View source for Race and health in the United States

{{short description|Overview article}}
{{Race}}

Research shows many [[health disparities]] among different [[Race and ethnicity in the United States|racial and ethnic groups in the United States]].<ref name="USC Price">{{cite web |author=<!--Staff writer(s); no by-line.--> |date=2023 |title=How to Improve Access to Health Care: Issues & Potential Solutions |url=https://healthadministrationdegree.usc.edu/blog/how-to-improve-access-to-health-care/ |url-status=live |website=healthadministrationdegree.usc.edu |location=[[Los Angeles]] and [[Sacramento, California]] |publisher=[[USC Price School of Public Policy]], [[University of Southern California]] |archive-url=https://web.archive.org/web/20230421051321/https://healthadministrationdegree.usc.edu/blog/how-to-improve-access-to-health-care/ |archive-date=21 April 2023 |access-date=12 May 2023}}</ref><ref name="Black-HIV/AIDS">{{cite journal |last1=Murdock |first1=Christopher J. |last2=Laurencin |first2=Lynne |last3=Christensen |first3=Donna M. |last4=Laurencin |first4=Cato T. |date=June 2018 |title=HIV/AIDS and the African-American Community 2018: A Decade Call To Action |journal=Journal of Racial and Ethnic Health Disparities |publisher=[[Springer Nature]] |volume=5 |issue=3 |pages=449–458 |doi=10.1007/s40615-018-0491-0 |pmc=8224540 |pmid=29869005 |issn=2196-8837}}</ref><ref name="Latino HIV Crisis">{{cite journal |last1=Guilamo-Ramos |first1=V |last2=Thimm-Kaiser |first2=M |last3=Benzekri |first3=A |last4=Chacón |first4=G |last5=Rios |first5=E |last6=Scaccabarrozzi |first6=L |date=January 2020 |title=The Invisible US Hispanic/Latino HIV Crisis: Addressing Gaps in the National Response |journal=[[American Journal of Public Health]] |publisher=[[American Public Health Association]] |volume=110 |issue=1 |pages=27–31 |doi=10.2105/AJPH.2019.305309 |pmc=6893335 |pmid=31725313 |issn=0090-0036}}</ref><ref name="Am. J. Health Behav.">{{cite journal |last1=Lee |first1=S. |last2=Martinez |first2=G. |last3=Ma |first3=G. |last4=Hsu |first4=C. E. |last5=Robinson |first5=E. S. |last6=Bawa |first6=J. |last7=Juon |first7=H.-S. |date=January–February 2010 |title=Barriers to Health Care Access in 13 Asian American Communities |editor-last=Glover |editor-first=Elbert D. |editor-link=Elbert Glover |journal=[[American Journal of Health Behavior]] |publisher=PNG Publications and Scientific Research Limited |volume=34 |issue=1 |pages=21–30 |doi=10.5993/AJHB.34.1.3 |issn=1945-7359 |pmc=6628721 |pmid=19663748 |s2cid=31669071}}</ref><ref name="Med. Care">{{cite journal |last1=Armstrong |first1=Katrina |last2=Putt |first2=Mary |last3=Halbert |first3=Chanita H. |last4=Grande |first4=David |last5=Schwartz |first5=Jerome Sanford |last6=Liao |first6=Kaijun |last7=Marcus |first7=Noora |last8=Demeter |first8=Mirar B. |last9=Shea |first9=Judy A. |date=February 2013 |title=Prior Experiences of Racial Discrimination and Racial Differences in Health Care System Distrust |journal=[[Medical Care (journal)|Medical Care]] |publisher=[[Lippincott Williams & Wilkins]] on behalf of the [[American Public Health Association]] |volume=51 |issue=2 |pages=144–150 |doi=10.1097/mlr.0b013e31827310a1 |issn=0025-7079 |pmc=3552105 |pmid=23222499 |s2cid=46125799}}</ref> Different outcomes in mental and physical health exist between all [[Race and ethnicity in the United States census|U.S. Census-recognized racial groups]], but these differences stem from different historical and current factors, including [[genetics]], [[Socioeconomic status|socioeconomic factors]], and [[racism]].<ref name="Med. Care"/> Research has demonstrated that numerous health care professionals show [[implicit bias]] in the way that they treat patients.<ref>{{cite journal |vauthors=FitzGerald C, Hurst S |title=Implicit bias in healthcare professionals: a systematic review |journal=BMC Medical Ethics |volume=18 |issue=1 |page=19 |date=March 2017 |pmid=28249596 |pmc=5333436 |doi=10.1186/s12910-017-0179-8 |doi-access=free }}</ref> Certain diseases have a higher prevalence among specific racial groups, and life expectancy also varies across groups.<ref name="Black-HIV/AIDS"/><ref name="Latino HIV Crisis"/><ref name="Am. J. Health Behav."/>

==Background==
{{Main|Health and race|Healthcare in the United States}}
[[File:HealthAssess.jpeg|thumb|Health ratings by race in the United States]]

The [[Race and ethnicity in the United States census|U.S. Census definition of race]] is often applied in biomedical research in the United States. According to the Census Bureau in 2018, race refers to one's self-identification with a certain racial group. The Bureau also specifies that its use of "race" is as a social concept, not a biological or anthropological one.<ref name=":0">{{cite web |url=https://www.census.gov/topics/population/race/about.html |title=About Race |author=US Census Bureau |website=www.census.gov |language=EN-US |access-date=2019-04-08 |archive-date=2020-12-29 |archive-url=https://web.archive.org/web/20201229172441/https://www.census.gov/topics/population/race/about.html |url-status=live }}</ref> The Census Bureau recognizes five races: [[African Americans|Black or African American]], [[White Americans|White (European American)]], [[Asian Americans|Asian]], [[Native Hawaiians|Native Hawaiian]] or other [[Pacific Islander]], and [[Native Americans in the United States|American Indian]] or Alaska Native. Despite the fact that the United States continues to become more diverse, these Census categories have not changed for almost 20 years.<ref>{{cite journal |vauthors=Perez AD, Hirschman C |title=The Changing Racial and Ethnic Composition of the US Population: Emerging American Identities |journal=Population and Development Review |volume=35 |issue=1 |pages=1–51 |date=March 2009 |pmid=20539823 |pmc=2882688 |doi=10.1111/j.1728-4457.2009.00260.x}}</ref> The Census Bureau also recognizes differences in ethnicity among the population, and it defines ethnicity as whether a person is of Hispanic origin or not. For this reason, ethnicity is broken out into two categories in its data, [[Hispanic and Latino Americans|Hispanic or Latino]] and Not Hispanic or Latino. Hispanics may report as any race.<ref>{{cite web |url=https://www.census.gov/mso/www/training/pdf/race-ethnicity-onepager.pdf |title=Race & Ethnicity |website=United States Census Bureau |access-date=2019-04-08 |archive-date=2019-01-18 |archive-url=https://web.archive.org/web/20190118113614/https://www.census.gov/mso/www/training/pdf/race-ethnicity-onepager.pdf |url-status=live }}</ref>

The [[2010 United States Census|2010 U.S. Census]] further specifies the number of Americans who identified with each racial and ethnic group; in 2010, 38.9 million identified as African American, 14.6 million as Asian American, 2.9 million as American Indian or Alaskan Native and 50.4 million as Hispanic or Latino.<ref>{{cite web |url=https://www.census.gov/ |title=U.S. Census website |author=U. S. Census Bureau |website=[[United States Census Bureau]] |language=en |access-date=2019-04-08 |archive-date=2021-07-09 |archive-url=https://web.archive.org/web/20210709054630/https://www.census.gov/ |url-status=live }}</ref>

Measures of the relationship between race and medicine are imperfect and inconsistent. The 2000 U.S. Census definition is inconsistently applied across the range of studies that address race as a medical factor, making it more difficult to assess racial categorization in medicine. Additionally, the socially constructed nature of race makes it so that the different health outcomes experienced by different racial groups can be connected to social factors rather than inherent biological ones.<ref>{{Cite journal |vauthors=Prewitt K |date=January 2005|title=Racial classification in America: where do we go from here? |journal=Daedalus |volume=134 |issue=1 |pages=5–17 |doi=10.1162/0011526053124370 |s2cid=57572572 |issn=0011-5266|doi-access=free }}</ref> A 2023 scoping review of the literature found that in studies conducted in multiracial or multiethnic populations, the inclusion of race or ethnicity variables lacked thoughtful conceptualization and informative analysis regarding race or ethnicity as indicators of exposure to racialized social disadvantage.<ref>{{Cite journal |last1=Cené |first1=Crystal W. |last2=Viswanathan |first2=Meera |last3=Fichtenberg |first3=Caroline M. |last4=Sathe |first4=Nila A. |last5=Kennedy |first5=Sara M. |last6=Gottlieb |first6=Laura M. |last7=Cartier |first7=Yuri |last8=Peek |first8=Monica E. |date=2023-01-19 |title=Racial Health Equity and Social Needs Interventions: A Review of a Scoping Review |url=https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800612 |journal=JAMA Network Open |language=en |volume=6 |issue=1 |pages=e2250654 |doi=10.1001/jamanetworkopen.2022.50654 |issn=2574-3805 |pmc=9857687 |pmid=36656582 |access-date=2024-01-25 |archive-date=2024-01-20 |archive-url=https://web.archive.org/web/20240120141546/https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800612 |url-status=live }}</ref> This highlights the need for the more thoughtful and theoretically sound rationale for the inclusion of race or ethnicity variables in health research, aligning with the understanding of race as a social construct and acknowledging its role as a marker of exposure to racialized social disadvantage.<ref>{{Cite web |last1=Cené |first1=Crystal W. |last2=Viswanathan |first2=Meera |last3=Fichtenberg |first3=Caroline M. |last4=Sathe |first4=Nila A. |last5=Kennedy |first5=Sara M. |last6=Gottlieb |first6=Laura M. |last7=Cartier |first7=Yuri |last8=Peek |first8=Monica E. |date=January 2023 |title=Racial Health Equity and Social Needs Interventions: Rapid Review |url=https://www.pcori.org/research-results/2021/rapid-review-racial-health-equity-and-social-needs-interventions |access-date=2024-01-25 |archive-date=2023-12-04 |archive-url=https://web.archive.org/web/20231204130046/https://www.pcori.org/research-results/2021/rapid-review-racial-health-equity-and-social-needs-interventions |url-status=live }}</ref>

There are significant disparities in health outcomes between the five racial groups recognized by the U.S. Census. These health disparities are in part caused by different levels of income across the five groups recognized by the U.S. Census.<ref name=":8">{{cite web |url=https://www.rwjf.org/en/library/collections/racism-and-health.html |title=Race, Racism & Health |website=Robert Wood Johnson Foundation}}</ref> There are also notable differences in access to healthcare and the quality of healthcare received by those who identify with different racial categories.

[[Racism|Bias and racism]] also contribute to disparities in health outcomes. Non-white racial groups may experience bias and racism within the medical system, impacting these groups' access to and quality of care.<ref>{{cite journal |vauthors=Williams DR, Rucker TD |title=Understanding and addressing racial disparities in health care |journal=Health Care Financing Review |volume=21 |issue=4 |pages=75–90 |date=2000 |pmid=11481746 |pmc=4194634}}</ref> Additionally, the racism experienced in daily life affects health outcomes. The stress associated with [[racism]] can negatively impact a person's physical and [[mental health]]<ref name=":8" /> and has been shown to contribute to health problems such as depression, anxiety, insomnia, heart disease, skin rashes, and gastrointestinal problems.<ref>{{cite web |url=https://www.psychologytoday.com/blog/evidence-based-living/201710/examining-the-link-between-racism-and-health |title=Examining the Link Between Racism and Health |website=Psychology Today |language=en-US |access-date=2019-04-08}}</ref> As a scientifically studied topic in medicine, racism's [[Medical Subject Headings]] code for the [[United States National Library of Medicine]]'s [[MEDLINE|MEDLARS/MEDLINE]], [[PubMed]] and [[PubMed Central]] bibliographic and [[open access]] [[medical journal]] databases is [https://www.ncbi.nlm.nih.gov/mesh/68063505 D063505].

==Life expectancy==

The twentieth century witnessed a great expansion of the upper bounds of the human life span. At the beginning of the century, average [[life expectancy]] in the United States was 47 years. By the century's end, the average life expectancy had risen to over 70 years, and it was not unusual for Americans to exceed 80 years of age. However, although [[longevity]] in the U.S. population has increased substantially, [[Race (classification of human beings)|race]] disparities in longevity have been persistent. African American life expectancy at birth is persistently five to seven years lower than European Americans.<ref name="lavest">{{cite journal |vauthors=LaVeist TA |title=Racial segregation and longevity among African Americans: an individual-level analysis |journal=Health Services Research |volume=38 |issue=6 Pt 2 |pages=1719–33 |date=December 2003 |pmid=14727794 |pmc=1360970 |doi=10.1111/j.1475-6773.2003.00199.x}}</ref> By 2018 that difference had shrunk to 3.6 years.<ref name=":12" />

As of 2020, Hispanics had a life expectancy at birth of 78.8 years, followed by non-Hispanic Whites at 77.6 years and non-Hispanic blacks at 71.8 Years.<ref>{{cite web |last1=Arias |first1=Elizabeth |last2=Tejada-Vera |first2=Betzaida |last3=Ahmad |first3=Farida |last4=Kochanek |first4=Kenneth D |title=Provisional Life Expectancy Estimates for 2020 |url=https://www.cdc.gov/nchs/data/vsrr/vsrr015-508.pdf |date=July 2021}}</ref> In 2021, life expectancy for Native Americans was 65 years. For black Americans, 71; for white Americans, 76; for Hispanic Americans, 78; and 84 for Asian Americans.<ref>{{cite news |last1=Achenbach |first1=Joel |title=Life expectancy in U.S. is falling amid surges in chronic illness - Washington Post |url=https://www.washingtonpost.com/health/interactive/2023/american-life-expectancy-dropping/ |agency=Washington Post |date=2023}}</ref>

A study by Jack M. Guralnik, Kenneth C. Land, Dan Blazer, Gerda G. Fillenbaum, and Laurence G. Branch found that education had a substantially stronger relation to total life expectancy and active life expectancy than did race. While 65-year-old black men had a lower total life expectancy (11.4 years) and active life expectancy (10 years) than white men (total life expectancy, 12.6 years; active life expectancy, 11.2 years), those differences were reduced when controlling for education. The same was not true for females: at 65 years old, black and white women had similar life expectancies to white women. And at ages 75 and 85, both black men and black women had significantly longer life expectancies than their white peers, with the black advantage being even greater when matching for education.<ref>{{cite journal | vauthors = Guralnik JM, Land KC, Blazer D, Fillenbaum GG, Branch LG | title = Educational status and active life expectancy among older blacks and whites | journal = The New England Journal of Medicine | volume = 329 | issue = 2 | pages = 110–6 | date = July 1993 | pmid = 8510687 | doi = 10.1056/NEJM199307083290208 | doi-access = free }}</ref>

During the 20th century, the difference in life expectancy between black and white men in the United States did not decline.<ref>{{cite journal | vauthors = Sloan FA, Ayyagari P, Salm M, Grossman D | title = The longevity gap between Black and White men in the United States at the beginning and end of the 20th century | journal = American Journal of Public Health | volume = 100 | issue = 2 | pages = 357–63 | date = February 2010 | pmid = 20019309 | pmc = 2804648 | doi = 10.2105/AJPH.2008.158188 }}</ref>

{| class="wikitable sortable mw-collapsible"
|+Life expectancy by race in each state in 2018
!State
!All Races<ref name=":12">{{Cite web|url=https://www.countyhealthrankings.org/health-data/texas|title=Texas &#124; County Health Rankings & Roadmaps|website=www.countyhealthrankings.org}}</ref>
!White<ref name=":12" />
!Hispanic<ref name=":12" />
!Black<ref name=":12" />
!Asian<ref name=":12" />
!American Indian
and Alaska Native<ref name=":12" />
|- style="background:FF6347;" class="sortbottom" |-
|'''{{Flag|United States}}'''
|'''78.7'''
|'''78.6'''
|'''82.0'''
|'''75.0'''
|'''86.3'''
|'''77.4'''
|-
|{{Flag|Alabama}}
|75.4
|76.0
|79.1
|72.9
|80.2
|78.7
|-
|{{Flag|Alaska}}
|78.8
|80.0
|80.9
|79.0
|87.1
|70.5
|-
|{{Flag|Arizona}}
|79.9
|80.0
|81.0
|76.8
|87.0
|71.8
|-
|{{Flag|Arkansas}}
|75.9
|76.0
|79.2
|72.8
|80.6
|78.4
|-
|{{Flag|California}}
|81.6
|80.7
|83.6
|76.0
|87.6
|75.7
|-
|{{Flag|Colorado}}
|80.5
|80.6
|81.0
|77.2
|87.9
|74.2
|-
|{{flag|Connecticut}}
|80.9
|80.6
|82.9
|78.0
|87.2
|83.6
|-
|{{Flag|Delaware}}
|78.4
|78.5
|81.3
|75.2
|85.7
|83.1
|-
|{{Flag|District of Columbia}}
|78.6
|87.5
|87.8
|72.6
|89.5
|98.5
|-
|{{Flag|Florida}}
|80.0
|79.9
|82.1
|76.1
|86.1
|81.6
|-
|{{flagicon|Georgia (U.S. state)}} [[Georgia (U.S. state)|Georgia]]
|77.8
|78.0
|81.3
|75.5
|85.2
|80.8
|-
|{{Flag|Hawaii}}
|82.3
|81.3
|87.9
|80.9
|83.7
|81.9
|-
|{{Flag|Idaho}}
|79.3
|79.1
|83.1
|81.3
|84.9
|74.6
|-
|{{Flag|Illinois}}
|79.3
|79.1
|82.9
|73.9
|85.3
|83.0
|-
|{{Flag|Indiana}}
|77.0
|76.8
|82.0
|73.2
|85.1
|81.2
|-
|{{Flag|Iowa}}
|79.4
|79.3
|81.8
|74.8
|86.6
|80.1
|-
|{{Flag|Kansas}}
|78.5
|78.2
|81.5
|73.8
|84.2
|79.1
|-
|{{Flag|Kentucky}}
|75.4
|75.5
|79.6
|72.9
|80.2
|78.9
|-
|{{Flag|Louisiana}}
|76.1
|77.1
|80.9
|73.1
|81.1
|80.5
|-
|{{Flag|Maine}}
|78.7
|78.6
|82.1
|80.9
|85.9
|83.8
|-
|{{Flag|Maryland}}
|79.1
|80.0
|81.9
|75.3
|87.3
|83.7
|-
|{{Flag|Massachusetts}}
|80.5
|80.2
|82.1
|78.8
|86.1
|84.1
|-
|{{Flag|Michigan}}
|78.0
|78.0
|80.9
|73.5
|86.0
|79.8
|-
|{{flag|Minnesota}}
|80.9
|81.0
|83.4
|79.3
|86.8
|69.9
|-
|{{Flag|Mississippi}}
|74.9
|76.0
|79.3
|72.6
|80.8
|79.2
|-
|{{Flag|Missouri}}
|77.3
|77.5
|81.9
|73.6
|84.6
|81.0
|-
|{{Flag|Montana}}
|78.8
|79.3
|82.1
|81.9
|86.1
|69.5
|-
|{{Flag|Nebraska}}
|79.6
|79.6
|82.1
|73.9
|86.3
|71.1
|-
|{{Flag|Nevada}}
|78.5
|76.8
|80.7
|76.3
|84.1
|74.9
|-
|{{Flag|New Hampshire}}
|79.5
|79.3
|83.5
|80.8
|87.6
|84.4
|-
|{{Flag|New Jersey}}
|80.4
|80.2
|82.7
|74.8
|87.2
|84.1
|-
|{{Flag|New Mexico}}
|78.1
|78.7
|78.6
|74.8
|81.8
|73.9
|-
|{{Flag|New York}}
|81.3
|81.0
|82.4
|78.0
|87.4
|83.7
|-
|{{Flag|North Carolina}}
|78.0
|78.5
|81.8
|75.0
|84.3
|76.8
|-
|{{Flag|North Dakota}}
|79.9
|80.1
|85.1
|82.1
|88.3
|69.7
|-
|{{Flag|Ohio}}
|76.9
|77.1
|81.1
|73.0
|85.9
|80.6
|-
|{{Flag|Oklahoma}}
|76.0
|76.1
|80.9
|72.9
|81.0
|73.6
|-
|{{Flag|Oregon}}
|79.8
|79.5
|84.0
|77.5
|86.4
|76.9
|-
|{{Flag|Pennsylvania}}
|78.3
|78.3
|82.2
|73.2
|86.9
|82.2
|-
|{{Flag|Rhode Island}}
|79.9
|79.7
|83.9
|73.6
|86.4
|84.0
|-
|{{Flag|South Carolina}}
|77.0
|78.0
|81.4
|73.6
|83.1
|80.9
|-
|{{Flag|South Dakota}}
|79.1
|80.0
|82.7
|81.2
|85.2
|67.8
|-
|{{Flag|Tennessee}}
|76.0
|76.1
|80.7
|72.7
|82.6
|80.4
|-
|{{Flag|Texas}}
|79.1
|78.5
|81.3
|74.2
|85.1
|81.8
|-
|{{Flag|Utah}}
|79.9
|79.6
|81.9
|80.2
|84.3
|74.3
|-
|{{Flag|Vermont}}
|79.7
|79.6
|83.1
|81.1
|87.2
|85.0
|-
|{{Flag|Virginia}}
|79.5
|79.7
|84.7
|74.5
|86.0
|82.3
|-
|{{Flag|Washington}}
|80.4
|80.1
|81.7
|78.0
|84.3
|74.0
|-
|{{Flag|West Virginia}}
|74.8
|74.8
|79.7
|72.2
|79.8
|79.0
|-
|{{Flag|Wisconsin}}
|79.4
|79.4
|83.3
|73.4
|85.8
|71.7
|-
|{{Flag|Wyoming}}
|79.0
|79.0
|81.8
|80.2
|85.2
|72.9
|-
|}

