Black History Month: From Stereotypes to the Discrimination of Black Women in Healthcare
In honour of Black History month, I would like to shed light on a concerning trend that heavily impacts a significant proportion of our population but remains largely ignored. There is a significant discrepancy in health outcomes of black and white women in the UK. Black women are more at risk from debilitating and chronic conditions, and they are the most likely demographic to experience mental health disorders including depression and anxiety. This issue can be traced back to the persistent structural racism in British society and the resulting biases and stereotypes projected on Black women. Stereotypes are employed subconsciously making them hard to identify and block, resulting in discrimination of already marginalised groups. Due to overlapping socioeconomic disadvantages and discrimination, Black women are one of the most vulnerable demographics with regard to health. In this blog, I will outline how the stereotypes associated with Black women in the UK directly result in their disproportionately lower level of health. By understanding this we can spot when they’re being employed, educated others about them, and mitigate this problem to provide equal access to healthcare.
This problem stems from stereotypes, ingrained into society and subconsciously affecting our attitudes and behaviour, which become extremely harmful when applied negatively to social groups. Black women in the UK are subjected to specific intersecting stereotypes. This can be traced back to systematic oppression that persists as institutional racism. This is harmful through overt discrimination and internalisation of projected characteristics by the target group. This blog will focus on the dominant ‘Strong Black Woman’ stereotype, and its implications for Black women’s health today. This is a very general stereotype that can be traced back to the racial stereotypes ‘mammy’ and ‘matriarch’ assuming strength, independence, and hostility towards advice.
In British society, Black women feel pressured to conform to this stereotype from all angles. Asking for help is perceived as showing pain or as a sign of weakness. This is compounded by the nature of the help often received. Due to persisting stereotypes, doctors are far more likely to misdiagnose, downplay symptoms and suggest the wrong treatment for Black patients compared to their white counterparts. This is because of the underrepresentation of Black people in medical training and in images/diagrams used to educate people about symptoms. Because of this, patients identify symptoms later and professionals often diagnose these symptoms later again, which often leaves Black people at greater risk of developing more severe ailments and often not being prescribed the necessary pain relief. There are also questions about whether measures nationally used are relevant in today’s diverse society. For example, the BMI scale used to measure health body fat ratio has been questioned recently (see sources below).
A 2016 study about the perceptions of medical students found that the majority of white students wrongly believed that Black people have a higher pain tolerance than white people, with 73% believing in biological differences between the races such as thicker skin and less sensitive nerve endings. Becoming a doctor or nurse requires a specialised degree which is exclusive due to factors including expense and travel. Unfortunately, there is still an economic discrepancy in the UK, with a high percentage of Black people having a low socioeconomic status, and often struggling to access university. Therefore, university courses, especially long medical degrees, are dominated by white students. So, the medical profession is disproportionately white. Not only are these the people writing the curriculum for new students affecting its cultural sensitivity and relevance, but they are also patient facing. Trusting relationships between medical staff and patients is crucial for the patient to achieve health benefits, this is difficult to cultivate if Black women do not feel represented or culturally understood in medical settings. A study from 2020 shows stereotypes carried through to employment. Furthermore, between 2005-2016 Black patients were 10% less likely to be admitted to hospital and 1.26 times more likely to die in the emergency department or the hospital.
Another factor that contributes to lower healthcare quality is socioeconomic status, intrinsically linked to levels of education. Unfortunately, marginalised ethnic groups are of a disproportionately lower economic status. This results in extra economic and educational barriers to accessing help, they may not be able to afford transport or have internet access to book appointments/search for services. Black women also experience intersecting discrimination from the ‘Strong Black Women’ stereotype. An internalisation of this stereotype could lead to the patient not seeking help quickly or downplaying their symptoms to avoid appearing weak. This can contribute to misdiagnosis.
An offshoot of this stereotypical image is a larger body type, resulting in an assumption of low care about health. This can result in a limited discussion about health, particularly weight management, which is critical in preventing chronic diseases related to obesity. These factors resulting in misdiagnosis and discrimination causes a lack of confidence and trust in the healthcare system impacting how frequently services are accessed. Mental health within Black communities is also stigmatised. But discussing it is particularly important for Black women who alongside normal societal pressures also have the ‘strength’ stereotype to contend with when accessing help, often feeling they should not need help or aren’t entitled to it. Even if they take steps to access it, they may downplay symptoms and/or be misdiagnosed by consciously or unconsciously racially biased medical professionals. Any form of discrimination within the healthcare system makes patients feel undermined and unsafe, impacting their desire to access repeated help which is crucial to address mental health issues. This is hugely important to understand as this demographic is the most likely to experience mental disorders from the racism and discrimination experienced by them as members of the Black community and as women. This is directly linked to high levels of stress, causing anxiety, depression, and other health issues, increasing the likelihood of developing mental disorders and chronic illnesses. For example, Black people aged 51-55 are 28% more likely to have a chronic illness than their white counterparts. Black women, compared to white women, on average have higher blood pressure and a lower life expectancy.
So how do we address this to ensure everyone has fair and equal access to the healthcare they deserve? The answer is education. Specifically, a campaign to dismantle these racist stereotypes and the prejudices that stem from them. By acknowledging these stereotypes, we are already taking an important step. Being able to check ourselves and others we can mitigate their harmful effects. Widespread use of multi-ethnic advertising of medical conditions to raise awareness of conditions is also a must. Furthermore, the images and examples used to train healthcare professionals should adequately reflect the diversity of British society, and the existence of ethnic and cultural stereotypes should be included in curricula. Over time stereotypes will be stripped of the power we have given them. If we can form and maintain them, we can dismantle them and regain control of our actions for the sake of everyone.
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Sources https://www.hsph.harvard.edu/news/hsph-in-the-news/discrimination-black-womens-health/ https://pubmed.ncbi.nlm.nih.gov/32856564/ https://www.medicalnewstoday.com/articles/racism-in-healthcare http://pure-oai.bham.ac.uk/ws/files/27990364/Andrews_et_al_Strong_female_and_black_Health_2015.pdf
Article cover courtesy of @ebrulillustrates on Instagram
Madeline Trudgian (She/Her)
Politics and international relations student at the University of Nottingham, intersectional feminist and blog writer for Our Streets Now. Passionate about women's education globally as a powerful tool to dismantle the patriarchy.