A majority of Black adults have had at least one negative experience with a health care provider, according to a new report. But young Black women are particularly likely to report a harmful interaction during routine health care.
More than 70% of Black women ages 18 to 49 said they’ve experienced at least one negative interaction with care providers, including dismissal of their pain or having to speak up to get proper care. Young Black women also are most likely to prefer seeing a Black doctor, expressing that health care providers who share their racial background are better at looking out for their best interests and treating them respectfully.
The finding was one of many in a Pew Research Center study that analyzed Black Americans’ perspectives on science, including medicine, health care, STEM education and science-related news.
Researchers highlighted the nuanced views Black adults hold about scientists and the health care system. Of the more than 14,000 participants, Black adults made up about 3,500 including those who identify as single-race, multiracial, and Hispanic.
Among Black women, “a lot of patients don’t feel heard,” said Cheryl Clark, an assistant professor of medicine at Harvard Medical School. “They don’t always feel that their symptoms are taken seriously.”
And the impact is dire. Across the United States, Black women are three to four times more likely to die from pregnancy-related complications than white women. Amid the coronavirus pandemic, the crisis has grown.
“It’s really important to take a look at what young Black women are saying about their caregiving experiences if we want to prevent that mortality,” said Clark, who is a physician at Brigham and Women’s Hospital in Boston.
The study also found that Black Americans’ trust for medical scientists has dropped since November 2020, a trend similar to the general public. Among white adults, the decline has been particularly significant. According to the study, there is now little difference in how white, Black, and Hispanic adults view medical scientists, a shift from prior surveys in which white adults were more likely to report high confidence in them.
More than 60% of Black adults report believing that serious medical misconduct is just as likely today as it was in the past, although those with more knowledge of the work medical researchers do were more likely to view them positively.
In the survey, researchers highlighted the Tuskegee experiment, during which Black men were intentionally denied treatment for syphilis beginning in the 1930s, as an extreme breach of trust. But individual interactions with the health care system may have an even larger impact, said Darrell Hudson, a health disparities researcher at the University of Washington St. Louis. Stories told within families and local communities about which hospitals mistreat Black patients erode trust in health and medicine.
“There are individual, patient-provider-level interactions, things that I’m not even sure providers are aware that they do that might be read as dismissive or might be seen as disrespectful,” he said. “Those reinforce the notion that these people don’t care about us.”
Respondents’ perceptions that their pain is being dismissed is supported by research on those experiences. In 2019, research from George Washington University showed that Black emergency room patients were 40% less likely to receive pain medication than white patients.
Still, in the Pew Research study, a majority of Black respondents expressed that their provider was either excellent or very good during their most recent visit. That’s an indication that trust is complex, Hudson said.
“People might not have a great deal of trust for the health care system, maybe they don’t trust the vaccines, but they have a really good primary care provider,” he said.
Considering all the factors that influence health, more than 60% of Black adults believe less access to quality medical care in their neighborhoods is an important reason why Black Americans face worse health outcomes.
That perception, experts say, tends to match reality. Neighborhood segregation persists across the country, said Dr. Gbenga Ogedegbe, director of NYU’s Institute for Excellence in Health Equity. “Forget race and ethnicity — your ZIP code is a major predictor of your life expectancy,” he said. If you live in a poor neighborhood, “your chances of living longer are much lower than if you live in a rich neighborhood.”
The density of hospitals is higher in wealthier neighborhoods, said Ogedegbe, and resources dwindle in less rich neighborhoods.
At the same time, “health is more than health care access,” said Hudson. “Do people actually have the access to the things that they need to follow doctor’s orders?”
The survey also explored the feelings of STEM — or science, technology, engineering, and math — professionals and their education experiences. Among those working in STEM, half of Black college graduates recalled mistreatment in their schooling, more than any other racial group.
Black students’ rate of mistreatment “probably is higher,” said Ebony McGee, an associate professor of diversity and STEM education at Vanderbilt University. She noted how overly praising Black students for getting the right answer may feel like they believe in students, but, from a racial lens, might equate to them not expecting Black students to have the right answer due to stereotypes.
“In STEM courses, we’re not told about racial microaggressions,” she said.
A majority of Black respondents also said they believed more youth would pursue careers in STEM if they saw more high achievers in the field who looked like them. McGee noted that representation of Black scientists and engineers provides more than inspiration.
Racial bias and the belief that Black skin is more resilient to pain and trauma affects how medicine is provided to Black Americans, she said. For example, pulse oximeters, which measure oxygen levels in the blood, are less accurate in Black patients. The NFL’s past “race norming” practice, which assumed Black players had lower cognitive function than white players, influenced the dementia tests used to determine payouts in a brain injury settlement. And the algorithms used to calculate kidney function take the patient’s race into account, adding a “race correction” that, in some cases, bumps Black patients lower on the transplant list.
Better representation in STEM could safeguard against policies like these, she said. “It’s really life or death.”