=== Socioeconomic factors ===
While [[socioeconomic status]] (SES) is a contributing factor in race health disparities, it does not account for all the variation.<ref name="Williams 2016"/> Even when controlling for socioeconomic status, racial divides in health persist. For example, Black Americans with college degrees have worse health outcomes than White and Hispanic Americans who have high school diplomas.<ref name="Williams 2019">{{cite journal |vauthors=Williams DR, Lawrence JA, Davis BA |title=Racism and Health: Evidence and Needed Research |journal=Annual Review of Public Health |volume=40 |pages=105–125 |date=April 2019 |pmid=30601726 |pmc=6532402 |doi=10.1146/annurev-publhealth-040218-043750 |doi-access=free}}</ref> Studies on heart disease mortality have found that gaps between Black and White Americans exist at every education level. A longitudinal study over more than twenty years found that Black physicians had higher prevalence of cardiovascular disease, earlier onset of disease, twice the incidence of [[hypertension]], and higher prevalence of [[diabetes]] compared to White physicians.<ref name="Williams 2016">{{cite journal |vauthors=Williams DR, Priest N, Anderson NB |title=Understanding associations among race, socioeconomic status, and health: Patterns and prospects |journal=Health Psychology |volume=35 |issue=4 |pages=407–11 |date=April 2016 |pmid=27018733 |pmc=4817358 |doi=10.1037/hea0000242}}</ref> For [[maternal mortality in the United States|maternal mortality]], Black women who are college graduates have pregnancy-related mortality ratios (number of pregnancy-related deaths for every 100,000 live births) that are 1.6 times greater than White women who had not finished high school.<ref>{{cite journal |vauthors=Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed K, Shapiro-Mendoza C, Callaghan WM, Barfield W |display-authors=6 |title=Racial/Ethnic Disparities in Pregnancy-Related Deaths - United States, 2007-2016 |journal=MMWR. Morbidity and Mortality Weekly Report |volume=68 |issue=35 |pages=762–765 |date=September 2019 |pmid=31487273 |pmc=6730892 |doi=10.15585/mmwr.mm6835a3}}</ref> Black women have higher maternity mortalilty rates than white women regardless of socioeconomic status and pre-existing health conditions.<ref>{{Cite web |title=Black Women's Maternal Health |url=http://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html |access-date=2020-11-25 |website=www.nationalpartnership.org |language=en |archive-date=2019-11-04 |archive-url=https://web.archive.org/web/20191104192729/http://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html |url-status=live }}</ref>

According to the ''American Journal of Preventive Medicine'', a data analysis was performed using ''The Behavioral Risk Factor System'' survey to examining the perceptions of racial privilege in healthcare among different races.<ref name = "Stepanikova_2017">{{cite journal | vauthors = Stepanikova I, Oates GR | title = Perceived Discrimination and Privilege in Health Care: The Role of Socioeconomic Status and Race | journal = American Journal of Preventive Medicine | volume = 52 | issue = 1S1 | pages = S86–S94 | date = January 2017 | pmid = 27989297 | doi = 10.1016/j.amepre.2016.09.024 | pmc = 5172593 }}</ref> These results showed that whites with a higher income and an educational background had an increase perception in receiving medical treatment and a decrease in discrimination. Oppose to blacks the perceptions were the complete opposite compared to whites.<ref name = "Stepanikova_2017" /> Several studies suggest that race is a positive association with socioeconomic (SES) and education when providing health services.<ref>{{cite journal | vauthors = Bird ST, Bogart LM, Delahanty DL | title = Health-related correlates of perceived discrimination in HIV care | journal = AIDS Patient Care and STDs | volume = 18 | issue = 1 | pages = 19–26 | date = January 2004 | pmid = 15006191 | doi = 10.1089/108729104322740884 }}</ref> Currently, there are future research being conducted to understand the concept behind racial privileges in the healthcare.{{Citation needed|date=June 2022}}

==Specific diseases==
Health disparities are well documented in minority populations such as [[African Americans]], [[Native Americans (US)|Native Americans]], and [[Latinos]].<ref name = "Goldberg_2004">{{cite book | vauthors = Goldberg J, Hayes W, Huntley J |date=November 2004 |title=Understanding Health Disparities |publisher=Health Policy Institute of Ohio |url=http://www.healthpolicyohio.org/pdf/healthdisparities.pdf |url-status=dead |archive-url=https://web.archive.org/web/20070927010615/http://www.healthpolicyohio.org/pdf/healthdisparities.pdf |archive-date=2007-09-27}}{{Page needed|date=September 2010}}</ref> In the year 1985,  a report, known as the Heckler Report, was released to address the state of concern regarding African American and minority populations.<ref name=":6">{{Cite web |last=<!--Not stated--> |date=2012 |title=Fact Sheet: Health Disparities |url=https://www.apa.org/topics/racism-bias-discrimination/health-disparities-defined |access-date=24 April 2021 |website=[[American Psychological Association|APA]] |language=en-US}}</ref> This report sought to look at statistical data that showed its prevalence and the action towards bridging this health equity gap.  The report identified six areas of health concern: cancer, cardiovascular disease and stroke, chemical dependency related to cirrhosis of the liver, diabetes, homicides and accidents, and infant mortality.<ref name=":6" />  When compared to [[European Americans]] and [[Asian Americans]], these minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes.<ref name = "Goldberg_2004" /> More importantly noted are the number of lives that could have been saved if healthcare were the same between both populations.<ref name=":6" /> That is, African Americans and minority populations having access to healthcare that meets their needs and seek to address this much needed change.

Minorities often have higher rates of [[cardiovascular disease]], [[HIV/AIDS]], and [[infant mortality]] than whites.<ref name = "Goldberg_2004" /> U.S. ethnic groups can exhibit substantial average differences in disease incidence, disease severity, disease progression, and response to treatment.<ref>Thomas Alexis LaVeist, ''[https://books.google.com/books?id=_FJ4C9uv3YkC Race, Ethnicity, and Health: A Public Health Reader]'' (San Francisco: Jossey-Bass, 2002).</ref>
* African Americans have higher rates of mortality than does any other racial or ethnic group for 8 of the top 10 causes of death.<ref name=hummer2004/> The cancer incidence rate among African Americans is 10% higher than among European Americans<ref name=autogenerated2>American Public Health Association (APHA), Eliminating Health Disparities: Toolkit (2004).{{Verify source|is this a book, website or what?|date=April 2010}}</ref> and the mortality rate from asthma is twice the rate of European Americans.<ref name=":18">{{Cite journal |last1=Israel |first1=Elliot |last2=Cardet |first2=Juan-Carlos |last3=Carroll |first3=Jennifer K. |last4=Fuhlbrigge |first4=Anne L. |last5=She |first5=Lilin |last6=Rockhold |first6=Frank W. |last7=Maher |first7=Nancy E. |last8=Fagan |first8=Maureen |last9=Forth |first9=Victoria E. |last10=Yawn |first10=Barbara P. |last11=Arias Hernandez |first11=Paulina |date=2022-04-21 |title=Reliever-Triggered Inhaled Glucocorticoid in Black and Latinx Adults with Asthma |journal=New England Journal of Medicine |language=en |volume=386 |issue=16 |pages=1505–1518 |doi=10.1056/NEJMoa2118813 |pmid=35213105 |pmc=10367430 |s2cid=247106044 |issn=0028-4793 |doi-access=free}}</ref>
* African Americans are found to have some of the highest rates of chronic Hepatitis C and Hepatitis C-related deaths in comparison to other populations.<ref name=":13">{{Cite web |title=Minority Health {{!}} NIH: National Institute of Allergy and Infectious Diseases |url=https://www.niaid.nih.gov/research/minority-health |access-date=2021-04-24 |website=www.niaid.nih.gov |language=en}}</ref>
* U.S. Latinos have higher rates of death from diabetes, liver disease, asthma, and infectious diseases than do non-Latinos.<ref>{{cite journal |vauthors=Vega WA, Amaro H |title=Latino outlook: good health, uncertain prognosis |journal=Annual Review of Public Health |volume=15 |issue=1 |pages=39–67 |year=1994 |pmid=8054092 |doi=10.1146/annurev.pu.15.050194.000351 |doi-access=free }}</ref><ref name=":18" />
* In 2015, nearly 2.2 million Hispanics/Latinos nationwide reported having asthma, with Puerto Rican Americans possessing almost tripled the asthma rate of the overall Hispanic population. A part of this disparity can be said to be due to the higher rates of pollution found in communities of people of color.<ref name=":13" />
* Adult African Americans and Latinos have approximately twice the risk as European Americans of developing diabetes.<ref name=autogenerated2 />
* Asian Americans are 60% more likely to being at risk of developing diabetes in comparison to European Americans and are more likely to develop the disease at lower BMIs and lower body weights. South Asians are especially more likely to developing diabetes as it is estimated South Asians are four times more likely to developing the disease in comparison to European Americans.<ref>{{cite web |url=http://aadi.joslin.org/content/asian/why-are-asians-higher-risk-diabetes |title=Why Do People of Asian Descent Get Diabetes? |publisher=Asian Diabetes Prevention Initiative |archive-url=https://web.archive.org/web/20150430065604/http://aadi.joslin.org/content/asian/why-are-asians-higher-risk-diabetes |archive-date=2015-04-30}}</ref><ref>{{cite web |url=http://asiandiabetesprevention.org/what-is-diabetes/why-are-asians-higher-risk |title=Why are Asians at Higher Risk? |publisher=Asian Diabetes Prevention Initiative |access-date=2014-09-19 |archive-date=2019-12-23 |archive-url=https://web.archive.org/web/20191223030351/http://asiandiabetesprevention.org/what-is-diabetes/why-are-asians-higher-risk |url-status=dead }}</ref><ref>{{cite journal |vauthors=McNeely MJ, Boyko EJ |title=Type 2 diabetes prevalence in Asian Americans: results of a national health survey |journal=Diabetes Care |volume=27 |issue=1 |pages=66–9 |date=January 2004 |pmid=14693968 |doi=10.2337/diacare.27.1.66 |url=http://care.diabetesjournals.org/content/27/1/66 |doi-access=free |access-date=2014-09-19 |archive-date=2024-07-12 |archive-url=https://web.archive.org/web/20240712165238/https://diabetesjournals.org/care/article/27/1/66/26735/Type-2-Diabetes-Prevalence-in-Asian-Americans |url-status=live }}</ref><ref>{{cite web |url=http://www.pamf.org/southasian/risk/concerns/diabetes.html |title=Type 2 Diabetes in South Asians |author=Palo Alto Medical Foundation |access-date=2014-09-19 |archive-date=2014-09-04 |archive-url=https://web.archive.org/web/20140904184654/http://www.pamf.org/southasian/risk/concerns/diabetes.html |url-status=live }}</ref>
* Native Americans suffer from higher rates of diabetes, tuberculosis, pneumonia, influenza, and alcoholism than does the rest of the U.S. population.<ref>{{cite journal |vauthors=Mahoney MC, Michalek AM |title=Health status of American Indians/Alaska Natives: general patterns of mortality |journal=Family Medicine |volume=30 |issue=3 |pages=190–5 |date=March 1998 |pmid=9532441}}</ref> Disparities in diabetes and cardiovascular disease have been hypothesized to be linked to higher rates of suboptimal sleep in this population.<ref>{{cite journal |vauthors=Nuyujukian DS |title=Sleep Duration and Diabetes Risk in American Indian and Alaska Native Participants of a Lifestyle Intervention Project |journal=Sleep |volume=39 |issue=11 |pages=1919–1926 |date=2016 |doi=10.5665/sleep.6216 |pmid=27450685 |pmc=5070746}}</ref><ref>{{cite journal |vauthors=Nuyujukian DS, Anton-Culver H, Manson SM, Jiang L |title=Associations of sleep duration with cardiometabolic outcomes in American Indians and Alaska Natives and other race/ethnicities: results from the BRFSS |url=https://www.sleephealthjournal.org/article/S2352-7218(19)30026-9/fulltext |journal=Sleep Health |date=2019 |volume=5 |issue=4 |pages=344–351 |doi=10.1016/j.sleh.2019.02.003 |pmid=30987947 |pmc=6935393 |access-date=2020-04-04 |archive-date=2020-06-26 |archive-url=https://web.archive.org/web/20200626070441/https://www.sleephealthjournal.org/article/S2352-7218(19)30026-9/fulltext |url-status=live }}</ref>
* European Americans die more often from heart disease and cancer than do Native Americans, Asian Americans, or Hispanics.<ref name=hummer2004>{{cite journal |vauthors=Hummer RA, Ellison CG, Rogers RG, Moulton BE, Romero RR |title=Religious involvement and adult mortality in the United States: review and perspective |journal=Southern Medical Journal |volume=97 |issue=12 |pages=1223–30 |date=December 2004 |pmid=15646761 |doi=10.1097/01.SMJ.0000146547.03382.94 |s2cid=6053725}}</ref>
* White Americans have far higher incident rates of melanoma of the skin or skin cancer than any other race/ethnicity in the US. In 2007 incident rates among white American males were approximately 25/100,000 people, whereas the next highest group (Hispanics and natives) has an incidence rate of approximately 5/100,000 people.<ref>{{cite web |url=https://www.cdc.gov/cancer/skin/statistics/race.htm |title=Skin Cancer Rates by Race and Ethnicity |publisher=Centers for Disease Control |access-date=2012-04-09 |archive-date=2020-02-17 |archive-url=https://web.archive.org/web/20200217133742/https://www.cdc.gov/cancer/skin/statistics/race.htm |url-status=live }}</ref>
* Asian Americans are at higher risk for [[hepatitis B]], [[liver cancer]], [[tuberculosis]], and [[lung cancer]].<ref>{{cite journal |vauthors=Chen MS, Hawks BL |s2cid=22775032 |title=A debunking of the myth of healthy Asian Americans and Pacific Islanders |journal=American Journal of Health Promotion |volume=9 |issue=4 |pages=261–8 |year=1995 |pmid=10150729 |doi=10.4278/0890-1171-9.4.261}}</ref> The subgroup of [[Filipino American]]s suffer health risks similar to that of African Americans and European Americans combined.<ref>{{cite book |vauthors=Gatewood JV, Zhou M |title=Contemporary Asian America: a multidisciplinary reader |url=https://archive.org/details/contemporaryasia00zhou |url-access=registration |publisher=New York University Press |location=New York |year=2000 |isbn=978-0-8147-9691-7}}</ref>
* According to the NIH, African Americans are more likely to develop diabetes. Usually, type 2 diabetes is more prominent in middle-aged adults. Being obese or having a family history can also affect this. Over the past 30 years in the US, "black adults are nearly twice as likely as white adults to develop type 2 diabetes."<ref name=":1">{{cite web |title=Factors contributing to higher incidence of diabetes for black Americans |url=https://www.nih.gov/news-events/nih-research-matters/factors-contributing-higher-incidence-diabetes-black-americans |publisher=United States National Institutes of Health (NIH) |date=2018-01-08 |access-date=2019-04-25 |archive-date=2020-06-15 |archive-url=https://web.archive.org/web/20200615231812/https://www.nih.gov/news-events/nih-research-matters/factors-contributing-higher-incidence-diabetes-black-americans |url-status=live }}</ref> Besides this difference just being between black and white adults, we see the greatest margin of comparison between black and white women.
* In 2015, 87 percent of all TB cases in the United States occurred in those that are identified as racial and ethnic minorities, especially Hispanics, Asians, and African Americans.<ref name=":13" /> Even more recently, African Americans are considered the group with the highest rate of infection, totaling more than 1,000 cases in 2019. Socioeconomic factors are the related cause, alongside it presenting barriers to treatment in the disease.<ref name=":6" />
* [[Sickle cell disease]] is more susceptible to be found in those of descent from places such as those in the Mediterranean, Italy, Turkey, and Greece, as well as Africa and regions of South and Central America.<ref name=":2">{{cite web |title=Sickle cell disease |url=https://ghr.nlm.nih.gov/condition/sickle-cell-disease |work=Genetics Home Reference |publisher=U.S. Department of Health & Human Services, National Institutes of Health, National Library of Medicine |access-date=2019-04-25 |archive-date=2016-05-15 |archive-url=https://web.archive.org/web/20160515204041/https://ghr.nlm.nih.gov/condition/sickle-cell-disease |url-status=live }}</ref>  The disease affects how oxygen is delivered to the red blood cells and is often diagnosed at a young age, discovered through a diagnosis of anemia.
* In a 2019 study on [[racial discrimination]] and [[Dental Health|dental health]] in the U.S. the authors found that the "emotional impact of racial discrimination" results in fewer visits to a dentist.<ref>{{cite journal | vauthors = Sabbah W, Gireesh A, Chari M, Delgado-Angulo EK, Bernabé E | title = Racial Discrimination and Uptake of Dental Services among American Adults | journal = International Journal of Environmental Research and Public Health | volume = 16 | issue = 9 | pages = 1558 | date = May 2019 | pmid = 31060202 | pmc = 6540199 | doi = 10.3390/ijerph16091558 | doi-access = free }}</ref>
* According to the National Health and Nutrition Examination Survey data, childhood obesity is more common among Hispanic (25.8%) and Black children (22.0%) compared to white children (14.1%).<ref>{{cite journal | vauthors = McGuire S | title = Shields M., Carroll M.D., Ogden C.L. adult obesity prevalence in Canada and the United States. NCHS data brief no. 56, Hyattsville, MD: National Center for Health Statistics, 2011 | journal = Advances in Nutrition | volume = 2 | issue = 4 | pages = 368–9 | date = July 2011 | pmid = 22332078 | doi = 10.3945/an.111.000497 | pmc = 3125686 | doi-access = free }}</ref>  In other studies the same results are seen in adults from the same race and ethnicity.
* A 2021 systematic review on hearing loss in adults found an absence of racial and ethnic diversity in studies that did not represent the diversity of the US population.<ref>{{Cite journal |last1=Pittman |first1=Corinne A. |last2=Roura |first2=Raúl |last3=Price |first3=Carrie |last4=Lin |first4=Frank R. |last5=Marrone |first5=Nicole |last6=Nieman |first6=Carrie L. |date=2021-07-01 |title=Racial/Ethnic and Sex Representation in US-Based Clinical Trials of Hearing Loss Management in Adults: A Systematic Review |url=https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2779267 |journal=JAMA Otolaryngology–Head & Neck Surgery |language=en |volume=147 |issue=7 |pages=656–662 |doi=10.1001/jamaoto.2021.0550 |pmid=33885733 |s2cid=233351877 |issn=2168-6181}}</ref>

== African Americans ==

===History===
{{further|Seasoning (slavery)|Slave health on plantations in the United States|Slavery hypertension hypothesis}}
Disparities in health and life span among blacks and whites in the US have long existed before today. Many [[African Americans]] and minorities weren't subjects of outreach, nor attended to for communicable or non-communicable conditions. Several incidents throughout early history show maltreatment, neglect, and being denied healthcare in comparison to the white population. Foregoing early treatment progresses infection, leads to disability, or ultimately death, dependent upon the disease. One of those namely events in history is the flu epidemic of 1918. The virus infected more than 675,000 people, with a total of 500 million worldwide.<ref name=":14">{{Cite web |last=Brooks |first=Rodney A. |title=Why African Americans Were More Likely to Die During the 1918 Flu Pandemic |url=https://www.history.com/news/1918-flu-pandemic-african-americans-healthcare-black-nurses |access-date=2021-04-24 |website=HISTORY |language=en}}</ref> Black communities were either refused care, received subpar attention, or, where available, expected and pursued aid from black nurses. Although current information reflects that minorities in the United States have lower life expectancies and encounter a larger number of health conditions than their white counterparts, the health of black people has not always been documented.<ref>{{Cite web |title=The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications |url=http://ajph.aphapublications.org/ |access-date=2021-04-24 |website=American Public Health Association (APHA) publications |language=en |archive-date=2019-05-14 |archive-url=https://web.archive.org/web/20190514164604/https://ajph.aphapublications.org/ |url-status=live }}</ref> Accurate numbers showing the number of African Americans infected, disabled, or died—or succumbed to it—aren't available; records remain scarce, since so few of those victims were able to get to institutional healthcare providers or agencies.<ref name=":14" /> David R. Williams and Chiquita Collins write that, although racial taxonomies are socially constructed and arbitrary, race is still one of the major bases of division in American life. Throughout US history racial disparities in health have been pervasive.<ref>{{cite journal| vauthors = Williams DR, Collins C |title=US Socioeconomic and Racial Differences in Health: Patterns and Explanations |journal=Annual Review of Sociology |date=August 1995 |volume=21 |issue=1 |pages=349–386 |doi=10.1146/annurev.so.21.080195.002025}}</ref> In a 2001 paper, Williams and Collins also argued that, although it is no longer being legally enforced, racial segregation is still one of the primary causes of racial disparities in health because it determines [[socioeconomic status]] by limiting access to education and employment opportunities.<ref name=wc2001>{{cite journal | vauthors = Williams DR, Collins C | title = Racial residential segregation: a fundamental cause of racial disparities in health | journal = Public Health Reports | volume = 116 | issue = 5 | pages = 404–16 | date = 2001 | pmid = 12042604 | pmc = 1497358 | doi = 10.1093/phr/116.5.404 }}</ref> Clayton and Byrd write that there have been two periods of health reform specifically addressing the correction of race-based health disparities. The first period (1865–1872) was linked to [[Freedmen's Bureau]] legislation and the second (1965–1975) was a part of the [[Civil Rights Movement]]. Both had dramatic and positive effects on black health status and outcome, but were discontinued. Even though African-American health status and outcome is slowly improving, black health has generally stagnated or deteriorated compared to whites since 1980.<ref>{{cite journal | vauthors = Clayton LA, Byrd WM | title = Race: a major health status and outcome variable 1980-1999 | journal = Journal of the National Medical Association | volume = 93 | issue = 3 Suppl | pages = 35S–54S | date = March 2001 | pmid = 12653396 | pmc = 2593960 }}</ref>

The Tuskegee study was another prime example of health disparities among African Americans.<ref name = "Olansky_1954">{{cite journal | vauthors = Olansky S, Simpson L, Schuman SH | title = Environmental factors in the Tuskegee study of untreated syphilis | journal = Public Health Reports | volume = 69 | issue = 7 | pages = 691–8 | date = July 1954 | pmid = 13177831 | doi = 10.2307/4588864 | jstor = 4588864 | pmc = 2024316 }}</ref> The study showed lack of medical treatment and discrimination among blacks.<ref name = "Olansky_1954" /> African Americans find it difficult to participant in clinical trials due to lack of understanding and knowledge received by researchers.<ref>{{cite journal | vauthors = Freimuth VS, Quinn SC, Thomas SB, Cole G, Zook E, Duncan T | title = African Americans' views on research and the Tuskegee Syphilis Study | journal = Social Science & Medicine | volume = 52 | issue = 5 | pages = 797–808 | date = March 2001 | pmid = 11218181 | doi = 10.1016/s0277-9536(00)00178-7 | hdl = 1903/22694 | hdl-access = free }}</ref>

