been precisely the reverse. Schools that were already deeply segregated twenty-five or thirty years ago are no less segregated now, while thousands of other schools around the country that had been integrated either voluntarily or by the force of law have since been rapidly resegregating.
And while this is institutional Racism, it has profound effect on the personal:
High school students whom I talk with in deeply segregated neighborhoods and public schools seem far less circumspect than their elders and far more open in their willingness to confront these issues. “It’s more like being hidden,” said a fifteen-year-old girl… attempting to explain to me the ways in which she and her classmates understood the racial segregation of their neighborhoods and schools. “It’s as if you have been put in a garage where, if they don’t have room for something but aren’t sure if they should throw it out, they put it there where they don’t need to think of it again.”
I asked her if she thought America truly did not “have room” for her or other children of her race. “Think of it this way,” said a sixteen-year-old girl sitting beside her. “If people in New York woke up one day and learned that we were gone, that we had simply died or left for somewhere else, how would they feel?”
“How do you think they’d feel?” I asked.
I’ll give the girl’s answer, soon. But first, I just want to say: we have a lot of work to do. We’re ignoring large classes of people, treating them like second class citizens, and as Kozol notes, ignoring injustices in the North this decade which would be grounds for outrage on our part had they taken place in the South in the middle of the 20th century.
Racism has become an inconvenient truth and we’ve spent far too long dismissing and ignoring it. And I think many of us would like to continue doing so.
Oh, and that sixteen year old girl? The one who talked about how people would feel if they all just disappeared or died? Her response?
Her response was that she thought most of us would be “relieved.”
I don’t know that I can argue with her on that.