In 1932, the Tuskegee study was involved with 600 black men, 399 with syphilis and 201 with no disease.<ref name="cdc.gov">{{Cite web |date=2020-12-10 |title=Tuskegee Study - Timeline - CDC - NCHHSTP |url=https://www.cdc.gov/tuskegee/timeline.htm |access-date=2021-04-09 |website=www.cdc.gov |language=en-us |archive-date=2011-09-03 |archive-url=https://web.archive.org/web/20110903161044/http://www.cdc.gov/tuskegee/timeline.htm |url-status=live }}</ref> Researchers explained to the men they were being treated for "bad blood," a term used in the study to describe several ailments, including syphilis, anemia, and fatigue.<ref name="cdc.gov"/> The men were told by researchers and health professionals that they would be participating in a study to cure their current illnesses.<ref name="cdc.gov"/> The men in the study later found they were not being treated for the purpose they agreed upon. This study resulted in a class action lawsuit due to lack of evidence, no consent, misleading information, and medical neglect.<ref name="cdc.gov"/> As a result, by July 1972 when the study ended, over 100 participants had died, 40 spouses had been diagnosed, and disease had been passed to 19 children at birth.<ref>{{Cite web |last=Nix |first=Elizabeth |title=Tuskegee Experiment: The Infamous Syphilis Study |url=https://www.history.com/news/the-infamous-40-year-tuskegee-study |access-date=2021-04-09 |website=HISTORY |language=en |archive-date=2021-04-08 |archive-url=https://web.archive.org/web/20210408051619/https://www.history.com/news/the-infamous-40-year-tuskegee-study |url-status=live }}</ref>

In one study, researchers found medical professionals perceive black patients to be less susceptible to pain than their white patients. White patients are given better treatment and access than black patients. As a result, black patients are more vulnerable to disease than white counterparts.<ref>{{Cite news|last=Royles|first=Dan|title=Perspective {{!}} Years of medical abuse make Black Americans less likely to trust the coronavirus vaccine|language=en-US|newspaper=Washington Post|url=https://www.washingtonpost.com/outlook/2020/12/15/years-medical-abuse-make-black-americans-less-likely-trust-covid-vaccine/|access-date=2021-04-09|issn=0190-8286|archive-date=2021-04-09|archive-url=https://web.archive.org/web/20210409005335/https://www.washingtonpost.com/outlook/2020/12/15/years-medical-abuse-make-black-americans-less-likely-trust-covid-vaccine/|url-status=live}}</ref>

Demographic changes can have broad effects on the health of ethnic groups. Cities in the United States have undergone major social transitions during the 1970s, 1980s, and 1990s. Notable factors in these shifts have been sustained rates of black poverty and intensified racial segregation, often as a result of [[redlining]].<ref name="eastny">{{cite book |url=https://books.google.com/books?id=TWo8OFJpFtAC |title=How East New York Became a Ghetto |vauthors=Thabit W |isbn=978-0-8147-8267-5 |page=42 |year=2003 |publisher=NYU Press |access-date=2016-09-24 |archive-date=2024-07-12 |archive-url=https://web.archive.org/web/20240712165237/https://books.google.com/books?id=TWo8OFJpFtAC |url-status=live }}</ref> Indications of the effect of these social forces on black-white differentials in health status have begun to surface in the research literature.<ref>{{cite journal |vauthors=Laveist TA |title=Segregation, poverty, and empowerment: health consequences for African Americans |journal=The Milbank Quarterly |volume=71 |issue=1 |pages=41–64 |year=1993 |pmid=8450822 |doi=10.2307/3350274 |jstor=3350274}}</ref>

Race has played a decisive role in shaping systems of medical care in the United States. The divided health system persists, in spite of federal efforts to end segregation, health care remains, at best widely segregated both exacerbating and distorting racial disparities.<ref>{{cite book |title=Health Care Divided: Race and Healing a Nation |vauthors=Smith DB |year=1999 |publisher=University of Michigan Press |isbn=978-0-472-10991-3}}{{Page needed|date=September 2010}}</ref> Furthermore, the risks for many diseases are elevated for socially, economically, and politically disadvantaged groups in the United States, suggesting to some that environmental factors and not genetics are the causes of most of the differences.<ref>{{cite journal |vauthors=Cooper RS, Kaufman JS, Ward R |title=Race and genomics |journal=The New England Journal of Medicine |volume=348 |issue=12 |pages=1166–70 |date=March 2003 |pmid=12646675 |doi=10.1056/NEJMsb022863}}</ref><ref name=cooper2003>Cooper RS, "Genetic factors in ethnic disparities in health," in Anderson NB, Bulatao RA, Cohen B, eds., ''Critical perspectives on racial and ethnic differences in health in later life'', (Washington DC: National Academy Press, 2004), 267–309.</ref><ref>{{Cite journal |last1=Lin |first1=Jielu |last2=Thompson |first2=Martie P. |last3=Kaslow |first3=Nadine J. |date=May 2009 |title=The mediating role of social support in the community environment—psychological distress link among low-income African American women |url=https://onlinelibrary.wiley.com/doi/10.1002/jcop.20307 |journal=Journal of Community Psychology |language=en |volume=37 |issue=4 |pages=459–470 |doi=10.1002/jcop.20307 |issn=0090-4392 |access-date=2024-03-25 |archive-date=2024-03-25 |archive-url=https://web.archive.org/web/20240325172226/https://onlinelibrary.wiley.com/doi/10.1002/jcop.20307 |url-status=live }}</ref>

===Racism===
{{Main|Racism against black Americans}}
{{see also|Minority stress|John Henryism|Slavery hypertension hypothesis|Weathering hypothesis}}

Racial differences in health often persist even at equivalent socioeconomic levels. Individual and institutional discrimination, along with the stigma of inferiority, can adversely affect health. Racism can also directly affect health in multiple ways.<ref name="urlBlack doctor's death becomes a symbol of racism in coronavirus care | Coronavirus | The Guardian">{{cite web |url=https://www.theguardian.com/world/2020/dec/26/black-doctors-death-becomes-a-symbol-of-racism-in-coronavirus-care |title=Black doctor's death becomes a symbol of racism in coronavirus care &#124; Coronavirus &#124; The Guardian |website=[[TheGuardian.com]] |date=26 December 2020 |access-date=4 January 2021 |archive-date=12 July 2024 |archive-url=https://web.archive.org/web/20240712165237/https://www.theguardian.com/world/2020/dec/26/black-doctors-death-becomes-a-symbol-of-racism-in-coronavirus-care |url-status=live }}</ref> Residence in poor neighborhoods, racial bias in medical care, the stress of experiences of discrimination and the acceptance of the societal stigma of inferiority can have deleterious consequences for health.<ref name=autogenerated1>{{cite journal | vauthors = Williams DR | title = Race, socioeconomic status, and health. The added effects of racism and discrimination | journal = Annals of the New York Academy of Sciences | volume = 896 | issue = 1 | pages = 173–88 | year = 1999 | pmid = 10681897 | doi = 10.1111/j.1749-6632.1999.tb08114.x | bibcode = 1999NYASA.896..173W | hdl = 2027.42/71908 | s2cid = 26852165 | url = https://deepblue.lib.umich.edu/bitstream/2027.42/71908/1/j.1749-6632.1999.tb08114.x.pdf | hdl-access = free | access-date = 2019-09-01 | archive-date = 2012-01-26 | archive-url = https://web.archive.org/web/20120126203618/http://deepblue.lib.umich.edu/bitstream/2027.42/71908/1/j.1749-6632.1999.tb08114.x.pdf | url-status = live }}</ref><ref>{{cite journal | vauthors = Williams DR, Mohammed SA | title = Discrimination and racial disparities in health: evidence and needed research | journal = Journal of Behavioral Medicine | volume = 32 | issue = 1 | pages = 20–47 | date = February 2009 | pmid = 19030981 | pmc = 2821669 | doi = 10.1007/s10865-008-9185-0 }}</ref> Racism is a key determinant of socioeconomic status (SES) in the United States, and SES, in turn, is a fundamental cause of racial inequities in health.<ref>{{cite journal| vauthors = Phelan JC, Link BG |date=2015|title=Is Racism a Fundamental Cause of Inequalities in Health?|journal=Annual Review of Sociology |volume=41 |issue=1|pages=311–330|doi=10.1146/annurev-soc-073014-112305|doi-access=free}}</ref> Using [[Psychometrics of racism|The Schedule of Racist Events]] (SRE), an 18-item self-report inventory that assesses the frequency of racist discrimination. [[Hope Landrine]] and Elizabeth A. Klonoff found that racist discrimination was frequent in the lives of African Americans and is strongly correlated to psychiatric symptoms.<ref>{{cite journal |vauthors=[[Hope Landrine|Landrine H]], Klonoff EA |s2cid=145535500 |doi=10.1177/00957984960222002 |title=The Schedule of Racist Events: A Measure of Racial Discrimination and a Study of Its Negative Physical and Mental Health Consequences |year=1996 |journal=Journal of Black Psychology |volume=22 |pages=144–168 |issue=2}}</ref>

A study on racist events in the lives of African American women found that lifetime racism was positively correlated to lifetime history of both physical disease and frequency of recent common colds. These relationships were largely unaccounted for by other variables. Demographic variables such as income and education were not related to experiences of racism. The results suggest that racism can be detrimental to African Americans' well-being.<ref>{{cite journal |vauthors=Kwate NO, Valdimarsdottir HB, Guevarra JS, Bovbjerg DH |title=Experiences of racist events are associated with negative health consequences for African American women |journal=Journal of the National Medical Association |volume=95 |issue=6 |pages=450–60 |date=June 2003 |pmid=12856911 |pmc=2594553}}</ref> The physiological stress caused by racism has been documented in studies by [[Claude Steele]], Joshua Aronson, and Steven Spencer on what they term "[[stereotype threat]]."<ref>{{cite journal |vauthors=Blascovich J, Spencer SJ, Quinn D, Steele C |title=African Americans and high blood pressure: the role of stereotype threat |journal=Psychological Science |volume=12 |issue=3 |pages=225–9 |date=May 2001 |pmid=11437305 |doi=10.1111/1467-9280.00340 |s2cid=2590855}}</ref>

Kennedy et al. found that both measures of collective disrespect were strongly correlated with black mortality (r = 0.53 to 0.56), as well as with white mortality (r = 0.48 to 0.54). A 1 percent increase in the prevalence of those who believed that blacks lacked innate ability was associated with an increase in age-adjusted black mortality rate of 359.8 per 100,000 (95% confidence interval: 187.5 to 532.1 deaths per 100,000).  These data suggest that racism, measured as an ecologic characteristic, is associated with higher mortality in both blacks and whites.<ref>{{cite journal |vauthors=Kennedy BP, Kawachi I, Lochner K, Jones C, Prothrow-Stith D |title=(Dis)respect and black mortality |journal=Ethnicity & Disease |volume=7 |issue=3 |pages=207–14 |year=1997 |pmid=9467703}}</ref>

Two local governments in the US have issued declarations stating that racism constitutes a [[Public health emergency (United States)|public health emergency]]: the [[Milwaukee County, Wisconsin]] executive in May 2019, and the [[Cleveland City Council]], in June 2020.<ref>{{Cite web |vauthors=Dirr A |title=Milwaukee County executive signs resolution declaring racism a public health crisis |url=https://www.jsonline.com/story/news/local/milwaukee/2019/05/20/abele-signs-resolution-declaring-racism-public-health-crisis/3741809002/ |access-date=2020-06-28 |website=Milwaukee Journal Sentinel |language=en-US |archive-date=2019-10-08 |archive-url=https://web.archive.org/web/20191008033529/https://www.jsonline.com/story/news/local/milwaukee/2019/05/20/abele-signs-resolution-declaring-racism-public-health-crisis/3741809002/ |url-status=live }}</ref><ref>{{Cite web |vauthors=Goist R |date=2020-06-28 |title=What happens after declaring racism a public health crisis? A Wisconsin county offers a clue |url=https://www.cleveland.com/news/2020/06/what-happens-after-a-city-or-county-declares-racism-a-public-health-crisis-a-wisconsin-county-offers-a-clue.html |access-date=2020-06-28 |website=Cleveland.com |language=en |archive-date=2020-06-29 |archive-url=https://web.archive.org/web/20200629185106/https://www.cleveland.com/news/2020/06/what-happens-after-a-city-or-county-declares-racism-a-public-health-crisis-a-wisconsin-county-offers-a-clue.html |url-status=live }}</ref>

Princeton Survey Research Associates found that in 1999 most whites were unaware that race and ethnicity may affect the quality and ease of access to health care.<ref>{{cite journal |vauthors=Lillie-Blanton M, Brodie M, Rowland D, Altman D, McIntosh M |title=Race, ethnicity, and the health care system: public perceptions and experiences |journal=Medical Care Research and Review |volume=57 Suppl 1 |issue=4 suppl |pages=218–35 |year=2000 |pmid=11092164 |doi=10.1177/1077558700574010 |url=http://mcr.sagepub.com/cgi/pmidlookup?view=long&pmid=11092164 |access-date=2011-03-25 |archive-date=2024-07-12 |archive-url=https://web.archive.org/web/20240712165238/https://journals.sagepub.com/doi/abs/10.1177/1077558700057001S10 |url-status=live }}</ref>

===Inequalities in health care===
{{Main|Medical racism in the United States}}
{{further|Racial biases in medical decision-making tools}}
There is a great deal of research into [[inequalities in health care]]. In 2003, the [[Institute of Medicine]] released a report showing that race and ethnicity were significantly associated with the quality of healthcare received, even after controlling for socioeconomic factors such as access to care.<ref>{{cite book |url=http://www.nap.edu/catalog/10260/unequal-treatment-confronting-racial-and-ethnic-disparities-in-health-care |title=Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care |work=Institute of Medicine |date=2003 |access-date=24 March 2016 |doi=10.17226/10260 |isbn=978-0-309-08532-8 |archive-date=21 March 2016 |archive-url=https://web.archive.org/web/20160321172044/http://www.nap.edu/catalog/10260/unequal-treatment-confronting-racial-and-ethnic-disparities-in-health-care |url-status=live }}</ref> In some cases these inequalities are a result of income and a lack of health insurance, a barrier to receiving services. Almost two-thirds (62 percent) of Hispanic adults aged 19 to 64 (15 million people) were uninsured at some point during the past year, a rate more than triple that of working-age white adults (20 percent). One-third of working-age black adults (more than 6 million people) were also uninsured or experienced a gap in coverage during the year. Blacks had the most problems with [[medical debt]], with 31 percent of black adults aged 18 to 64 reporting Past-Due Medical Debt, vs. 23 percent of whites and 24 percent of Hispanics.<ref>{{cite web |vauthors=Karpman M, Caswell KJ |title=Past-due medical debt among nonelderly adults, 2012–15. |location=Washington, DC |publisher=Urban Institute |date=March 2017 |url=https://article.images.consumerreports.org/prod/content/dam/consumerist/2017/03/past_due_medical_debt.pdf |access-date=2019-07-19 |archive-date=2019-07-19 |archive-url=https://web.archive.org/web/20190719193104/https://article.images.consumerreports.org/prod/content/dam/consumerist/2017/03/past_due_medical_debt.pdf |url-status=live }}</ref>

Compared with white women, black women are twice as likely and Hispanic women are nearly three times as likely to be uninsured.<ref>{{cite web |title=Health Care for Minority Women: Recent Findings |series=Program Brief. AHRQ Publication No. 09-PB003 |date=April 2009 |publisher=Agency for Healthcare Research and Quality |location=Rockville, MD |url=http://www.ahrq.gov/research/minority.htm |url-status=dead |archive-url=https://web.archive.org/web/20110523163218/http://www.ahrq.gov/research/minority.htm |archive-date=2011-05-23 }}</ref> However, a survey conducted in 2009, which examined whether patient race influences physician's prescribing, found that racial differences in outpatient prescribing patterns for hypertension, hypercholesterolemia, and diabetes are likely attributable to factors other than prescribing decisions based on patient race. Medications were recommended at comparable rates for hypercholesterolemia, hypertension and diabetes between Whites and African Americans.<ref name=rathore>{{cite journal | vauthors = Rathore SS, Ketcham JD, Alexander GC, Epstein AJ | title = Influence of patient race on physician prescribing decisions: a randomized on-line experiment | journal = Journal of General Internal Medicine | volume = 24 | issue = 11 | pages = 1183–91 | date = November 2009 | pmid = 19705205 | pmc = 2771231 | doi = 10.1007/s11606-009-1077-7 }}</ref>

It has been argued that other cases of inequalities in health care reflect a [[systemic bias]] in the way medical procedures and treatments are prescribed for different ethnic groups. Raj Bhopal writes that the history of [[Scientific racism|racism in science]] and medicine shows that people and institutions behave according to the ethos of their times and warns of dangers to avoid in the future.<ref>{{cite journal | vauthors = Bhopal R | title = Spectre of racism in health and health care: lessons from history and the United States | journal = BMJ | volume = 316 | issue = 7149 | pages = 1970–3 | date = June 1998 | pmid = 9641943 | pmc = 1113412 | doi = 10.1136/bmj.316.7149.1970 }}</ref>
[[Nancy Krieger]] contended that much modern research supported the assumptions needed to justify racism. Racism contributes to unexplained inequities in health care, including treatment for heart disease,<ref>{{cite journal | vauthors = Oberman A, Cutter G | title = Issues in the natural history and treatment of coronary heart disease in black populations: surgical treatment | journal = American Heart Journal | volume = 108 | issue = 3 Pt 2 | pages = 688–94 | date = September 1984 | pmid = 6332513 | doi = 10.1016/0002-8703(84)90656-2 }}</ref> renal failure,<ref>{{cite journal | vauthors = Kjellstrand CM | title = Age, sex, and race inequality in renal transplantation | journal = Archives of Internal Medicine | volume = 148 | issue = 6 | pages = 1305–9 | date = June 1988 | pmid = 3288159 | doi = 10.1001/archinte.1988.00380060069016 }}</ref> bladder cancer,<ref>{{cite journal | vauthors = Mayer WJ, McWhorter WP | title = Black/white differences in non-treatment of bladder cancer patients and implications for survival | journal = American Journal of Public Health | volume = 79 | issue = 6 | pages = 772–5 | date = June 1989 | pmid = 2729474 | pmc = 1349641 | doi = 10.2105/AJPH.79.6.772 }}</ref> and pneumonia.<ref>{{cite journal | vauthors = Yergan J, Flood AB, LoGerfo JP, [[Paula Diehr|Diehr P]] | title = Relationship between patient race and the intensity of hospital services | journal = Medical Care | volume = 25 | issue = 7 | pages = 592–603 | date = July 1987 | pmid = 3695664 | doi = 10.1097/00005650-198707000-00003 | s2cid = 11637921 }}</ref> Raj Bhopal writes that these inequalities have been documented in numerous studies.  The consistent and repeated findings that black Americans receive less health care than white Americans—particularly where this involves expensive new technology—is an indictment of American health care.<ref>{{cite journal | title = Black-white disparities in health care | journal = JAMA | volume = 263 | issue = 17 | pages = 2344–6 | date = May 1990 | pmid = 2182918 | doi = 10.1001/jama.263.17.2344 | author1 = Council on Ethical Judicial Affairs }}</ref>

The infant mortality rate for African Americans is approximately twice the rate for European Americans, but, in a study that looked at members of these two groups who belonged to the military and received care through the same medical system, their infant mortality rates were essentially equivalent.<ref>{{cite journal | vauthors = Rawlings JS, Weir MR | title = Race- and rank-specific infant mortality in a US military population | journal = American Journal of Diseases of Children | volume = 146 | issue = 3 | pages = 313–6 | date = March 1992 | pmid = 1543178 | doi = 10.1001/archpedi.1992.02160150053020 }}</ref> Recently a study was conducted by the KFF, the Henry J Kaiser Family Foundation, in order to learn more about the infant mortality rate throughout the United States. All fifty states were surveyed. Different distributions of racial categories used in the study includes, "Non-Hispanic White, Non-Hispanic Black, American Indian or Alaska Native, Asian or Pacific Islander, or Hispanic".<ref name=":3">"Infant Mortality Rate by Race/Ethnicity". The Henry J. Kaiser Family Foundation. 2018-06-04. Retrieved 2018-10-13.</ref>
The infant mortality rate was compiled by the number of infant deaths per one thousand live births. In 2015, on an average nationwide, the United States reported that for Non-Hispanic white had an infant mortality rate of NSD meaning there as not enough sufficient data, Non-Hispanic black's rate was 11.3, Indian or Alaska Native's was 8.3, Pacific Islander was 4.2, and the infant mortality rate on average for Hispanic was 5.0.<ref name=":3" />

Recent immigrants to the United States from Mexico have better indicators on some measures of health than do Mexican Americans who are more assimilated into American culture.<ref>{{cite journal | vauthors = Franzini L, Ribble J, Spears W | title = The effects of income inequality and income level on mortality vary by population size in Texas counties | journal = Journal of Health and Social Behavior | volume = 42 | issue = 4 | pages = 373–87 | date = December 2001 | pmid = 11831138 | doi = 10.2307/3090185 | jstor = 3090185 }}</ref> Diabetes and obesity are more common among Native Americans living on U.S. reservations than among those living outside reservations.<ref>Cooper ''et al.'' 1997{{Verify source|found a couple of papers by cooper in 1997, but none about diabetes in native americans|date=April 2010}}</ref> The number of Native Americans diagnosed increased by 29% just between the years of 1990 and 1997. The prevalence of this among women and men shows that women more often have diabetes than men, especially in communities of Native American people.<ref name="pmid11128353">{{cite journal | vauthors = Burrows NR, Geiss LS, Engelgau MM, Acton KJ | title = Prevalence of diabetes among Native Americans and Alaska Natives, 1990-1997: an increasing burden | journal = Diabetes Care | volume = 23 | issue = 12 | pages = 1786–90 | date = December 2000 | pmid = 11128353 | doi = 10.2337/diacare.23.12.1786 | doi-access = free }}</ref>

A report from Wisconsin's Department of Health and Family Services showed that while black women are more likely to die from [[breast cancer]], white women are more likely to be diagnosed with breast cancer. Even after diagnosis, black women are less likely to get treatment compared to white women.<ref>''[http://dhfs.wisconsin.gov/wcrs/pdf/cancerwi0004.pdf Wisconsin Cancer Incidence and Mortality, 2000-2004] {{webarchive|url=https://web.archive.org/web/20080530004014/http://dhfs.wisconsin.gov/wcrs/pdf/cancerwi0004.pdf |date=2008-05-30 }}'' Wisconsin Department of Health and Family Services</ref> University of Wisconsin African-American studies Professor Michael Thornton said the report's results show [[racism]] still exists today. "There's a lot of research that suggests that who gets taken seriously in hospitals and doctors' offices is related to race and gender," Thornton said. "It's related to the fact that many black women are less likely to be taken seriously compared to the white women when they go in for certain illnesses."<ref>''[http://badgerherald.com/news/2007/10/24/breast_cancer_rates_.php Breast cancer rates differ in races] {{Webarchive|url=https://web.archive.org/web/20100213225528/http://badgerherald.com/news/2007/10/24/breast_cancer_rates_.php |date=2010-02-13 }}'' by Amanda Villa
Wednesday, October 24, 2007. Badger Herald</ref>

Krieger writes that given growing appreciation of how race is a social, not biological, construct, some epidemiologists are proposing that studies omit data on "race" and instead collect better socioeconomic data. Krieger writes that this suggestion ignores a growing body of evidence on how noneconomic as well as economic aspects of racial discrimination are embodied and harm health across the lifecourse.<ref>{{cite journal | vauthors = Krieger N | s2cid = 45756159 | title = Refiguring "race": epidemiology, racialized biology, and biological expressions of race relations | journal = International Journal of Health Services | volume = 30 | issue = 1 | pages = 211–6 | year = 2000 | pmid = 10707306 | doi = 10.2190/672J-1PPF-K6QT-9N7U }}</ref> [[Gilbert C. Gee]]'s study ''A Multilevel Analysis of the Relationship Between Institutional and Individual Racial Discrimination and Health Status'' found that individual (self-perceived) and institutional (segregation and [[redlining]]) racial discrimination is associated with poor health status among members of an ethnic group.<ref>{{cite journal | vauthors = Gee GC | title = A multilevel analysis of the relationship between institutional and individual racial discrimination and health status | journal = American Journal of Public Health | volume = 92 | issue = 4 | pages = 615–23 | date = April 2002 | pmid = 11919062 | pmc = 1447127 | doi = 10.2105/AJPH.92.4.615 }}</ref>

In the 2020 covid pandemic, a disproportionate rate in the amount of covid deaths in the African American communities compared to other racial groups has been demonstrated in some part of the United States. Many cases such as covid and AIDs has led more African Americans to lose trust in healthcare intuitions and the government that is supposed to protect their rights.  Milwaukee County is just one of many examples of such communities that were hit hard by covid. African American represented three fourths of covid deaths. This has been a common factor for many parts of the countries major populated cities that have has high percentage of African Americans.<ref>{{Cite web|last=Wells|first=Lindsay|title=A Legacy of Mistrust: African Americans and the US Healthcare System|url=https://proceedings.med.ucla.edu/wp-content/uploads/2020/06/Wells-A200421LW-rko-Wells-Lindsay-M.D.-BLM-formatted.pdf|access-date=2021-12-10|archive-date=2021-12-10|archive-url=https://web.archive.org/web/20211210011953/https://proceedings.med.ucla.edu/wp-content/uploads/2020/06/Wells-A200421LW-rko-Wells-Lindsay-M.D.-BLM-formatted.pdf|url-status=live}}</ref>

=== Race-Based Diagnoses ===
[[Race (human categorization)|Racial groups]], especially [[minority group]]s, are frequently exposed to different types of barriers when in need of medical treatment. The [[World Health Organization]] identifies some of these barriers, including unequal access to health services, lack of [[cultural sensitivity]], differing quality of services, timeliness of access to such services, and general [[Health equity|discrimination in healthcare]] systems.<ref>{{Cite web |last=World Health Organization |date=August 2001 |title=WHO's Contribution to the World Conference Against Racism, Racial Discrimination, Xenophobia and Related Intolerance |url=http://apps.who.int/iris/bitstream/handle/10665/66891/WHO_SDE_HDE_HHR_01.2.pdf;jsessionid=354408353DCE8B94047C97433E72FB01?sequence=1 |access-date=2022-02-24}}</ref> Certain racial groups can receive different courses of treatment, diagnoses, and [[Prescription drug|prescription medications]] than those that self-identify as other races.<ref>{{Cite web |title=Pharmacogenetics, personalized medicine, and race {{!}} Learn Science at Scitable |url=http://www.nature.com/scitable/topicpage/pharmacogenetics-personalized-medicine-and-race-744 |access-date=2022-02-24 |website=www.nature.com |language=en |archive-date=2024-07-12 |archive-url=https://web.archive.org/web/20240712165312/https://www.nature.com/scitable/topicpage/pharmacogenetics-personalized-medicine-and-race-744/ |url-status=live }}</ref> These differences can be commonly linked to correction factors in [[medical calculator]]s, [[algorithm]]s that are unable to account for variables rooted in social disparities, and [[drug]]s designed for specific racial populations. [[BiDil]] is a drug used to treat congestive [[heart failure]] in [[black people]].<ref>{{Cite web |title=BiDil (isosorbide dinitrate/hydralazine HCl) Heart Failure Medication |url=https://www.bidil.com/ |access-date=2022-02-24 |website=www.bidil.com |archive-date=2022-02-24 |archive-url=https://web.archive.org/web/20220224061132/https://www.bidil.com/ |url-status=live }}</ref> The [[Food and Drug Administration]] initially rejected applications of the medication since their clinical trials did not demonstrate any efficacy for a general racial population within the [[United States]], except for [[African Americans]].<ref name=":02">{{Cite journal |last1=Sankar |first1=Pamela |last2=Kahn |first2=Jonathan |date=2005-01-01 |title=BiDil: Race Medicine Or Race Marketing? |url=https://www.healthaffairs.org/doi/10.1377/hlthaff.W5.455 |journal=Health Affairs |volume=24 |issue=Suppl1 |pages=W5–455 |doi=10.1377/hlthaff.W5.455 |pmid=16219647 |issn=0278-2715 |access-date=2022-03-01 |archive-date=2024-07-12 |archive-url=https://web.archive.org/web/20240712165241/https://www.healthaffairs.org/doi/10.1377/hlthaff.W5.455 |url-status=live }}</ref> BiDil's manufacturer, NitroMed, then completed a clinical trial that solely enrolled African Americans. They found a decrease in mortality for this exclusive group and in 2005, the FDA approved the drug's usage exclusively for black patients.<ref name=":02" /> It is currently still in use with the same stipulation.

BiDil has been considered to be a "race drug"<ref name=":17">{{Cite journal |last=Krimsky |first=Sheldon |date=2012-01-14 |title=The short life of a race drug |journal=The Lancet |language=English |volume=379 |issue=9811 |pages=114–115 |doi=10.1016/S0140-6736(12)60052-X |issn=0140-6736 |pmid=22256352|s2cid=30592769 |doi-access=free }}</ref> by some in the medical community. Backlash stems from a debate on whether race can be a reliable factor in making diagnoses and prescriptions. Those that oppose its usage believe its prescription process to be unscientific. With respect to BiDil's racialization, [[Sheldon Krimsky]] wrote, "'self-identified race' is a subjective term, influenced by cultural factors, and not even grounded in the ancestral [[genomics]]."<ref name=":17" />

Ziad Obermeyer M.D., et al. found that a specific algorithm, which determines what patients need further care, favors additional medical attention towards [[white people]] over black people.<ref>{{Cite journal |last1=Obermeyer |first1=Ziad |last2=Powers |first2=Brian |last3=Vogeli |first3=Christine |last4=Mullainathan |first4=Sendhil |date=2019-10-25 |title=Dissecting racial bias in an algorithm used to manage the health of populations |journal=Science |volume=366 |issue=6464 |pages=447–453 |language=EN |doi=10.1126/science.aax2342|pmid=31649194 |bibcode=2019Sci...366..447O |s2cid=204881868 |doi-access=free }}</ref> This analysis was based on data concerning average [[health costs]] that are incurred by these specific races. The same article puts forward the claim, "Bias occurs because the algorithm uses health costs as a proxy for health needs," as African Americans have been found to face disproportionate poverty levels in the United States and are forced to spend less on [[Health care in the United States|healthcare]] than white patients.<ref>{{Cite web |last=Bureau |first=US Census |title=Inequalities Persist Despite Decline in Poverty For All Major Race and Hispanic Origin Groups |url=https://www.census.gov/library/stories/2020/09/poverty-rates-for-blacks-and-hispanics-reached-historic-lows-in-2019.html |access-date=2022-02-24 |website=Census.gov |archive-date=2020-09-17 |archive-url=https://web.archive.org/web/20200917070757/https://www.census.gov/library/stories/2020/09/poverty-rates-for-blacks-and-hispanics-reached-historic-lows-in-2019.html |url-status=live }}</ref> This bias caused the algorithm to find that black patients are generally healthier than white patients and a conclusion was created by the algorithm that black patients do not need extra care in such instances.

Estimated [[glomerular filtration rate]] (eGFR) is a scored measurement of a patient's [[kidney]] function. Once measured, healthcare providers can utilize the test score to determine the quality of kidneys' filtering ability in a given patient. According to a study by Dr. Darshali Vyas, et al., the equation for eGFR reports a higher score for black patients by a factor of 1.210,<ref name=":23">{{Cite journal |last1=Vyas |first1=Darshali A. |last2=Eisenstein |first2=Leo G. |last3=Jones |first3=David S. |date=2020-06-17 |title=Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms |journal=New England Journal of Medicine |volume=383 |issue=9 |pages=874–882 |language=en |doi=10.1056/NEJMms2004740|pmid=32853499 |s2cid=221359557 |doi-access=free }}</ref> which the study's authors doubt the validity of. The algorithm's developers backed the results, citing that black people have higher [[creatinine]] levels, which can be a [[Confounding|lurking variable]] in eGFR calculations. Vyas makes a rebuttal to this idea, stating, "Explanations that have been given for this finding include the notion that black people release more creatinine into their blood at baseline, in part because they are reportedly more muscular." In reality, this [[generalization]] may not be the case and can be harmful to minorities that encounter such correction factors.

Similarly, the [[Delivery after previous caesarean section|vaginal birth after Caesarean section]] (VBAC) medical calculator is used to estimate the probability that a patient will successfully complete a [[Vaginal delivery|vaginal birth]] if they have already had a birth via [[Caesarean section]]. There are correction factors based on race that have been commonly used in this calculator; self-reported African American patients' results are multiplied by a factor of 0.671.<ref name=":23" /> The VBAC calculator is in the process of being altered by the Maternal-Fetal Medicine Units Network, as of December 2021, to omit race and ethnicity in the interest of ignoring such "[[Social constructionism|socially constructed]] variables"<ref>{{Cite journal |last1=Grobman |first1=William A. |last2=Sandoval |first2=Grecio |last3=Rice |first3=Madeline Murguia |last4=Bailit |first4=Jennifer L. |last5=Chauhan |first5=Suneet P. |last6=Costantine |first6=Maged M. |last7=Gyamfi-Bannerman |first7=Cynthia |last8=Metz |first8=Torri D. |last9=Parry |first9=Samuel |last10=Rouse |first10=Dwight J. |last11=Saade |first11=George R. |date=2021-12-01 |title=Prediction of vaginal birth after cesarean delivery in term gestations: a calculator without race and ethnicity |url=https://www.ajog.org/article/S0002-9378(21)00587-1/abstract |journal=American Journal of Obstetrics & Gynecology |language=English |volume=225 |issue=6 |pages=664.e1–664.e7 |doi=10.1016/j.ajog.2021.05.021 |issn=0002-9378 |pmid=34043983 |pmc=8611105 |access-date=2022-03-01 |archive-date=2024-07-12 |archive-url=https://web.archive.org/web/20240712165240/https://www.ajog.org/article/S0002-9378(21)00587-1/abstract |url-status=live }}</ref> that may be inaccurate.

=== Mental health ===
Stress can be derived from many individualistic factors or experiences, has multiple effects on health.  Stress is also associated with chronic diseases. Stress that is derived from racism has specific contextual factors, which adds a daily burden to African-Americans and other demographic groups that are discriminated against. These demographic groups do not often realize that these stressors may be contributing to the state of their mental health.<ref>{{cite web|url=https://www.apa.org/pi/oema/resources/ethnicity-health/racism-stress.aspx|title=Physiological & Psychological Impact of Racism and Discrimination for African-Americans|website=American Psychological Association|access-date=9 November 2018}}</ref> Groups of people are also affected in ways that may not be outward acts of racism by another person, but through education, economics, the justice system, and largely through law enforcement. It is also possible that people who hold racist ideals have mental health problems as well, such as self-centeredness, inability to empathize, and paranoia over groups of people they are discriminating against. Individuals can develop complexes about ethnic groups and races, automatically displaying emotions without learning about the people themselves, and will cut off all friendliness to them.<ref>{{cite web|url=https://www.psychologytoday.com/us/blog/the-pacific-heart/201708/after-charlottesville-is-racism-mental-illness|title=After Charlottesville: Is Racism a Mental Illness?| vauthors = Chandra R |website= Psychology Today|access-date=9 November 2018}}</ref>

There are many [[Obstacles to receiving mental health services among African American youth|barriers]] that exist in the relationship for African Americans accessing mental health services. These barriers can range from family dynamics, institutional racism, socioeconomic status, and a host of other reasons.  This is particularly true for African Americans in need of mental health services who could benefit from effective treatment. "Effective treatment exists for many mental disorders, an indicator of need for mental health services (MHS), receive any treatment. This underutilization is more pronounced among African Americans than Non Hispanic whites (Villatoro & Aneshensel, 2014).<ref>{{cite journal | vauthors = Villatoro AP, Aneshensel CS | title = Family Influences on the Use of Mental Health Services among African Americans | journal = Journal of Health and Social Behavior | volume = 55 | issue = 2 | pages = 161–180 | date = June 2014 | pmid = 24872466 | pmc = 4395552 | doi = 10.1177/0022146514533348 }}</ref> There is something to be said about the lack of utilization of mental health services amongst African Americans. There are several possible explanations for the state of mental health use in African American communities. While many African Americans do not receive mental health services, those who do receive services are negatively impacted by the institutional bias that exists between them and non-black counselors. In a study of 47 clinicians and 129 African Americans who sought therapy, researchers found that African Americans tend to have a healthy cultural paranoia about their non-black therapists. Interviews with them found Black patients simultaneously engaged in and ''scanned'' the encounter for feelings of comfort; safety in disclosing personal information; being trustful of the provider; and being listened to, understood, and respected by the provider. For some patients, judgments about the initial encounter seem to have less to do with clinical expertise or experience of the provider and more with perceptions of empathy and the quality of the interpersonal connection between the two individuals (Earl, Alegría, Mendieta, & Diaz Linhart, 2011<ref>{{cite journal | vauthors = Earl TR, Alegría M, Mendieta F, Linhart YD | title = "Just be straight with me:" an exploration of Black patient experiences in initial mental health encounters | journal = The American Journal of Orthopsychiatry | volume = 81 | issue = 4 | pages = 519–25 | date = October 2011 | pmid = 21977937 | pmc = 3220950 | doi = 10.1111/j.1939-0025.2011.01123.x }}</ref>). In order to improve the outcomes of therapy for African Americans, it is imperative that non-black therapists are culturally competent. Increasing cultural competence of mental health clinicians will help foster an empathetic relationship between clinicians and their clients.

In addition, the social environment in which African Americans live in plays a role in their mental health. As it relates to African Americans, it is not enough to deal with them independent of the world they exist in. Mental health clinicians must strive to see their African American clients within the context of the environments they move through. How these social factors impact the African American client must be examined and thoroughly processed by both the clinician and the client. The examination of how social factors influence individual thought and behavior is particularly critical for African Americans. Social environment constructs, psychosocial mediators, and sociodemographic are factors that have to be considered when it comes to African Americans and mental health. Ecological approaches that aim to systematically modify how the world interacts with blackness, life experiences that African Americans perceive as stressful, depression, and perceived racial discrimination, may have the greatest impact on mental health in African Americans and may lead to additional improvements in the holistic well-being of African Americans (Mama, Li, Basen-Enquist, Lee, Thompson, Wetter, Nguyen, Reitzel, & McNeill, 2015).<ref>{{cite journal | vauthors = Mama SK, Li Y, Basen-Engquist K, Lee RE, Thompson D, Wetter DW, Nguyen NT, Reitzel LR, McNeill LH | title = Psychosocial Mechanisms Linking the Social Environment to Mental Health in African Americans | journal = PLOS ONE | volume = 11 | issue = 4 | pages = e0154035 | date = 2016-04-27 | pmid = 27119366 | pmc = 4847864 | doi = 10.1371/journal.pone.0154035 | bibcode = 2016PLoSO..1154035M | doi-access = free }}</ref> For example, there must be institutional efforts at a national and grassroots level that address the numerous social issues impacting African American communities. Particularly, programs that enhance their life outcomes. In other words, there must be advocacy for African American clients who are engaging in therapy, and that advocacy must extend to the world they live in outside of their therapy sessions.

African American millennial's mental health has also raised concerns due to the lack of being able to find employment. African American males between the age of twenty and twenty-four were studied and were found to experience unemployment at almost double the rate of their white peers. Mental issues are presented in the form of addictions such alcohol and smoking. Conditions of depression have reported as well. Societal pressure of gender norm is one factor that leads to mental health issues for African American males.<ref>{{Cite web|date=August 2018|title=Black Male Millennial Unemployment and Mental Health|url=https://www.apa.org/advocacy/health-disparities/black-male-unemployment.pdf|access-date=2021-12-10|archive-date=2021-12-10|archive-url=https://web.archive.org/web/20211210023604/https://www.apa.org/advocacy/health-disparities/black-male-unemployment.pdf|url-status=live}}</ref>

=== Maternal and child health ===
{{Main|Black maternal mortality in the United States|Race and maternal health in the United States}}
[[File:Tamara W. talks about being ignored as a Black mother.ogg|thumb|Tamara speaks about feeling "ignored" as a Black mother in the United States in 2019.]]
African American women are three to four times more likely to die in childbirth than white women, while their babies are twice as likely to die than white babies, even when controlled for many factors such as education, income, and health. Danyelle Solomon argues that "White racism" is the highest cause of unrest in communities, pushing them further apart, and causing more black women and infants to die because of it.<ref name="americanprogress.org">{{cite web|url=https://www.americanprogress.org/issues/race/reports/2018/04/18/449774/racism-evergreen-toxin-killing-black-mothers-infants/|title=Racism: The Evergreen Toxin Killing Black Mothers and Infants|vauthors=Solomon D|website=Center for American Progress|date=18 April 2018|access-date=9 November 2018|archive-date=9 November 2018|archive-url=https://web.archive.org/web/20181109112033/https://www.americanprogress.org/issues/race/reports/2018/04/18/449774/racism-evergreen-toxin-killing-black-mothers-infants/|url-status=live}}</ref> Racism affects several components of a black woman's life in regards to being able to give birth or currently carrying. Racism found in the delivery of health care and social service means black women often receive substandard care in comparison to white women.<ref name="ReferenceA">{{Cite web|last1=Taylor|first1=Jamila|last2=Novoa|first2=Cristina|last3=Hamm|first3=Katie|last4=Phadke|first4=Shilpa|title=Eliminating Racial Disparities in Maternal and Infant Mortality|url=https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/|access-date=2021-04-24|website=Center for American Progress|date=2 May 2019|language=en-US|archive-date=2021-04-24|archive-url=https://web.archive.org/web/20210424005845/https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/|url-status=live}}</ref> As well, denial of care to black women that seek help when enduring pain, or that health care and social service providers fail to treat them with dignity and respect when it comes to their wellbeing.<ref name="ReferenceA"/> African American women face greater chances than white women to have chronic stress which can stem from living in impoverished neighborhoods or encountering discrimination. These embedded stressors as a result of societal inequities and prejudice could largely explain the underlying health disparities in negative birth outcomes. Although studies examining the effects of prenatal stress are limited, for a few reasons, evidence does support the consequences of high levels of stress or anxiety.<ref name=":15">{{Cite web|last=Poggi|first=E.|date=May 3, 2006|title=Prenatal Exposure to Stress and Stress Hormones Influences Child Development|url=https://www.du.edu/neurodevelopment/media/documents/prenatalstress_development.pdf|access-date=March 17, 2021|website=University of Denver|archive-date=July 9, 2020|archive-url=https://web.archive.org/web/20200709181747/https://www.du.edu/neurodevelopment/media/documents/prenatalstress_development.pdf|url-status=live}}</ref> Women are said to bear low birth weight or preterm infants from elevated stress or anxiety, and even more so with a lack of social support.<ref name=":15" /> In the aftermath, newborns become predisposed to issues, such poor physical development, from the mother's stress during pregnancy. With that being said, stress from racism not only affects mental and physical wellbeing, but disproportionately place black infants at a disadvantage for future attainment.

Racism in education has decreased significantly over the past century, however this does not help increase the income for black people, and increased incomes do not provide better health opportunities, especially for mothers and infants.<ref name="americanprogress.org" /> Higher education and income levels for black mothers does not affect this mortality rate. There are also higher chances that a complication will occur during birth. Solomon argues that the 'toxin' of these rates is racism, which has created a toxic environment for minority groups to live in with multiple stressors that effect health.<ref name="americanprogress.org" />

In 2012, a study was conducted on early pregnancy women which followed their children from birth to 5 years old to determine the risk factors of obesity among low-income black children.<ref name = "Janjua_2012">{{cite journal | vauthors = Janjua NZ, Mahmood B, Islam MA, Goldenberg RL | title = Maternal and Early Childhood Risk Factors for Overweight and Obesity among Low-Income Predominantly Black Children at Age Five Years: A Prospective Cohort Study | journal = Journal of Obesity | volume = 2012 | pages = 457173 | date = 2012 | pmid = 23056928 | doi = 10.1155/2012/457173 | pmc = 3465910 | doi-access = free }}</ref> However, the study showed that children of overweight and obese mothers are more than likely to become obese or overweight by the age of 5.<ref name = "Janjua_2012" /> According to the ''U.S. Department of Health and Human Services Office of Minority,'' African American women have the highest rates of obesity or being overweight compared to any other groups in the United States.<ref>{{Cite web|title=Obesity and African Americans - The Office of Minority Health|url=https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=25|access-date=2021-03-04|website=www.minorityhealth.hhs.gov|archive-date=2021-02-27|archive-url=https://web.archive.org/web/20210227211104/https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=25|url-status=live}}</ref>

===Cardiovascular disease===
{{See also|Cardiovascular disease}}
Research has explored the effect of encounters with racism or discrimination on physiological activity.  Most of the research has focused on traits that cause exaggerated responses, such as neuroticism, strong racial identification, or hostility.<ref name="pmid12554577">{{cite journal | vauthors = Harrell JP, Hall S, Taliaferro J | title = Physiological responses to racism and discrimination: an assessment of the evidence | journal = American Journal of Public Health | volume = 93 | issue = 2 | pages = 243–8 | date = February 2003 | pmid = 12554577 | pmc = 1447724 | doi = 10.2105/AJPH.93.2.243 }}</ref>  Several studies suggest that [[high blood pressure|higher blood pressure]] levels are associated with a tendency not to downplay racist and discriminatory incidents, or that directly addressing or challenging unfair situations reduces blood pressure.<ref name="pmid12554577" /> Personal experiences of racist behaviors increase stress and blood pressure.<ref name="pmid12554577" />

Although the relationship racism and health is unclear and findings have been inconsistent, three likely mechanisms for cardiovascular damage have been identified:<ref name="pmid12811228">{{cite journal | vauthors = Wyatt SB, Williams DR, Calvin R, Henderson FC, Walker ER, Winters K | s2cid = 6145121 | title = Racism and cardiovascular disease in African Americans | journal = The American Journal of the Medical Sciences | volume = 325 | issue = 6 | pages = 315–31 | date = June 2003 | pmid = 12811228 | doi = 10.1097/00000441-200306000-00003 }}</ref>
* [[Institutional racism]] leads to limited opportunities for socioeconomic mobility, differential access to goods and resources, and poor living conditions.
* Personal experiences of racism acts as a [[stressor]] and can induce psychophysiological reactions that negatively affect cardiovascular health.
* Negative self-evaluations and accepting negative cultural stereotypes as true ([[internalized racism]]) can harm cardiovascular health.

According to the U.S. Department of Health and Human Services Office of Minority Health, in 2018, African Americans were 30% more likely to die from heart disease than non-Hispanic whites.<ref>{{Cite web|title=Heart Disease and African Americans - The Office of Minority Health|url=https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=19|access-date=2021-03-04|website=www.minorityhealth.hhs.gov|archive-date=2021-03-04|archive-url=https://web.archive.org/web/20210304171920/https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=19|url-status=live}}</ref>

=== Alzheimer's disease ===
{{See also|Alzheimer's disease in African Americans}}
[[Alzheimer's disease]] (AD) is a progressive, irreversible neurodegenerative disease and it is the leading cause of dementia.<ref>{{Cite web|url=https://www.alz.org/alzheimers-dementia/what-is-alzheimers|title=What is Alzheimer's Disease? Symptoms & Causes &#124; alz.org|access-date=2022-12-09|archive-date=2022-12-09|archive-url=https://web.archive.org/web/20221209235915/https://www.alz.org/alzheimers-dementia/what-is-alzheimers|url-status=live}}</ref> African Americans are disproportionately affected by Alzheimer's, with higher prevalence and incidence in African Americans than the overall average.<ref>{{Cite journal |last1=Mayeda |first1=Elizabeth Rose |last2=Glymour |first2=M Maria |last3=Quesenberry |first3=Charles P |last4=Whitmer |first4=Rachel A |date=2016-02-11 |title=Inequalities in dementia incidence between six racial and ethnic groups over 14 years |journal=Alzheimer's & Dementia |volume=12 |issue=3 |pages=216–224 |doi=10.1016/j.jalz.2015.12.007 |issn=1552-5260 |pmc=4969071 |pmid=26874595}}</ref><ref>{{Cite web |date=2016-01-01 |title=CDC Newsroom |url=https://www.cdc.gov/media/releases/2018/p0920-alzheimers-burden-double-2060.html |access-date=2022-12-09 |website=CDC |language=en-us}}</ref> Genetics are a huge risk factor for Alzheimer's, but known high-risk genes for the disease have different effect sizes in African Americans compared to other racial groups.<ref>{{Cite journal |last1=Rajabli |first1=Farid |last2=Feliciano |first2=Briseida E. |last3=Celis |first3=Katrina |last4=Hamilton-Nelson |first4=Kara L. |last5=Whitehead |first5=Patrice L. |last6=Adams |first6=Larry D. |last7=Bussies |first7=Parker L. |last8=Manrique |first8=Clara P. |last9=Rodriguez |first9=Alejandra |last10=Rodriguez |first10=Vanessa |last11=Starks |first11=Takiyah |last12=Byfield |first12=Grace E. |last13=Sierra Lopez |first13=Carolina B. |last14=McCauley |first14=Jacob L. |last15=Acosta |first15=Heriberto |date=2018-12-05 |title=Ancestral origin of ApoE ε4 Alzheimer disease risk in Puerto Rican and African American populations |journal=PLOS Genetics |volume=14 |issue=12 |pages=e1007791 |doi=10.1371/journal.pgen.1007791 |issn=1553-7390 |pmc=6281216 |pmid=30517106 |doi-access=free }}</ref>

Many of the risk factors for Alzheimer's such as high blood pressure and diabetes are more prevalent in African American communities. Therefore making Alzheimer's disproportionately impact black communities within America.  The [[Alzheimer's Impact Movement]] is an association that seeks to advance the care for those who have Alzheimer's and [[Dementia]]. The Washington Heights-Inwood Columbia Aging Project in 2020 collected data on the percentages of people aged 65 or older with Alzheimer's disease or other types of Dementia. For each demographic ages 65–74, 75-84, and 85+, the proportion of African Americans with Alzheimer's were two times larger than the proportion of white individuals within those age groups. Although African Americans are more likely to develop Alzheimer's, they are only 34% more likely to receive a diagnoses for their condition. If diagnosed, it's typical for the disease to have already developed into the later stages with further deteriorated cognition. As a result, African Americans tend to pay substantially more for health services.<ref>{{Cite web |date=2020 |title=Race, Ethnicity, and Alzheimer's |url=https://aaic.alz.org/downloads2020/2020_Race_and_Ethnicity_Fact_Sheet.pdf}}</ref> For African Americans in 2014 it was discovered that the average per-person Medicare payment was 35% higher than white individuals with Alzheimer's. Another study set on by The Chicago health and Aging project in 2018 found that the higher risk of Alzheimer's disease could stem from disparities within educational attainment. Findings from the study portray a contradiction between cognition decline and cognition and Dementia risk. The findings could reflect upon lacking cognitive reserves developed over their lifespan. Exposure to racism, access to resources, and exposures to neurotoxins have consequentially leading to poorer cognitive function and disproportionately develop Dementia.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718953/ Cognitive aging in black and white Americans: Cognition, cognitive decline, and incidence of Alzheimer disease dementia]<ref>{{Cite journal |last1=Weuve |first1=Jennifer |last2=Barnes |first2=Lisa L. |last3=Mendes de Leon |first3=Carlos F. |last4=Rajan |first4=Kumar B. |last5=Beck |first5=Todd |last6=Aggarwal |first6=Neelum T. |last7=Hebert |first7=Liesi E. |last8=Bennett |first8=David A. |last9=Wilson |first9=Robert S. |last10=Evans |first10=Denis A. |date=January 2018 |title=Cognitive Aging in Black and White Americans: Cognition, Cognitive Decline, and Incidence of Alzheimer Disease Dementia |url=http://journals.lww.com/00001648-201801000-00019 |journal=Epidemiology |language=en |volume=29 |issue=1 |pages=151–159 |doi=10.1097/EDE.0000000000000747 |pmid=28863046 |issn=1044-3983|pmc=5718953 }}</ref>

===Fear of racism===
{{see also|The talk (racism in the United States)}}
It has been argued that while actual racism continues to harm health, fear of racism, due to historical precedents, can cause  minority populations to avoid seeking medical help. For example, a 2003 study found that a large percentage of respondents perceived discrimination targeted at African American women in the area of [[reproductive health]].<ref>{{cite journal | vauthors = Thorburn Bird S, Bogart LM | title = Birth Control Conspiracy Beliefs, Perceived Discrimination, and Contraception among African Americans: An Exploratory Study | journal = Journal of Health Psychology | volume = 8 | issue = 2 | pages = 263–76 | date = March 2003 | pmid = 22114130 | doi = 10.1177/1359105303008002669 | s2cid = 19640525 }}</ref> Likewise beliefs such as "The government is trying to limit the Black population by encouraging the use of condoms" have also been studied as possible explanations for the different attitudes of whites and blacks towards efforts to prevent the spread of [[HIV]]/[[AIDS]].<ref>{{cite journal | vauthors = Bird ST, Bogart LM | title = Conspiracy beliefs about HIV/AIDS and birth control among African Americans: implications for the prevention of HIV, other STIs, and unintended pregnancy | journal = The Journal of Social Issues | volume = 61 | issue = 1 | pages = 109–26 | date = March 2005 | pmid = 17073026 | doi = 10.1111/j.0022-4537.2005.00396.x }}</ref>

Infamous examples of real racism in the past, such as the [[Tuskegee Syphilis Study]] (1932–1972), have injured the level of trust in the Black community towards public health efforts. The Tuskegee study deliberately left Black men diagnosed with syphilis untreated for 40 years. It was the longest nontherapeutic experiment on human beings in medical history. The AIDS epidemic has exposed the Tuskegee study as a historical marker for the legitimate discontent of Black people with the public health system. The false belief that AIDS is a form of [[genocide]] is rooted in recent experiences of real racism. These theories range from the belief that the government promotes drug abuse in Black communities to the belief that HIV is a manmade weapon of racial warfare. Researchers in public health hope that open and honest conversations about racism in the past can help rebuild trust and improve the health of people in these communities.<ref>{{cite journal | vauthors = Thomas SB, Quinn SC | title = The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community | journal = American Journal of Public Health | volume = 81 | issue = 11 | pages = 1498–505 | date = November 1991 | pmid = 1951814 | pmc = 1405662 | doi = 10.2105/AJPH.81.11.1498 }}</ref> In 2001 the [[National Medical Association|Journal of the National Medical Association]] has concluded that this fear causes those within the African American community to avoid clinical trials. Although these trials are now set up to protect participants, black communities remain wary. This also has its downsides, as it's impossible to know if drugs will impact white and colored persons the same without these trials.<ref name=":19">{{Cite journal |last=G.W |first=Harrison |date=2001 |title=Impact of biomedical research on African Americans |journal=Journal of the National Medical Association |volume=93 |issue=3 Suppl |pages=6S–7S |pmid=12653393 |pmc=2593959 }}</ref> Past medical malpractice has led to distrust, which in turn makes creating necessary medicine for the black community more difficult.  Perpetuating the lack of resources and health care available to black communities. The experimentation and abuse set onto black bodies in the pursuit of medical development has a long and treacherous history. The Tuskegee experiment is one of the more well known experiment, where black men with [[Syphilis]] were left untreated to ease the doctors' curiosities concerning the natural course of the disease when left untreated. Many of the men were told that their study was concerning "bad blood" and nothing more. The doctors would dissuade these individuals from seeking outside help, while performing blood draws, spinal taps, and autopsies.<ref name=":20">{{Cite journal |last1=Alsan |first1=Marcella |last2=Wanamaker |first2=Marianne |date=2018-02-01 |title=Tuskegee and the Health of Black Men* |url=https://academic.oup.com/qje/article/133/1/407/4060075 |journal=The Quarterly Journal of Economics |language=en |volume=133 |issue=1 |pages=407–455 |doi=10.1093/qje/qjx029 |pmid=30505005 |pmc=6258045 |issn=0033-5533 |access-date=2023-05-18 |archive-date=2024-07-12 |archive-url=https://web.archive.org/web/20240712165810/https://academic.oup.com/qje/article-abstract/133/1/407/4060075?redirectedFrom=fulltext |url-status=live }}</ref> The Tuskegee experiments have had generational consequences in the belief of health care. There are many in the black community who believe the government  injected syphilis virus into those men in the experiment. Although this has not been factually proven, rumors within the community were enough to create long withstanding distrust. The same goes for agreeing to being an organ donor on a drivers license. Many African Americans will immediately say no, as there's a belief that their organs will be misused.<ref name=":21">{{Cite journal |last1=Scharff |first1=Darcell P. |last2=Mathews |first2=Katherine J. |last3=Jackson |first3=Pamela |last4=Hoffsuemmer |first4=Jonathan |last5=Martin |first5=Emeobong |last6=Edwards |first6=Dorothy |date=August 2010 |title=More than Tuskegee: Understanding Mistrust about Research Participation |url=https://muse.jhu.edu/article/389044 |journal=Journal of Health Care for the Poor and Underserved |language=en |volume=21 |issue=3 |pages=879–897 |doi=10.1353/hpu.0.0323 |pmid=20693733 |issn=1548-6869 |pmc=4354806 |access-date=2023-05-18 |archive-date=2023-06-27 |archive-url=https://web.archive.org/web/20230627125242/https://muse.jhu.edu/article/389044 |url-status=live }}</ref>

Many of the violent and inhuman actions taken towards people of color have shaped how African Americans within the U.S view health care. The Mississippi Appendectomy is where many black slaves were used as test subjects to treat [[vesicovaginal fistula]]s, an experiment performed by [[J. Marion Sims|Dr. James Marion Sims]]. Dr. Sims was heralded as a brilliant physician, despite his inhumane experimentation on black women to further his career. Experiments such as these transformed after the [[Fifteenth Amendment to the United States Constitution|15th Amendment]], where many white citizens were afraid of black populations gaining too much power. The forceful sterilization of black women without their knowledge is one of the many examples of white Americans attempting to regulate and control populations within black communities. Although injustice like this has become illegal in recent years, the fear it has created remains, resulting in the distrust of health care professionals and birth control methods.  Many woman have not received justice for the things done to them.<ref>{{Cite web |title=RISD/Athenaeum / All Locations |url=https://librarycat.risd.edu/wamvalidate?url=https%3A%2F%2F0-eds-s-ebscohost-com.librarycat.risd.edu%3A443%2Feds%2Fdetail%2Fdetail%3Fvid%3D0%26sid%3D3c02b90e-8a6a-4a68-a9aa-b0d1c0c977af@redis%26bdata%3DJnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3D%3D |access-date=2023-05-18 |website=librarycat.risd.edu}}</ref> Medical research has historically been a form of violence for black communities living within the United States.

In 2001 the [[National Medical Association|Journal of the National Medical Association]] has concluded that this fear causes those within the African American community to avoid clinical trials. Although these trials are now set up to protect participants, black communities remain wary. This also has its downsides, as it's impossible to know if drugs will impact white and colored persons the same without these trials.<ref name=":19" /> Past medical malpractice has led to distrust, which in turn makes creating necessary medicine for the black community more difficult. Perpetuating the lack of resources and health care available to black communities. The experimentation and abuse set onto black bodies in the pursuit of medical development has a long and treacherous history. The Tuskegee experiment is one of the more well known experiment, where black men with [[Syphilis]] were left untreated to ease the doctors' curiosities concerning the natural course of the disease when left untreated. Many of the men were told that their study was concerning "bad blood" and nothing more. The doctors would dissuade these individuals from seeking outside help, while performing blood draws, spinal taps, and autopsies.<ref name=":20" /> The Tuskegee experiments have had generational consequences in the belief of health care.  There are many in the black community who believe the government  injected syphilis virus into those men in the experiment. Although this has not been factually proven, rumors within the community were enough to create long withstanding distrust. The same goes for agreeing to being an organ donor on a drivers license. Many African Americans will immediately say no, as there's a belief that their organs will be misused.<ref name=":21" />

Hospitals have long been spaces that have made black persons within the United States feel unwelcomed. Hospitals that were available to black communities have a history of being underfunded and racially discriminatory environments. A study performed in early 2022 by [[Lown Institute]] identified hospitals which still used segregation practices that would underserve patients from colored communities. Meanwhile, some of the more inclusive hospitals gain less revenue than these hospitals with exclusionist practices.<ref>{{Cite web |last=Garber |first=Judith |date=2022-08-08 |title=Hospitals serving more Black patients are at a financial disadvantage, study finds |url=https://lowninstitute.org/hospitals-serving-more-black-patients-are-at-a-financial-disadvantage-study-finds/ |access-date=2023-05-18 |website=Lown Institute |language=en-US |archive-date=2023-05-09 |archive-url=https://web.archive.org/web/20230509005733/https://lowninstitute.org/hospitals-serving-more-black-patients-are-at-a-financial-disadvantage-study-finds/ |url-status=live }}</ref> Many of these hospitals receive lower payments for patient care. This could be the direct result of the present wealth imbalances between races within the United States. Research done by the [[Journal of General Internal Medicine]] has determined that persevering funding disparities have led to less quality resources for hospitals that predominantly serve black patients.<ref>{{Cite journal |last1=Himmelstein |first1=Gracie |last2=Ceasar |first2=Joniqua N |last3=Himmelstein |first3=Kathryn EW |date=February 2023 |title=Hospitals That Serve Many Black Patients Have Lower Revenues and Profits: Structural Racism in Hospital Financing |journal=Journal of General Internal Medicine |language=en |volume=38 |issue=3 |pages=586–591 |doi=10.1007/s11606-022-07562-w |pmid=35931911 |issn=0884-8734|pmc=9361904 }}</ref>

Studies by the [[Health and Human Rights|Health and Human Rights Journal]] in 2020 have determined widening health disparities in the wake of COVID-19. Testing kits were initially provided equally among the labs within the U.S., however, there was a lack of consideration of population density within those communities. It was determined that many African Americans lacked access to these tests. Within Kansas, out of roughly 94,780 tests, only 4,854 were used by African Americans, while 50,070 were used by white individuals. African Americans within the state made up roughly one third of all COVID-19 related deaths, demonstrating how Black communities were disproportionately impacted. The predisposal of low wage jobs to communities of color impact the ability to access necessary health resources.  Black communities' fear and distrust within health professionals has led to underlying health issues becoming untreated. When a person with these health issues comes into contact with COVID-19, it becomes a much more lethal situation.<ref>{{Cite journal |last=Reyes M. |first=Vasquez |date=2020 |title=The Disproportional Impact of COVID-19 on African Americans. Health Hum Rights |journal=Health and Human Rights |volume=22 |issue=2 |pages=299–307 |pmid=33390715 |pmc=7762908 }}</ref>

===Environmental racism===
{{Main|Environmental racism}}
{{see also|Cancer Alley}}
Environmental racism is the intentional or unintentional targeting of minority communities for the siting of [[pollution|polluting]] [[Industry (economics)|industries]] such as [[toxic waste]] disposal, through the race-based differential enforcement of environmental rules and regulations and exclusion of people of color from public and private boards and regulatory bodies, resulting in greater exposure of the community to pollution. RD Bullard writes that a growing body of evidence reveals that people of color and low-income persons have borne greater environmental and health risks than the society at large in their neighbourhoods, workplaces and playgrounds.<ref>{{cite journal|doi=10.1080/13549839908725577 |title=Dismantling Environmental Racism in the USA |year=1999 | vauthors = Bullard RD |journal=Local Environment |volume=4 |pages=5–19 |issue=1|bibcode=1999LoEnv...4....5B }}</ref>

Environmental racism stems from the environmental movement of the 1960s and 1970s, which focused on environmental reform and wildlife preservation and protection, and was led primarily by the middle class. The early environmental movement largely ignored the plight of poor people and people of color who, even in the mid-20th century, were increasingly exposed to environmental hazards.<ref>{{cite journal | vauthors = Northridge ME, Shepard PM | author-link1 = Mary Northridge | title = Environmental racism and public health | journal = American Journal of Public Health | volume = 87 | issue = 5 | pages = 730–2 | date = May 1997 | pmid = 9184496 | pmc = 1381040 | doi = 10.2105/ajph.87.5.730 }}</ref>

Policies related to [[redlining]] and [[urban decay]] can also act as a form of [[environmental racism]], and in turn, affect public health. Urban minority communities may face environmental racism in the form of parks that are smaller, less accessible and of poorer quality than those in more affluent or white areas in some cities.<ref name="parks">''[http://www.berkeleydaily.org/text/article.cfm?issue=11-13-07&storyID=28458 Minority Communities Need More Parks, Report Says] {{webarchive|url=https://web.archive.org/web/20080220064123/http://www.berkeleydaily.org/text/article.cfm?issue=11-13-07&storyID=28458 |date=2008-02-20 }}'' by Angela Rowen The Berkeley Daily Planet</ref> This may have an indirect effect on health since young people have fewer places to play and adults have fewer opportunities for exercise.<ref name="parks"/>

Although impoverished or underdeveloped communities are at greater risk of contracting illnesses from public areas and disposal sites, they are also less likely to be located near a distinguished hospital or treatment center. Hospitals relocate to wealthier areas where the majority of patients are privately insured, thus reducing the number of low-income patients.<ref name=":7">{{cite news|url=https://money.cnn.com/2015/04/20/news/economy/hospitals-relocating/index.html|title=Hospitals leave poorer communities for more wealthier ones | vauthors = Galewitz P |work=CNNMoney|access-date=2018-11-05}}</ref> Whereas hospitals were previously established in the areas with the greatest need, most are now focused on economic gain from private insurance companies, and are threatened by Medicare funding cuts.<ref name=":7" />

Robert Wallace writes that the pattern of the [[AIDS]] outbreak during the 80s was affected by the outcomes of a program of '[[planned shrinkage]]' directed in African-American and Hispanic communities, and implemented through systematic denial of municipal services, particularly fire extinguishment resources, essential for maintaining urban levels of population density and ensuring community stability.<ref>{{cite journal | vauthors = Wallace R | title = Urban desertification, public health and public order: 'planned shrinkage', violent death, substance abuse and AIDS in the Bronx | journal = Social Science & Medicine | volume = 31 | issue = 7 | pages = 801–13 | year = 1990 | pmid = 2244222 | doi = 10.1016/0277-9536(90)90175-R }}</ref> [[Institutionalized racism]] affects general health care as well as the quality of AIDS health intervention and services in minority communities. The overrepresentation of minorities in various disease categories, including AIDS, is partially related to environmental racism. The national response to the AIDS epidemic in minority communities was slow during the 1980s and '90s showing an insensitivity to ethnic diversity in prevention efforts and AIDS health services.<ref>{{cite journal | vauthors = Hutchinson J | title = AIDS and racism in America | journal = Journal of the National Medical Association | volume = 84 | issue = 2 | pages = 119–24 | date = February 1992 | pmid = 1602509 | pmc = 2637751 }}</ref>

=== Institutionalized racism ===
A major downfall of the U.S. healthcare system is the unconscious racial biases held by many white American doctors, often resulting in decreased quality of care for African American patients. One such example is the discrepancy in cardiovascular surgical procedures between white and black patients. Compared to their white counterparts, black patients are less likely to receive necessary coronary bypass surgeries and lipid-lowering medications upon discharge from the hospital.<ref name="Betancourt_2018">{{cite book|vauthors=Betancourt JR, Green AR|chapter=Racial and Ethnic Disparities in Health Care|date=2018|chapter-url=http://accessmedicine.mhmedical.com/content.aspx?aid=1155941056|title=Harrison's Principles of Internal Medicine|veditors=Jameson JL, Fauci AS, Kasper DL, Hauser SL|edition=20|publisher=McGraw-Hill Education|access-date=2018-11-05|archive-date=2024-07-12|archive-url=https://web.archive.org/web/20240712165818/https://accessmedicine.mhmedical.com/content.aspx?bookid=2129&sectionid=192010456|url-status=live}}</ref> This means that black patients leave treatment centers with a significantly different health outcome. African American patients are also less likely to receive a referral for [[Cardiac rehabilitation]] following a cardiac event and/or surgery.<ref>{{cite journal | vauthors = Koehler AN, Hodgson JL, et al. | title = Biopsychosocial-Spiritual Factors Impacting African American Patients' Cardiac Rehabilitation Referral and Participation | journal = Journal of Cardiopulmonary Rehabilitation and Prevention | volume = 36 | issue = 5 | pages = 320–330 | date = September 2016 | doi = 10.1097/HCR.0000000000000183 | pmid = 27496250 | s2cid = 10829735 | doi-access = free }}</ref> As a result, this potentially exacerbates other issues, creates development of ancillary conditions, disability, or even death from a lack of care due to subliminal racism. It is actions like these from White doctors that contribute to the higher incidence of non-communicable disease, such as heart disease, in the black community and shorter life expectancy. Some White health care providers also maintain problematic, overt ideas about their Black patients, with being seen as less intelligent, less able to abide by treatment regimens, and more inclined to be subjects of risky behavior than their White counterparts.<ref>{{Cite journal|last1=Hall|first1=William J.|last2=Chapman|first2=Mimi V.|last3=Lee|first3=Kent M.|last4=Merino|first4=Yesenia M.|last5=Thomas|first5=Tainayah W.|last6=Payne|first6=B. Keith|last7=Eng|first7=Eugenia|last8=Day|first8=Steven H.|last9=Coyne-Beasley|first9=Tamera|date=2015-10-15|title=Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review|journal=American Journal of Public Health|volume=105|issue=12|pages=e60–e76|doi=10.2105/AJPH.2015.302903|issn=0090-0036|pmc=4638275|pmid=26469668}}</ref> Institutionalized racism exhibits itself both in material conditions and in access to power.<ref name=":16" /> Whether through differential delivery and access to a quality education, appropriate housing, necessary employment, or any others that are regarded as the basics or necessities in life, reflect material conditions.<ref name=":16">{{Cite journal|last=Jones|first=Camara|date=August 2000|title=Levels of Racism: A Theoretic Framework and a Gardener's Tale|url=https://www.health.state.mn.us/communities/practice/resources/equitylibrary/docs/jones-allegories.pdf|journal=[[American Journal of Public Health]]|volume=90|issue=8|pages=1212–1215|doi=10.2105/ajph.90.8.1212|pmid=10936998|pmc=1446334|access-date=2021-03-19|archive-date=2020-11-02|archive-url=https://web.archive.org/web/20201102205342/https://www.health.state.mn.us/communities/practice/resources/equitylibrary/docs/jones-allegories.pdf|url-status=live}}</ref> An education is foundational to being able to achieve and attain for a better standards of living and longevity in life. However, with inequity in an education comes being place at a disadvantage, which doesn't level the playing ground for equal attainment. In the case of the black community, not only is the population discriminated against on the basis of race, but socioeconomic status, which gives rise to even greater inequality. In the aspect of access to power, examples include differential access to information (including one's own history), resources and expressing concerns or rights as equal members of the public.

One potential cause of this discrepancy in treatment is the systematic racism present in the medical field that targets the work of African American scientists. Research shows that doctors and scientists of color are significantly underfunded in the medical community, and are less likely than their white colleagues to win research awards from the [https://www.nih.gov/ National Institute of Health (NIH)]. Since patients of color are often treated by white doctors, miscommunication is common; research shows that many Americans feel their doctors do not listen to their questions or concerns, or are too uncomfortable to ask certain medical questions.<ref name="Betancourt_2018" />

To help build trust in the health care system amongst the African American community one step would be the need to address the lack of African American doctors. Studies have shown that African Americans make up thirteen percent of the United States population and only represent four percent of doctors in the country. One example is the lack of "Black" OGBYN. Many African American women have stated that their preference for a black doctor is derived from adverse issues coming from childbirth, and Black women are three times more likely to die from complications of childbirth than white women. This is only one example among many where the lack of representation is hurting a community that makes up a high percentage of the United States healthcare cases.<ref>{{Cite news|last=Zaragovia|first=Veronica|title=Trying To Avoid Racist Health Care, Black Women Seek Out Black Obstetricians|language=en|work=NPR.org|url=https://www.npr.org/sections/health-shots/2021/05/28/996603360/trying-to-avoid-racist-health-care-black-women-seek-out-black-obstetricians|access-date=2021-12-10|archive-date=2024-07-12|archive-url=https://web.archive.org/web/20240712165810/https://www.npr.org/sections/health-shots/2021/05/28/996603360/trying-to-avoid-racist-health-care-black-women-seek-out-black-obstetricians|url-status=live}}</ref>

===Segregation===
Some researchers suggest that racial segregation may lead to disparities in health and mortality.  Thomas LaVeis (1989; 1993) tested the hypothesis that [[Racial segregation in the United States|segregation]] would aid in explaining race differences in infant mortality rates across cities. Analyzing 176 large and midsized cities, LaVeist found support for the hypothesis. Since LaVeist's studies, segregation has received increased attention as a determinant of race disparities in mortality.<ref name="lavest"/> Studies have shown that mortality rates for male and female African Americans are lower in areas with lower levels of [[residential segregation]]. Mortality for male and female [[European Americans]] was not associated in either direction with residential segregation.<ref>{{cite journal | vauthors = Hart KD, Kunitz SJ, Sell RR, Mukamel DB | title = Metropolitan governance, residential segregation, and mortality among African Americans | journal = American Journal of Public Health | volume = 88 | issue = 3 | pages = 434–8 | date = March 1998 | pmid = 9518976 | pmc = 1508338 | doi = 10.2105/AJPH.88.3.434 }}</ref>

In a study by Sharon A. Jackson, Roger T. Anderson, Norman J. Johnson and Paul D. Sorlie the researchers found that, after adjustment for family income, [[Mortality rate|mortality]] risk increased with increasing minority residential segregation among Blacks aged 25 to 44 years and non-Blacks aged 45 to 64 years. In most age/race/gender groups, the highest and lowest mortality risks occurred in the highest and lowest categories of residential segregation, respectively. These results suggest that minority residential segregation may influence mortality risk and underscore the traditional emphasis on the social underpinnings of disease and death.<ref>{{cite journal | vauthors = Jackson SA, Anderson RT, Johnson NJ, Sorlie PD | title = The relation of residential segregation to all-cause mortality: a study in black and white | journal = American Journal of Public Health | volume = 90 | issue = 4 | pages = 615–7 | date = April 2000 | pmid = 10754978 | pmc = 1446199 | doi = 10.2105/AJPH.90.4.615 }}</ref>

Rates of heart disease among African Americans are associated with the segregation patterns in the neighborhoods where they live (Fang ''et al.'' 1998). Stephanie A. Bond Huie writes that neighborhoods affect health and mortality outcomes primarily in an indirect fashion through environmental factors such as smoking, diet, exercise, stress, and access to health insurance and medical providers.<ref>{{cite journal|doi=10.1080/027321701300202028 |title= The Concept of Neighborhood in Health and Mortality Research |year=2001 | vauthors = Huie SA |s2cid= 143628724 |journal=Sociological Spectrum |volume=21 |pages=341–358|issue=3}}</ref> Moreover, segregation strongly influences premature mortality in the US.<ref>{{cite journal | vauthors = Cooper RS, Kennelly JF, Durazo-Arvizu R, Oh HJ, Kaplan G, Lynch J | title = Relationship between premature mortality and socioeconomic factors in black and white populations of US metropolitan areas | journal = Public Health Reports | volume = 116 | issue = 5 | pages = 464–73 | year = 2001 | pmid = 12042610 | pmc = 1497360 | doi = 10.1016/S0033-3549(04)50074-2 }}</ref>

A 2024 study found that residential segregation resulted in negative birth outcomes for non-Hispanic Black infant populations in the area, while no comparable effects were detected for non-Hispanic White infant populations. <ref>{{cite journal |last1=Vu |first1=Hoa | last2=Green | first2 = Tiffany | last3 = Swan | first3 = Laura |title=Born on the wrong side of the tracks: Exploring the causal effects of segregation on infant health |journal=[[Journal of Health Economics]] |volume=95 |year=2024 |url = https://doi.org/10.1016/j.jhealeco.2024.102876}}</ref>

=== Racism towards doctors and health care professionals ===
Many healthcare professionals have experienced hate and racist remarks towards them at work. Whether it be at a hospital, a walk-in clinic, or a family doctor's office, people are hit with bias-based comments concerning "general bias, ethnicity / national origin, race, age, gender, accent, religion, political views, weight, medical education from outside the US, sexual orientation, and more".<ref name=":5">{{cite web | vauthors = Tedeschi B | date = 18 October 2017 | title = 6 in 10 doctors report abusive remarks from patients, and many get little help coping with the wounds | url = https://www.statnews.com/2017/10/18/patient-prejudice-wounds-doctors/ | work = STAT | access-date = 25 April 2019 | archive-date = 25 April 2019 | archive-url = https://web.archive.org/web/20190425041018/https://www.statnews.com/2017/10/18/patient-prejudice-wounds-doctors/ | url-status = live }}</ref> This study conducted features the races of "African American/Black, Asian, Caucasian, and Hispanic"<ref name=":5" /> Training for doctors to handle this type of prejudice at their work is very low. The even greater downfall are men and women who become faced with bigotry from unruly, demeaning, and complicated patients that disrupt delivery of care. Doctors and healthcare professionals could feel years of education could have been unworthy of such circumstances, unappreciated, and uninspired for continued service. Although all healthcare professionals could be at risk for discrimination from patients, some populations come to experience it a greater rate. While the number of doctors and other critical healthcare professionals are in need, the thoughts of dealing with racism or any other prejudice can be discouraging.

The group that comes to greatest experience racism are black healthcare professionals, such as doctors and nurses that are tasked with the duty of providing care to the general public. Like much of the views held by white doctors regarding black patients, reflect the same perspectives of white patients regarding black doctors. A patient's denial of care based on the attending physician's race or background can raise thorny ethic, legal, and clinical issues that could have been avoided in the first place. Even more, black faculty members have encountered a lack of mentorship and sponsorship, barriers to promotion and advancement, and lack of supportive, alongside hostile, work environments as factors in attrition from academic medical centers. Experiencing discrimination is associated with several negatives including career outcomes and an unwelcoming work environment. Professionals can often feel alone and reluctant to be accepting of racism as a part of the profession. A greater initiative from healthcare organizations surrounding policy that protects not only black doctors, but other professionals that deliver unsurpassed care retains the much needed diversity and leadership in medicine.

===Homicide===
Homicide plays a significant role in the racial gap in life expectancy. In 2008, homicide accounted for 19% of the gap among black men, though it did not play a significant role in the decline in the gap from 2003 to 2008.<ref>{{cite journal | vauthors = Harper S, Rushani D, Kaufman JS | title = Trends in the black-white life expectancy gap, 2003-2008 | journal = JAMA | volume = 307 | issue = 21 | pages = 2257–9 | date = June 2012 | pmid = 22706828 | doi = 10.1001/jama.2012.5059 | doi-access = free }}</ref> A report from the [[U.S. Department of Justice]] states "In 2005, homicide victimization rates for blacks were 6 times higher than the rates for whites."<ref>[http://www.ojp.usdoj.gov/bjs/homicide/race.htm Homicide trends in the U.S.] {{webarchive|url=https://web.archive.org/web/20061212100248/http://www.ojp.usdoj.gov/bjs/homicide/race.htm |date=2006-12-12 }}, U.S. Department of Justice</ref> Research by [[Robert J. Sampson]] indicates that the high degree of residential segregation in African American neighborhoods is responsible for the high homicide rate among African Americans.<ref name=wc2001/>

===Trends===
Based on data for 1945 to 1999, forecasts for relative black: white age-adjusted, all-cause mortality and white: black life expectancy at birth showed trends toward increasing disparities. From 1980 to 1998, average numbers of excess deaths per day among American blacks relative to whites increased by 20%.<ref>{{cite journal | vauthors = Levine RS, Foster JE, Fullilove RE, Fullilove MT, Briggs NC, Hull PC, Husaini BA, Hennekens CH | title = Black-white inequalities in mortality and life expectancy, 1933-1999: implications for healthy people 2010 | journal = Public Health Reports | volume = 116 | issue = 5 | pages = 474–83 | year = 2001 | pmid = 12042611 | pmc = 1497364 | doi = 10.1016/s0033-3549(04)50075-4 }}</ref> David Williams writes that higher disease rates for blacks (or African Americans) compared to whites are pervasive and persistent over time, with the racial gap in mortality widening in recent years for multiple causes of death.<ref name=autogenerated1 /> [[Junk food]] advertisements target African Americans.<ref>{{cite web | vauthors = Ravitz J | work = CNN | date = 15 January 2019 | title = Black and Hispanic youth are targeted with junk food ads, research shows | url = https://www.cnn.com/2019/01/15/health/junk-food-ads-black-hispanic-youth/index.html | access-date = 2 June 2020 | archive-date = 13 April 2020 | archive-url = https://web.archive.org/web/20200413043431/https://www.cnn.com/2019/01/15/health/junk-food-ads-black-hispanic-youth/index.html | url-status = live }}</ref>

===Sexually transmitted diseases===
African Americans have higher rates of [[HIV]] and other STDs.<ref>[https://www.cdc.gov/health-disparities-hiv-std-tb-hepatitis/populations/black-african-american.html#:~:text=In%202018%2C%20African%20American%2FBlack,were%20attributed%20to%20heterosexual%20contact. Health Disparities in Black or African American People]</ref>

== Latinos and Hispanics ==

=== History ===
While [[Hispanic and Latino Americans|Latino and Hispanic]] populations are not considered a race category by the U.S. Census, this section of the article refers to Latinos or Hispanics as an ethnic group, as classified by the Census Bureau. Hispanic usually refers to the language and individuals whose ancestry comes from a Spanish-speaking country. Latino usually refers to geography, specifically to Latin America, including Mexico, the Caribbean, Central America and South America.<ref>{{Cite web|url=https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts|title=Mental Health Disparities: Diverse Populations|access-date=2020-05-20|archive-date=2020-05-07|archive-url=https://web.archive.org/web/20200507160530/https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts|url-status=dead}}</ref> References to the Latino and Hispanic community in the United States are frequently linked to discussions about immigration. The geographic origins of Hispanic and Latino influxes of immigration have changed through the years. During the 2010s [[Latin America]]n and [[Caribbean]] countries have accounted for the main source of immigrant populations migrating towards the United States.

The [[Hispanic paradox|Hispanic Paradox]] is an important aspect of discussions around the history of the health of Latino and Hispanic populations in the United States. In 1986, Prof. Kyriakos Markides conceived the term "the Hispanic paradox" to refer to the epidemiological phenomenon that Hispanic individuals in the US live longer than their white non-Hispanic counterparts despite the general lower socioeconomic status of the population and their relative lack of access to healthcare. The [[Centers for Disease Control and Prevention|US Centers for Disease Control and Prevention]] published a report on May 5, 2015, relating to the general status and causes of deaths of Hispanic population in the United States. The report utilized mortality indicators and national health surveillance of Hispanic populations compared to their White counterparts to explore the possibility of Markides' [[Hispanic paradox|paradox]]. Primarily results indicated that Hispanic deaths from diabetes, liver disease, and homicide were substantially higher than in non-Hispanic white populations. Nevertheless, Hispanics generally had a 24% lower risk of all-cause mortality and lower risks of nine of the leading 15 causes of death in the USA (most notably, cancer and heart disease).

Tied to the health status of Latinos and Hispanic in the United States is an observed mistrust of doctors and the health system. This mistrust can stem from language barriers, threat of [[discrimination]] and historical events that dismissed the consent of patients like the [[Sterilization of Latinas|sterilization of Latina women]] in California until 1979. According to a study conducted by the [[United States Census Bureau]], Hispanics were the population that was most likely to have never visited a medical provider, with 42.3 percent reporting that they had never done so. The [https://pubmed.ncbi.nlm.nih.gov/12019990/ U.S healthcare system] is largely geared toward serving English speakers which creates an issue for Latino and Hispanic individuals that don't speak English. Five(55%) of the nine studies examining access to acre found a significant adverse effect of language; three (33%) found mixed or weak evidence that language affected access. Six (86%) of the seven studies evaluating quality of care found a significant detrimental effect of language barriers.

=== Mental health ===
In many Hispanic and Latino communities, [[mental health]] problems are viewed as a sign of weakness and are not necessarily validated. Hispanics/'''Latino''' are often cited as a high-risk group for mental health issues, particularly for [[substance abuse]], [[Depression (mood)|depression]], and [[anxiety]]. A study conducted from 2008 to 2011, sampled more than 16,000 Hispanics/Latinos ages 18 to 74 in four diverse communities in the states of New York, Chicago, San Diego, and Miami. The findings demonstrated that 27 percent of Hispanics/Latinos in the study reported high levels of depressive symptoms.

[https://www.mhanational.org/issues/latinohispanic-communities-and-mental-health U.S population] is made up of 17.8% Hispanic and Latino individuals. Out of those individuals, 15% had a diagnosable mental illness. This means 8.9 million people who are Latino or Hispanic suffered from a mental illness. Immigrants in this community face inequalities in socioeconomic status, education, and access to health care services.<ref>{{Cite web|url=https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts|title=Mental Health Disparities: Diverse Populations|access-date=2020-05-20|archive-date=2020-05-07|archive-url=https://web.archive.org/web/20200507160530/https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts|url-status=dead}}</ref> Hispanics are one of the lowest races/ethnicities to receive treatment based on research from 2013.

Research have signaled multiple sources of stress that could potentially impact mental health outcomes in Hispanic/Latino communities. For example, language influences the way patients are evaluated. Several studies have found that [[Multilingualism|bilingual]] patients are evaluated differently when interviewed in English as opposed to Spanish and that Hispanics are more frequently under-treated. Furthermore, Hispanics/Latinos are more likely to report poor communication with their health provider. Income has also proven to be a significant factor that impacts the mental health of Latino communities, as low-income individuals may have limited access to mental health services. Nationally, 21.1% of Hispanics are uninsured compared to 7.5% non-Hispanic individuals. Low insurance coverage affects this group of people because ethnicity plays a role, immigration status, and [https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts citizenship status.] Only 1 in 10 Hispanics with a [[mental disorder]] utilizes mental health services from a general health care provider.  Moreover, only 1 in 20 Hispanic individuals receives such services from a mental health specialist.

=== Maternal and child health ===
{{Main|Race and maternal health in the United States}}
According to the Census Bureau, while the number of non-Hispanic white women of childbearing age (15–44 years) is projected to decrease from 36.5 million in 2010 to 35.2 million in 2020, the number of Hispanic women of childbearing age is projected to increase from 11.8 million in 2010 to more than 13.8 million Hispanic women. The increase in the Hispanic population in the United States is driven in part by high fertility rates. During 2012, the fertility rate for Hispanic identifying women was 74.4 births per 1,000 women of ages 15–44. In 2012, Hispanic women accounted for 23 percent or 907,677 of all of the 3,952,841 live births in the United States. Within the Hispanic population, the majority of births occurred among those of Mexican descent (61.2%), followed by Central/South American (14.5%), Puerto Rican (7.4%), and Cuban (1.9%).

There is high medical disparity amongst hospitals contributing to high mortality rates based on resources compared to non-Hispanic and [https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts white mothers.] Examining the data from 2010, the [[Infant mortality|infant mortality rate]] (death during the first year of life) among Hispanic women was 5.3 per 1,000 [[Live birth (human)|live births]]. This rate accounted for more than 20 percent of all infant deaths in the United States during the year 2010. According to the National Center for Health Statistics, "when specific causes of infant mortality are examined the leading cause of infant deaths in 2010 among Hispanics was [[birth defect]]s (136.5 per 100,000 live births), followed by prematurity/[[Low birth weight|low birth-weight]] (85.0 per 100,000 live births), maternal complications of pregnancy. Hispanic mothers were 70 percent as likely to receive late or no prenatal care as compared to non-Hispanic white mothers, in [https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=68 2017]. Research suggests that improving quality of the lowest-performing hospitals could benefit both non-Hispanic white and Hispanic women while reducing ethnic disparities in serve maternal [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380443/ morbidity rates.]

=== Access to healthcare ===
Hispanic health is often shaped by factors such as language/cultural barriers, lack of access to preventive care,  [https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 the lack of health insurance], illegal immigration status, mistrust, and [https://www.aafp.org/afp/2013/0101/p48.html illiteracy.] The Centers for Disease Control and Prevention has cited some of the leading causes of illness and death among Hispanics, which include heart disease, cancer, unintentional injuries (accidents), stroke, and diabetes. Latino and Hispanic communities have a hard time communicating with health professionals due to a language or cultural barrier; as a result, they turn to outside sources for help and [https://www.aarp.org/health/conditions-treatments/info-2018/latinos-hispanics-doctors-nursing-homes.html medication.] The survey finds that half of those who have faced these barriers turned to a family member or to another health care provider for assistance. Many hospitals and offices lack trained interpreters and rely on ad hoc interpretation by bilingual staff or even the children of [https://www.aafp.org/afp/2013/0101/p48.html patients]. Latino and Hispanic communities have concerns when it comes to long care services in the United States. Some have concerns about finding nursing homes and assisted-living facilities that will respect their religious or spiritual beliefs, though fewer have the same concern about home [https://www.aarp.org/health/conditions-treatments/info-2018/latinos-hispanics-doctors-nursing-homes.html health aides.] The lack of education creates another barrier for individuals in these communities that are bilingual but can't understand medical terms. According to a 2017 U.S. Census Bureau report, 68.7 percent of Hispanics in comparison to 92.9 percent non-Hispanic whites had a [https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 high school diploma.] More than one-fourth of Hispanic adults in the United States lack a usual health care provider, and a similar proportion report obtaining no health care information from medical personnel in the [https://www.pewresearch.org/hispanic/2008/08/13/hispanics-and-health-care-in-the-united-states-access-information-and-knowledge/ past year.]  Latino adults receive information from an alternative source, such as television and radio, based on a [https://www.pewresearch.org/hispanic/2008/08/13/hispanics-and-health-care-in-the-united-states-access-information-and-knowledge/ PHC survey.] Not only are most Latinos obtaining information from media sources, but a sizeable proportion (79 percent) say they are acting on this information. Many Latinos are accustomed to self-treating because most pharmaceuticals are available without prescription in their home countries. Immigrants may face additional obstacles to care, including illegal immigration status (fears of deportation), illiteracy, and a radically different set of [https://www.aafp.org/afp/2013/0101/p48.html health beliefs.]

== Native Americans and Alaska Natives ==
{{Main|Health of Native Americans in the United States}}

=== History ===
[[History of Native Americans in the United States|American Indian and Alaska Native populations]] in the United States have experienced disproportionately negative health outcomes compared to non-Hispanic whites since colonists arrived at the continent in the 15th century, particularly due to epidemics introduced by colonial groups and violent encounters with colonists.{{Citation needed|date=November 2023}} A [[Modern social statistics of Native Americans#Health standards|disparity]] in health outcomes between American Indians and Alaska Natives and the general U.S. population persists today, largely due to a lack of access to adequate medical care, language barriers, and decreased quality of medical services in regions with significant American Indian and Alaska Native populations. One of the elements of the inequality involves the lack of research that begins to look into access to medical care for Native Americans, and when research does exist, it tends to be broad and not focus on specific elements, including childhood.<ref>{{cite journal | vauthors = Sarche M, Spicer P | title = Poverty and health disparities for American Indian and Alaska Native children: current knowledge and future prospects | journal = Annals of the New York Academy of Sciences | volume = 1136 | pages = 126–36 | date = 2008 | issue = 1 | pmid = 18579879 | pmc = 2567901 | doi = 10.1196/annals.1425.017 | bibcode = 2008NYASA1136..126S }}</ref> As of October 2019, American Indian and Alaska Native people who are born today have a life expectancy of 73 years, compared to the 78.5 years for the general American population.<ref name=":0" />

The [[Indian Health Service|Indian Health Service (IHS)]] is a federal agency committed to serving the health needs of American Indian and Alaska Native populations. Two pieces of legislation, the Snyder Act of 1921 and Indian Health Care Improvement Act of 1976, obligated the United States government to provide healthcare to federally recognized Native American tribes.<ref>{{cite web|url=https://www.ihs.gov/ihcia/|title=Indian Health Care Improvement Act {{!}} Indian Health Service (IHS)|website=Indian Health Care Improvement Act|language=en|access-date=2019-04-09|archive-date=2019-04-01|archive-url=https://web.archive.org/web/20190401000655/https://www.ihs.gov/ihcia/|url-status=live}}</ref> In 1955, this responsibility moved to the IHS, housed under the U.S. Department of Health and Human Services.<ref name=":22">{{cite book|url=https://www.ncbi.nlm.nih.gov/books/NBK425854/|title=Native American Health: Historical and Legal Context|vauthors=Weinstein JN, Geller A, Negussie Y, Baciu A, ((Committee on Community-Based Solutions to Promote Health Equity in the United States)), ((Board on Population Health and Public Health Practice)), ((Engineering Health and Medicine Division, National Academies of Sciences ))|date=2017-01-11|publisher=National Academies Press (US)|isbn=978-0-309-45296-0|access-date=2019-04-25|archive-date=2020-12-23|archive-url=https://web.archive.org/web/20201223032940/https://www.ncbi.nlm.nih.gov/books/NBK425854/|url-status=live}}</ref> In 2019, the IHS served over 2.3 million American Indians and Alaska Natives from 573 different federally-recognized tribes.<ref name=":32">{{cite web|url=https://www.ihs.gov/newsroom/factsheets/ihsprofile/|title=IHS Profile {{!}} Fact Sheets|website=Newsroom|language=en|access-date=2019-04-09}}</ref>

Since its implementation, the IHS has been criticized for its treatment of patients. Most notably, throughout the 1960s and 1970s, the IHS forcibly [[Sterilization of Native American women|sterilized]] thousands of American Indian and Alaska Native women.<ref name=":42">{{cite journal|vauthors=Torpy SJ|date=2000|title=Native American Women and Coerced Sterilization: On the Trail of Tears in the 1970s|url=https://www.law.berkeley.edu/php-programs/centers/crrj/zotero/loadfile.php?entity_key=QFDB5MW3|journal=American Indian Culture and Research Journal|volume=24|issue=2|pages=1–22|doi=10.17953/aicr.24.2.7646013460646042|via=Berkeley Law|access-date=2019-04-25|archive-date=2019-10-28|archive-url=https://web.archive.org/web/20191028030140/https://www.law.berkeley.edu/php-programs/centers/crrj/zotero/loadfile.php?entity_key=QFDB5MW3|url-status=dead}}</ref> A 2000 study found that between 1973 and 1976, physicians at four IHS facilities – those in Albuquerque, Oklahoma City, Phoenix, and Aberdeen, South Dakota – sterilized 3,406 women, 3,001 of whom were of childbearing age at the time.<ref name=":42" />

The federal government has been criticized for the lack of funding granted to the IHS. Expenditures per capita for IHS have been substantially lower than those for other federally funded healthcare programs.<ref name=":22" /> Studies have found that physicians employed by the IHS express a need for increased funding for the agency, to adequately meet the healthcare needs of American Indians and Alaska Natives in the United States.<ref name=":22" />

Because the IHS serves only federally-recognized tribes, not all people in the United States that identify with this racial group have access to IHS resources. The American Indian and Alaska Native population includes, but is not limited to, those who are affiliated with federally recognized tribes – there are also state-recognized tribes and unrecognized tribes, and individuals who do not live on tribal lands but identify as Native American.<ref name=":32" /> Thus, while IHS plays a role in the health outcomes of American Indian and Alaska Native identifying people in the United States, it is not the sole determinant of health outcomes for this census group.

=== Mental health ===
American Indian and Alaska Native identifying people are more likely to have unmet mental health needs, and to experience major depressive episodes than the non-Hispanic white population. In 2016, 6.7% of American Indian and Alaska Native adults reported having needs for mental health services that had been unmet in the last twelve months, compared to 5.4% of the non-Hispanic white population. 8.3% of American Indian and Alaska Native adults reported experiencing a major depressive episode in the past twelve months, whereas only 7.4% non-Hispanic white adults did so.<ref name=":52">Urban Indian Health Institute, Seattle Indian Health Board. (2016). Community Health Profile: National Aggregate of Urban Indian Health Program Service Areas. Seattle, WA: Urban Indian Health Institute.</ref> 

American Indian and Alaska Native adolescents are more likely to have experienced a major depressive episode in their lifetime, with 16.7% of adolescents in 2016 reporting such an episode compared to 14.4 of non-Hispanic white adolescents.<ref name=":52" /> The 2014 White House Report on Native Youth noted that Native Americans between the ages of 15 and 24 years [[Suicide among Native Americans in the United States|were 2.5 times more likely to commit suicide]] than the national average.<ref>{{Cite web|url=https://boardingschoolhealing.org/education/impact-of-historical-trauma/|title=Impact of Historical Trauma|last=NABS|website=The National Native American Boarding School Healing Coalition|language=en-US|access-date=2020-04-22}}</ref> Rates of post-traumatic stress disorder (PTSD) are also higher for American Indians and Alaska Natives than the general United States population.<ref>{{cite journal | vauthors = Beals J, Novins DK, Whitesell NR, Spicer P, Mitchell CM, Manson SM | title = Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: mental health disparities in a national context | journal = The American Journal of Psychiatry | volume = 162 | issue = 9 | pages = 1723–32 | date = September 2005 | pmid = 16135633 | doi = 10.1176/appi.ajp.162.9.1723 }}</ref>

[[Historical trauma]] is also an issue faced by Native Americans. [[Maria Yellow Horse Brave Heart|Dr. Maria Yellow Horse Brave Heart]] first described historical trauma for Native Americans in the 1980s as, "cumulative emotional and psychological wounding", which in turn affects both physical and mental health.<ref name=":4">{{Cite web|url=https://dodgingbullets.org/historical-trauma-the-effects-of-learned-helplessness-in-american-indian-children-2/|title=Historical Trauma & The Effects|website=Dodging Bullets|language=en-US|access-date=2020-04-22}}</ref> The traumatic events she references include imprisonment and genocide, among other causes.<ref name=":4" /> She outlines the six steps of the historical trauma as follows: 1) First Contact (including the grieving period and following colonization period), 2) Economic Competition, 3) Invasion (causing more death and grieving), 4) Reservation Period, 5) [[American Indian boarding schools|Boarding School]] Period (focusing on the destruction of cultural aspects, including family structure and language), and 6) Forced Relocation.<ref name=":4" />

Some critics of current mental health practices have argued that mental health professionals working with American Indian and Alaska Native communities should adjust their practices to patients' cultures, particularly by increasing attention to spirituality.<ref name=":52" /> There have also been efforts to increase understanding of how the symptoms of [[Diagnostic and Statistical Manual of Mental Disorders|DSM-recognized]] disorders may differ in indigenous communities as a result of different cultural practices.<ref name=":52" />

In 2016, American Indian and Alaska Native youth were slightly less likely than non-Hispanic white youth to receive specialty mental health services. They were significantly more likely to receive non-specialty mental health services such as counseling from social workers, school counselors, and pediatricians.<ref name=":52" />

[[Alcohol and Native Americans|Alcoholism in American Indian and Alaska Native populations]] has often been studied, although the rates found depend on both the statistics used and how the statistics are divided. One study from 1995 found that 26.5% of deaths for American Indian and Alaska Native men were alcohol-related, while about 13.2% were for women.<ref name=":9">Beauvais, Fred (1998). "American Indians and Alcohol" (PDF). ''Spotlight on Special Populations''. 22, No. 4.</ref> Another study from 1996 found that in 1993, 34% of adolescents (grades 7–12) reported they had ever been drunk.<ref name=":9" /> Historically, the perceived rates of alcoholism in Native Americans led to the stereotype that they are genetically more prone to alcoholism.<ref name=":9" /> This stereotype has been called into question, with modern researchers instead focusing on how [[historical trauma]]<ref name=":4" /> and [[Posttraumatic stress disorder|PTSD]] are correlated with [[alcoholism]].<ref name=":9" />

=== Maternal and child health ===
{{Main|Race and maternal health in the United States}}

In 2016, maternal mortality rates were 4.5 times higher for American Indian and Alaska Native women than for non-Hispanic white women.<ref name=":52"/> Between 2008 and 2012, 5.3% of American Indian and Alaska Native women giving birth were diagnosed with gestational diabetes, compared to 3.7% of non-Hispanic white women.<ref name=":52" />

American Indian and Alaska Native women are less likely to receive prenatal care than non-Hispanic white women in the United States. In 2016, 60.4% of American Indian and Alaska Native women received prenatal care in their first trimester, compared to 81.6% of non-Hispanic white women. American Indian and Alaska Native women are significantly more likely to not begin receiving prenatal care until their third trimester – 9.3% of American Indian and Alaska Native women, compared to 2.9% of non-Hispanic white women. Whereas 0.8% of non-Hispanic white women do not receive any prenatal care throughout their pregnancy, 2.3% of American Indian and Alaska Native women go entirely without prenatal care.<ref name=":52" />

The infant mortality rate for American Indian and Alaska Native populations exceeds that of non-Hispanic white identifying people in the United States. In 2016, American Indians and Alaska Natives had an infant mortality rate of 8.4 per 1,000 live births, compared to 4.1 per 1,000 non-Hispanic white live births. 15.2% of infants born to American Indian and Alaska Native women are born prematurely, compared to 10.7% of infants born to non-Hispanic white women.<ref name=":52" />

=== Environmental Racism ===
Native American tribes in 2012 occupied 95 million acres of various ecosystems across the United States.<ref name=":10">{{cite journal | vauthors = Weinhold B | title = Climate change and health: a Native American perspective | journal = Environmental Health Perspectives | volume = 118 | issue = 2 | pages = A64-5 | date = February 2010 | pmid = 20123636 | pmc = 2831938 | doi = 10.1289/ehp.118-a64 }}</ref> Climate change affects the wildlife and resources that many tribes rely on, and activities such as [[Hydraulic fracturing|fracking]] threaten their access to clean water.<ref name=":10" /> Alaskan Native Americans use surrounding resources for approximately 80% of their diets and have faced [[coastal flooding]] as a result of climate change, so they are an especially vulnerable group.<ref name=":10" /> The tribes will sometimes be willing to stay on the same land they have occupied for many years, even if the environment becomes threatening, which leads to health problems such as consuming [[Environmental racism in the United States#Water quality|contaminated water]].<ref>{{Cite web|url=https://www.yaleclimateconnections.org/2012/06/native-americans-and-a-changing-climate/|title=Native Americans and a Changing Climate » Yale Climate Connections|date=2012-06-21|website=Yale Climate Connections|language=en-US|access-date=2020-04-22|archive-date=2020-04-06|archive-url=https://web.archive.org/web/20200406213044/https://www.yaleclimateconnections.org/2012/06/native-americans-and-a-changing-climate/|url-status=live}}</ref>

One of the most recent examples of environmental effects on American Indian and Alaska Native people is the [[Keystone Pipeline|Keystone XL Pipeline]] affair, which involves a 1,200-mile pipeline crossing through the territory of the [[Fort Belknap Indian Reservation|Fort Belknap Indian Community]] of [[Montana]] and the [[Rosebud Indian Reservation|Rosebud Sioux Tribe]] of [[South Dakota]].<ref name=":11">{{Cite news|url=https://www.npr.org/2018/09/10/646523140/native-american-tribes-file-lawsuit-seeking-to-invalidate-keystone-xl-pipeline-p|title=Native American Tribes File Lawsuit Seeking To Invalidate Keystone XL Pipeline Permit|website=NPR.org|date=10 September 2018|language=en|access-date=2020-04-22|last1=Romo|first1=Vanessa}}</ref> While then-President [[Barack Obama]] halted construction in 2015 following protests citing fears of water contamination and the lack of research on the impact for Native communities, President [[Donald Trump]] approved construction shortly upon entering office.<ref name=":11" /> In 2018, Native groups put forward a lawsuit against the 2017 permit citing a failure to respect historically established borders and to conduct a risk assessment.<ref name=":11" /> In October 2019, over 380,000 gallons of crude oil were spilled by the Keystone Pipeline in [[North Dakota]], affecting nearby [[wetland]]s.<ref>{{Cite web|url=https://nypost.com/2019/10/31/nearly-400000-gallons-of-oil-spill-from-keystone-pipeline-in-north-dakota/|title=Nearly 400,000 gallons of oil spill from Keystone pipeline in North Dakota| vauthors = Feuerherd B |date=2019-11-01|website=New York Post|language=en|access-date=2020-04-22}}</ref>

== Asian Americans ==
{{main|Health status of Asian Americans}}

=== History ===

Asian Americans have been a prominent group in the United States for the past 200 years. According to the U.S. Census Bureau, there were estimated to be more than 22 million Asian Americans in the United States as of 2018.<ref>{{cite web |url=https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_1YR_B02018&prodType=table |title=Stats table |website=factfinder.census.gov |format=PDF |access-date=2019-07-12 |archive-url=https://web.archive.org/web/20190411173518/https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_1YR_B02018&prodType=table |archive-date=2019-04-11 |url-status=dead }}</ref> The five most prominent subgroups amongst Asian Americans are: Chinese Americans, Indian Americans, Filipino Americans, Vietnamese Americans and Korean Americans.<ref>{{cite web |url= https://www.pewforum.org/2012/07/19/asian-americans-a-mosaic-of-faiths-overview/ |title= Asian Americans: A Mosaic of Faiths |work= Pew Research Center |date= July 19, 2012 |access-date= July 13, 2019 |archive-date= July 16, 2013 |archive-url= https://web.archive.org/web/20130716064702/http://www.pewforum.org/Asian-Americans-A-Mosaic-of-Faiths-overview.aspx |url-status= live }}</ref>

Asian immigration in large numbers began in the 19th century with significant populations of Chinese Americans, Korean Americans and Japanese Americans entering the United States. However, in the 20th century, other groups such as Indian Americans began to immigrate in larger numbers due to more specialized jobs available in the United States.<ref>{{cite web|url=https://asiasociety.org/education/asian-americans-then-and-now|title=Asian Americans Then and Now|website=Asia Society|language=en|access-date=2019-04-13|archive-date=2019-04-13|archive-url=https://web.archive.org/web/20190413193351/https://asiasociety.org/education/asian-americans-then-and-now|url-status=live}}</ref>

Asian Americans have often been subject to racism like other minority groups within the United States. This can be seen in events like the Japanese Internment camps like Camp Manzanar that were built during World War II for Japanese Americans to live in and were subject to inhumane treatment.<ref>{{cite web|url=https://www.history.com/topics/world-war-ii/japanese-american-relocation|title=Japanese Internment Camps|website=HISTORY|date=29 October 2021 }}</ref>

As Asian Americans have not been coming to America in the numbers of Hispanic immigrants and African Americans, there have been fewer instances in which they have been used in medical trials and unfairly compensated. In addition, as the wave of migration of Asians to the United States has happened more recently, the history of this group in the United States is relatively young. As a result, there have not been governmental efforts to address health disparities between Asian Americans and the general populations like there have been with other groups like Hispanic Americans, African Americans, and Native Americans.<ref>{{cite journal | vauthors = Ghosh C | title = A national health agenda for Asian Americans and Pacific Islanders | journal = JAMA | volume = 304 | issue = 12 | pages = 1381–2 | date = September 2010 | pmid = 20858884 | doi = 10.1001/jama.2010.1358 }}</ref>

Asian Americans are the fastest-growing major racial or ethnic group in the United States according to a Pew Research Center analysis of U.S. Census Bureau data.<ref>{{Cite web|title=Pew Research Center|url=https://www.pewresearch.org/|website=Pew Research Center|language=en-US|access-date=2020-05-20|archive-date=2019-10-02|archive-url=https://web.archive.org/web/20191002005236/https://www.pewresearch.org/|url-status=live}}</ref>  As this race has become more of an integral part of US population more initiatives have been implemented such to address health needs specifically such the Initiative on Race implemented by President Clinton to eliminate health disparities in and among all racial and ethnic groups.{{citation needed|date=April 2023}}  Further research within the past 20 years has shown that Asian Americans are at high risk for hepatitis B, liver cancer, tuberculosis, and lung cancer, among other conditions.<ref>{{Cite journal| vauthors = Montenegro X |date=2014-12-12|title=Caregiving among Asian Americans and Pacific Islanders: Infographic [Chinese]|doi=10.26419/res.00092.004|doi-access=free}}</ref> The Asian American cancer burden is unique as they are the only racial/ethnic population to experience cancer as the leading cause of death and it has unusual aspects such as experiencing proportionally more cancers of infectious origin, such as human papillomavirus‐induced cervical cancer, hepatitis B virus‐induced liver cancer, and stomach cancer, than any other racial/ethnic population and, at the same time, experiencing an increasing number of cancers associated with "Westernization."<ref>{{cite journal | vauthors = Chen MS, Chow EA, Nguyen TT | title = The Asian American Network for Cancer Awareness, Research, and Training (AANCART)'s contributions toward reducing Asian American cancer health disparities, 2000-2017 | journal = Cancer | volume = 124 | pages = 1527–1534 | date = April 2018 | issue = Suppl 7 | pmid = 29578598 | pmc = 5875706 | doi = 10.1002/cncr.31103 }}</ref> Similarly, Asian Americans have a heightened risk of type 2 diabetes as its presence makes up 21% of the Asian American population, twice as high as non-Hispanic whites.<ref>{{cite journal | vauthors = Menke A, Casagrande S, Geiss L, Cowie CC | title = Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012 | journal = JAMA | volume = 314 | issue = 10 | pages = 1021–9 | date = September 2015 | pmid = 26348752 | doi = 10.1001/jama.2015.10029 | doi-access = free }}</ref> Finally, cardiovascular disease, the leading cause of death for all Americans, continues to disproportionally affect the Asian Americans who are disadvantageous in society due to various social determinants. These social determinants leading to health disparity include but not limit to lack of language proficiency, health illiteracy due to lower educational attainment, racial discrimination, economic instability and poor community engagement.<ref>{{Cite book|last=National Heart, Lung, and Blood Institute.|title=Addressing cardiovascular health in Asian Americans and Pacific Islanders: a background report|date=2000|publisher=The Institute|oclc=1086378731}}</ref>

=== Maternal and child health ===
{{Main|Race and maternal health in the United States}}
In 2002, it was reported that Asian American births accounted for 5.2% of the births in the United States. One study that compared births among Indian Americans and non-Hispanic white Americans revealed that Indian Americans had significantly lower birth weights than did non-Hispanic white Americans. It was also revealed that Indian American mothers and non-Hispanic white American mothers had similar rates of adequate prenatal care.<ref>[https://s3.amazonaws.com/academia.edu.documents/45736119/j.ijgo.2007.02.01720160518-30388-se0zuo.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1554059159&Signature=R5glLEyAXYZuAQTIYJBFcwohzeU%3D&response-content-disposition=inline%3B%20filename%3DBirth_outcomes_of_Asian-Indian-Americans.pdf]{{dead link|date=July 2019}}</ref> In addition, when the infant mortality rates were compared between the groups, Asian Americans (excluding Pacific Islanders) had a lower rate than did non-Hispanic white Americans. However, Pacific Islanders had an infant mortality rate that was much higher than did the Asian Americans and the non-Hispanic white Americans.<ref>{{cite web|url=https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=53|title=Infant Health & Mortality - The Office of Minority Health|website=minorityhealth.hhs.gov}}</ref>  Similarly, Asian Americans had a maternal mortality rate that was lower than that of non-Hispanic whites as well as the national average in the United States.

The demographic overview of Asian Americans shows that the birth rate for Asian American and Pacific Islander women is higher than for all other groups except Hispanic women, those mothers tend to be older on average than mothers of other races with the highest rate of births occurring among women aged 30–34 years, older than for other groups, and teen birth rates are overall lower for this population.<ref name="pmid22670489">{{cite journal | vauthors = Martin JA, Hamilton BE, Ventura SJ, Osterman MJ, Kirmeyer S, Mathews TJ, Wilson EC | title = Births: final data for 2009 | journal = National Vital Statistics Reports | volume = 60 | issue = 1 | pages = 1–70 | date = November 2011 | pmid = 22670489 | doi = | url = |lccn=2012397450|oclc=759577790}}</ref>

One of the main concerns remains the disparity of prenatal care utilization among Asian American women in communities across the United States and research has shown that subgroups of Asian American mothers are less likely than others to receive early and adequate prenatal care.<ref>{{cite journal | vauthors = Koroukian SM, Rimm AA | title = The "Adequacy of Prenatal Care Utilization" (APNCU) index to study low birth weight: is the index biased? | journal = Journal of Clinical Epidemiology | volume = 55 | issue = 3 | pages = 296–305 | date = March 2002 | pmid = 11864801 | doi = 10.1016/s0895-4356(01)00471-1 }}</ref> According to HealthIndicators.gov, explaining the data, "APNCU is a measure of prenatal care utilization that combines the month of pregnancy prenatal care begun with the number of prenatal visits. Rates can be classified as "intensive use," "adequate," "intermediate," or "less than adequate." For this measure, adequate prenatal care is defined as a score of either "adequate" or "intensive use.""<ref>{{Cite web|title=Citrix Gateway|url=https://workspace.ccs.infinibytecloud.com/vpn/index.html|website=workspace.ccs.infinibytecloud.com|access-date=2020-05-20|archive-date=2020-05-17|archive-url=https://web.archive.org/web/20200517154011/https://workspace.ccs.infinibytecloud.com/vpn/index.html|url-status=live}}</ref>

On a more positive note, The rate of mortality for Asian American and Pacific Islander babies is 4.78 per 1,000 live births, lower than what is found in the general population.<ref>{{Cite book|title=Encyclopedia of human development|others=Salkind, Neil J.|isbn=1-4129-3634-9|location=Thousand Oaks, Calif.|oclc=63525305}}</ref>

=== Mental health ===

There are not many studies concerning mental health outcomes among Asian Americans. Mental health in this group is reported to be relatively better than that of the general population. The Chinese American Psychiatric Epidemiological Study (CAPES) was commissioned to determine the incidence of mental health problems in the DSM III in Chinese American populations. The results of the study showed that roughly 4.9% of the population of Chinese Americans experienced depression this compares to 17.1% of White Americans were classified as clinically depressed.<ref>{{cite web|url= http://espace.library.uq.edu.au/view/UQ:153226/UQ152922_OA.pdf|title= The Economic Costs of Schizophrenia|date= 1985|website= espace.library.uq.edu.au|access-date= 2019-07-12|archive-date= 2021-02-26|archive-url= https://web.archive.org/web/20210226001641/https://espace.library.uq.edu.au/data/UQ_153226/UQ152922_OA.pdf?Expires=1614298689&Key-Pair-Id=APKAJKNBJ4MJBJNC6NLQ&Signature=IefRc9VG0Tm4ak30KiXNEYIrv62MCgr5eT-vdFMkVrG-TH-63-7dz0vs~GnkcP9NY9zNEfZZLCDudWWwqiV~kfNZfVOIa6Ff9zifri6nOGCH9CgKY3L2~tZEu5Brwj4YyWeoAM5sWk-BR0lMySJu~NSs2~YB8i2Ml8rI-Or0OzbRLcMnDB1IjzglKoAcMbG0OuYvxCRbNEew8TnyXIMhrxd70lIfElX96ng~VcfLROfM1D8HnokNkub4VICyB3To55vdQNBP~Z~-6iVhbZ8A1BonZOkewrq2GsNNC9~ewl2MFFPfdO8tnIEd~kxLVRb99DZ6fBzG4QPw018FXrJMeA__|url-status= live}}</ref>  However, this may not be entirely indicative of the true trends with respect to mental health in the population of Asian Americans. According to the NGO Mental Health in America, 5.4% of Americans identify as Asian American, and 13% of this population reported having a diagnosable mental illness in the past year.<ref>{{cite web|url=http://www.mentalhealthamerica.net/issues/asian-americanpacific-islander-communities-and-mental-health|title=Asian American/Pacific Islander Communities and Mental Health|date=November 6, 2013|website=Mental Health America|access-date=April 25, 2019|archive-date=July 12, 2024|archive-url=https://web.archive.org/web/20240712171358/https://mhanational.org/user/login?destination=/issues/asian-american-pacific-islander-communities-and-mental-health-archive|url-status=live}}</ref> This proportion of Asian Americans experiencing depression is lower than that of non-Hispanic white Americans. This may be a result of underreporting or lack of diagnoses in the Asian American community due to cultural stigmas surrounding mental health.<ref>{{Cite web|url=https://www.nami.org/Blogs/NAMI-Blog/July-2019/Why-Asian-Americans-and-Pacific-Islanders-Don-t-go-to-Therapy|title={OG: Title}|date=July 25, 2019}}</ref>

Further the cultural factors play an important role in assessing the statistics related to mental health in this population.  Mental illness is highly stigmatized in many Asian cultures, so symptoms are likely underreported. Asian Americans thus express more somatic symptoms than their European American counterparts when under mental or emotional distress.  Because of this kind of cultural variation in mental disorders and expression of symptoms, lack of health care access, and an underutilization of mental health resources, researchers have difficulty obtaining accurate statistics about Asian American mental health<ref>{{Cite journal| vauthors = Lee J, Lei A, Sue S | date=September 2000|title=The Current State of Mental Health Research on Asian Americans|journal=Journal of Human Behavior in the Social Environment|language=en|volume=3|issue=3–4|pages=159–178|doi=10.1300/j137v03n03_11| s2cid=144267796|issn=1091-1359}}</ref>

Further, many Asian Americans are prone to the same conflicts from language barriers a different language and intergenerational conflicts.  For instance, a varying English proficiency among immigrant Asian parents can be a source of conflict between parents and children. One study shows that in immigrant Chinese families, the level of English proficiency in the parental generation correlates with indicators of child and adolescent psychological well-being.<ref>{{Cite book| vauthors = Lim SL |title=Acculturation consonance and dissonance: effect on parenting style, parent-adolescent relationship, and adolescent psychological well-being in immigrant Chinese-American families|oclc=53127002}}</ref>

==White Americans==
{{Main|Health status of White Americans}}
It has been hypothesized that racism in the US may also affect the health of White Americans. While they have better health than historically oppressed groups, the health of White Americans is poorer than that of Whites in other wealthy countries.<ref name="Williams 2019"/><ref>{{cite journal | vauthors = Malat J, Mayorga-Gallo S, Williams DR | title = The effects of whiteness on the health of whites in the USA | journal = Social Science & Medicine | volume = 199 | pages = 148–156 | date = February 2018 | pmid = 28716453 | doi = 10.1016/j.socscimed.2017.06.034 }}</ref> This line of argument posits that racism in Whites towards other ethnic groups has caused White opposition towards social welfare programs, the implementation of which would also benefit a large number of White Americans. Internalized feelings of racial superiority could have a role in the rising number of [[deaths of despair]] among low-income Whites.<ref name="Williams 2019"/>

The [[opioid epidemic in the United States]] is overwhelmingly white, sparing African-American and Latino communities because doctors unconsciously prescribe narcotics more cautiously to their non-white patients. "Racial stereotyping is having a protective effect on non-white populations," according to Dr. Andrew Kolodny, the co-director of the Opioid Policy Research Collaborative at Brandeis.<ref>{{Cite news|url=https://www.npr.org/2017/11/04/562137082/why-is-the-opioid-epidemic-overwhelmingly-white/|title=Why Is The Opioid Epidemic Overwhelmingly White? | vauthors = King N |date=4 November 2020|newspaper=NPR}}</ref>

==Vaccination==
In 2020, [[Moderna]] slowed enrollment in its COVID-19 vaccine testing for the purpose of increasing representation of minorities. In Phase 1a, vaccination eligibility was extended solely to public health workers and residents of long-term care facilities.<ref>{{cite web | title = CDC's COVID-19 Vaccine Rollout Recommendations | date = 14 May 2021 | url = https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations.html | publisher = US Centers for Disease Control and Prevention | access-date = 24 February 2021 | archive-date = 2 January 2022 | archive-url = https://web.archive.org/web/20220102115110/https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations.html | url-status = live }}</ref> 60% of public health workers were white. 75% of long-term care facility residents were white.<ref>{{cite web | title = Fmr. APHA President: Vaccine phasing "is not providing resources according to need" | work = MSNBC | date = 24 January 2021 | url = https://www.msnbc.com/ali-velshi/watch/fmr-apha-president-vaccine-phasing-is-not-providing-resources-according-to-need-99942982000 | access-date = 24 February 2021 | archive-date = 27 February 2021 | archive-url = https://web.archive.org/web/20210227014831/https://www.msnbc.com/ali-velshi/watch/fmr-apha-president-vaccine-phasing-is-not-providing-resources-according-to-need-99942982000 | url-status = live }}</ref> Prior to the September 2020 announcement, 20% of enrollees were Hispanic/Latino and 7% were black. At [[Pfizer]], 25% of enrollees were Hispanic or nonwhite, including 8% who were black.<ref>{{cite news |title=Moderna slows coronavirus vaccine trial enrollment to ensure minority representation, CEO says |url=https://www.cnbc.com/2020/09/04/moderna-slows-coronavirus-vaccine-trial-t-to-ensure-minority-representation-ceo-says.html |access-date=4 February 2021 |work=CNBC |date=4 September 2020 |language=en |archive-date=30 January 2021 |archive-url=https://web.archive.org/web/20210130151309/https://www.cnbc.com/2020/09/04/moderna-slows-coronavirus-vaccine-trial-t-to-ensure-minority-representation-ceo-says.html |url-status=live }}</ref><ref>{{cite news |vauthors=Goudie C, Markoff B, Tressel C, Weidner R |title=As COVID-19 vaccine nears, demand for diversity grows |url=https://abc7chicago.com/covid-19-vaccine-update-diversity-moderna/8028083/ |access-date=4 February 2021 |work=ABC7 Chicago |date=17 November 2020 |language=en |archive-date=3 December 2020 |archive-url=https://web.archive.org/web/20201203133811/https://abc7chicago.com/covid-19-vaccine-update-diversity-moderna/8028083/ |url-status=live }}</ref> A government representative cited "historical abuse", "present racial injustices and health care disparities", and "recent social unrest (and) the faltering economy" as factors impeding recruitment of blacks.<ref>{{cite news |title=Covid-19 vaccine trials have been slow to recruit Black and Latino people -- and that could delay a vaccine |url=https://www.cnn.com/2020/08/16/health/covid-19-vaccine-trial-black-minority-recruitment/index.html |access-date=4 February 2021 |work=CNN |date=16 August 2020 |archive-date=21 January 2021 |archive-url=https://web.archive.org/web/20210121102706/https://www.cnn.com/2020/08/16/health/covid-19-vaccine-trial-black-minority-recruitment/index.html |url-status=live }}</ref>

==Reproductive health==
{{excerpt|Women's reproductive health in the United States|Race and reproductive health}}

=== Health Care Services for women of color ===
Women of color disproportionately face additional challenges in accessing quality health care due to socioeconomic disparities and social determining factors of health. To reduce these disparities, health centers provide accessible health services for women, including women of color.

For example, a study from March 2016 to May 2017 surveyed 725 women seeking health services at two Planned Parenthood health centers- one in Louisiana and one in Kentucky- for their varying levels of access to care, including insurance stability and access to a regular source of care (RSOC). This study records that “more than 60% of women attending these health centers did not have a RSOC and nearly 40% experienced instability in insurance”. The most frequent reasons for attending these health centers were getting appointments quicker, acquiring confidential services, the low cost of services, and accessing services that are otherwise difficult to get because of insurance gaps, especially in states such as Louisiana that failed to expand Medicaid under the ACA.

For instance, The Women's Cancer Resource Center (WCRC), founded in 1986, provides support services and workshops that are language concordant and culturally-sensitive. The WCRC offers various types of emotional services, one of which is designed for the African American population and the other to the Latinx population. African Americans disproportionately face low quality of care and are more likely to be diagnosed with cancer at a younger age and later stage. Sister to Sister is a support group for African American women to empower them with accessible financial and health educational resources and wellness workshops while providing them with a safe and supportive space. In addition, these free services that exist in immigrant communities can be entirely inaccessible. Children in immigrant families (CIF) are more likely to experience adverse social determinants of health, suboptimal health service utilization, and increased rates of chronic illness compared to children in non-immigrant families due to disproportionate rates of parental unemployment and underemployment, limited English proficiency (LEP), and limited access and participation in public safety net programs that exist among immigrant communities. Language barriers and high rates of low health literacy reduces the utilization of these services because these communities struggle to navigate them. To meet the needs of the Latinx community, the Latina Services provides cancer services, emotional support, and health educational resources that are accessible, culturally sensitive, and language concordant to all patients who speak Spanish. Women Health Centers like the WCRC work to make health services accessible to all women, including women of color and those with cultural and language barriers.

==Health care workers==
===Minority representation in medicine===
It is estimated that minority populations will represent about half the U.S. population by 2050 which means that there will be a crucial need for more representation in medicine. Studies have shown that having a diverse physician workforce is essential for the future of health care because minority students are more likely to provide health services to underserved communities. A 2012 study done in California found that physicians from minority backgrounds were more likely to practice in underserved or areas of health shortages than their white counterparts, no matter what their specialty. When looking more into the study, it was discovered that doctors from minority backgrounds were more likely to work in underserved areas because many of them grew up in those same underserved communities and saw many of the health disparities that existed. As a result, they looked at working in underserved communities to give back.<ref name="AMA">{{Cite journal|date=2015-02-01|title=Promoting the Affordability of Medical Education to Groups Underrepresented in the Profession: The Other Side of the Equation|url=https://journalofethics.ama-assn.org/article/promoting-affordability-medical-education-groups-underrepresented-profession-other-side-equation/2015-02|journal=AMA Journal of Ethics|language=en|volume=17|issue=2|pages=172–175|doi=10.1001/virtualmentor.2015.17.2.oped1-1502|issn=2376-6980|doi-access=free|access-date=2020-07-15|archive-date=2020-07-17|archive-url=https://web.archive.org/web/20200717032118/https://journalofethics.ama-assn.org/article/promoting-affordability-medical-education-groups-underrepresented-profession-other-side-equation/2015-02|url-status=live}}</ref>

Other research has also shown that representation of minorities in the healthcare workforce has many positive influences such as healthcare access for underserved demographics, better cultural effectiveness between healthcare providers, and new medical research that includes all individuals of the population<ref name="HealthLeaders">{{Cite web|title=Medical Schools Failing to Increase Representation of Minority Groups|url=https://www.healthleadersmedia.com/clinical-care/medical-schools-failing-increase-representation-minority-groups|last=HealthLeaders|website=www.healthleadersmedia.com|language=en|access-date=2020-05-02|archive-date=2020-05-16|archive-url=https://web.archive.org/web/20200516195332/https://www.healthleadersmedia.com/clinical-care/medical-schools-failing-increase-representation-minority-groups|url-status=live}}</ref>

===Trends in admission===
An area of where this representation needs to happen really begins in the admissions offices of professional schools such as nursing, medicine, dentistry, and pharmacy. According to Cheney (2019), the number of students from underrepresented backgrounds applying to professional medical schools has increased, but this increase has not been enough to keep up with the rapidly increasing minority population. Overall, the numbers of underrepresented minority medical school students such as African Americans, Hispanics, and American Indians, or Alaska Natives enrollees increased slightly. However, the only group that showed a statistically significant increase in representation was Hispanic females. The article faults a lack of early educational opportunities for minority groups which is contributing to the low numbers of minorities pursuing careers in the health care field<ref name="HealthLeaders" />

Flores and Combs (2013) detail the barriers at the organizational level when it comes to recruiting minority applicants. Organizations, such as nursing schools, tend to operate on "normative actions." As a result, societal stereotypes became so instilled within the culture of organizations that it becomes difficult to change the climate of the organization. For long as history has existed, stereotypes of minorities have placed their roots into society and many still that hold true today. Because of this, many organizations tend to still display varying levels of both intentional and unintentional biases toward minorities<ref name="Flores">{{cite journal | vauthors = Flores K, Combs G | title = Minority representation in healthcare: increasing the number of professionals through focused recruitment | journal = Hospital Topics | volume = 91 | issue = 2 | pages = 25–36 | date = April 2013 | pmid = 23822547 | doi = 10.1080/00185868.2013.793556 | s2cid = 20160085 }}</ref> (Flores & Combs, 2013). For example, it explores the field of nursing. Nursing is one of the many healthcare careers where acceptance into school is very competitive. In the year 2006, minority applicants had an only 40% chance of being accepted into nursing school compared to over 85% of white applicants.  Acceptance rates for minority applications have improved only slightly since 2006.<ref name="Flores" />

Data from the American Medical Association indicates that the combined percentage of minority groups entering medical school such as African Americans, Native Americans, Latino backgrounds make up 31%. However, out this 31% about 15% are current medical school applicants, 12% become medical school graduates, while only 6% become practicing physicians, and it unclear what happened to the other 6%.<ref name="AMA" />

===Increasing minority representation in medicine===

Students interested in pursuing a career in medicine need to be reminded that a career in medicine takes time and a substantial financial investment where the revenue will be returned later down the line.  More early exposure programs targeted to underrepresented groups in high school would help, since early exposure has been linked to an increase of applications to medical school.  In these programs, students build their resumes while also establishing professional connections. Finally, admissions policies should be revised to create more diverse medical school classes rather than relying exclusively on academic achievements. As a result of this, helps to increase cultural competence within healthcare where providers have the opportunity to learn from colleagues of different ethnic and cultural backgrounds in order to care for patients from different backgrounds.<ref name="AMA" />

== Criticisms ==
Some scholars have argued for a genetic understanding of racial health disparities in the United States, suggesting that certain genes predispose individuals to specific diseases.<ref>{{cite journal | vauthors = Fine MJ, Ibrahim SA, Thomas SB | title = The role of race and genetics in health disparities research | journal = American Journal of Public Health | volume = 95 | issue = 12 | pages = 2125–8 | date = December 2005 | pmid = 16257933 | pmc = 1449495 | doi = 10.2105/AJPH.2005.076588 }}</ref> However, the U.S. Census Bureau's recognition of race as a social and not biological category necessitates a social understanding of the causes of health disparities. Additionally, the restricted options for "race" and "ethnicity" in Census Bureau data complicates the results of their findings.

This issue is illustrated with the example of those who identify themselves as Hispanic/Latino, typically a mix of White, American Indian and African ancestry. Although some studies include this as a "race", many such as the U.S. Census do not, forcing members of this group to choose between identifying themselves as one of the listed racial categories, even if they do not personally identify with it. Additionally, individuals who identify as biracial or multiracial must choose one category to identify with, limiting the ability of many Americans to select a census category that they actually identify with. The inability of many individuals to fully identify with one census category indicates the necessity of cultural, historical, and socio-economic explanations of health disparities rather than a biological one.<ref>{{cite web | vauthors = Gonzalez-Barrera A | title = 'Mestizo' and 'mulatto': Mixed-race identities among U.S. Hispanics | url = https://www.pewresearch.org/fact-tank/2015/07/10/mestizo-and-mulatto-mixed-race-identities-unique-to-hispanics/ | date = 10 July 2015 | publisher = Pew Research Center | access-date = 24 April 2019 | archive-date = 22 June 2020 | archive-url = https://web.archive.org/web/20200622191448/https://www.pewresearch.org/fact-tank/2015/07/10/mestizo-and-mulatto-mixed-race-identities-unique-to-hispanics/ | url-status = live }}</ref>

Census groupings have also been criticized for their broadness. "Race" and "ethnicity" are used in many different ways in the United States, and the lack of subgroups in Census categories fails to account for the diversity of people identifying with each group. Every group on the Census includes people who identify with a number of unrepresented racial and ethnic sub-categories, but the Hispanic/Latino ethnicity group and Asian racial group have been particularly criticized for this lack of specificity.<ref>{{cite news | url = https://www.nytimes.com/2013/08/22/opinion/fix-the-census-archaic-racial-categories.html | department = Opinion | title = Fix the Census' Archaic Racial Categories | vauthors = Prewitt K | date = 21 August 2013 | work = The New York Times | access-date = 24 April 2019 | archive-date = 24 April 2019 | archive-url = https://web.archive.org/web/20190424042835/https://www.nytimes.com/2013/08/22/opinion/fix-the-census-archaic-racial-categories.html | url-status = live }}</ref>

== See also ==
* [[National Institute on Minority Health and Health Disparities]]
* {{section link|Minority stress|Health outcomes among African Americans}}
* [[Black maternal mortality in the United States|Black Maternal Mortality in the United States]]
* [[Medical deserts in the United States|Medical Deserts in the United States]]
* {{section link|Modern social statistics of Native Americans|Health standards}}
* {{section link|Obesity in the United States|Race}}
* [[Environmental racism]]
* [[Environmental Racism in the United States]]
* [[Weathering hypothesis]]
* [[Food desert]]
* [[Ghetto tax]]
* [[Post Traumatic Slave Syndrome]]
* [[Racial biases in medical decision-making tools]]
* [[Race and crime in the United States]]

== References ==
{{reflist}}
{{Demographics of the United States}}

[[Category:Race and health in the United States| ]]
[[Category:Social problems in medicine]]