POC Disparities in Healthcare
Originally Written for VTPOC.net
Addressing racism in healthcare is often seen as a complex problem without a simple solution. Health-related scenarios involve many factors that make each patient unique with countless variables at play. Therefore, it’s not appropriate to make sweeping judgments about the healthcare system based solely on individual experiences unless there is clear evidence of egregious malpractice. That being said, it remains perplexing that Black Americans have a life expectancy that is four years shorter than that of white Americans. One of the most evident explanations for this discrepancy is linked to a common theme VT PoC advocates against: the presence of systemic racism within healthcare, which reflects the broader systemic racism prevalent in society and the undervaluing of BIPOC lives.
Let’s keep it local. As with anything in the United States, it’s crucial to consider historical context due to the consistent failures in addressing racist policies and practices. Vermont, in particular, has a very specific racist relationship with healthcare disparities in the form of the eugenics movement.
Eugenics is a field of study that aims to weed out less desirable genetic traits through experimentation and controlled reproduction. It was discredited after World War II due to its association with Nazism, but had a significant impact on our state from 1925 to 1936.
Guy W. Bailey, president of UVM from 1919 to 1940, approved the Eugenics Survey of Vermont, under the recommendation and leadership of Zoology professor Henry Perkins. The survey subjected Vermonters to harsh evaluations of their mental well-being by their practitioners. It recommended resettlement, and prior to a law banning it in 1931, sterilization of those deemed feebleminded. Even after 1931, surveyors could reject marriages for those they deemed unfit to reproduce. Where this ties into our newsletter topic is that it was racist practitioners who determined who was worthy of reproduction. Native Vermonters, members of the Abenaki tribe, suffered from this survey. Abenaki individuals were forcefully sterilized and institutionalized, and many children were separated from parents who were judged as unfit to care for them by surveyors.
Systematic racism in one of its ugliest forms if I’ve ever read it.
Fast forward to healthcare in Vermont today, the lasting effects of past atrocities are apparent. Healthcare spending per person is at an all time high, as are distrust in doctors across political divides due to misinformation, propaganda, and past failures like the eugenics survey. Immigrant and refugee populations have risen significantly, and the need for more medical practitioners has never been greater.
Many solutions to address racial disparities in treatment are only loosely addressed. A 2022 study by the state found that adult Vermonters of color are almost twice as likely to delay treatment due to the associated costs. The same survey found that in Vermont, 69% of white patients felt their cultural identity was respected, whereas less than half of Black patients did. Asian patients were even lower at 43%, and Native Hawaiian and Pacific Islanders reported an astonishing figure of only 36% feeling that their cultural identity was respected by medical professionals. Respect for cultural identity is critical to one’s treatment because it informs their trust in that treatment, their comfort and stress (which often aids their physical wellbeing), and their willingness to continue to receive care.
You’d think that an easy solution would be to simply hire more physicians of color – but the federal government doesn’t make that so easy. For starters, the financial barriers to even apply to medical school is unfair. The Medical School Admission Test (MCAT) is one that applicants often spend months studying for, and costs hundreds of dollars to take. That money is barely a drop in the bucket compared to the cost of actually applying to medical school, which can cost anywhere from $100-$500 per school. Moreover, only 43% of applicants applying last year were accepted. This figure could potentially be higher and allow more doctors to be trained. However, the real problem arises when they finish their four years of schooling. From there, students must apply to residency programs. These residency programs are capped by the federal government based on an arbitrary budget set in the late 90s and restricts the number of doctors who can be trained at a given time, not taking into account the number of students graduating from medical school. For BIPOC applicants, who often face financial disparities compared to white Americans, the financial burden can outweigh the risk of not getting into medical school or a residency slot.
Despite lack of action on the national level, there are some strides being made in the right direction within Vermont. Two that come to mind are initiatives by UVM and VT PoC ourselves.
The College of Nursing and Health Sciences at UVM have two peer mentoring programs in which all first year students are automatically enrolled in. One, called LinkUp, is in its relative infancy, aims to connect BIPOC students to BIPOC upperclassmen to make them more comfortable, seen, and guide them through academia. This is important because it not only tries to increase retention of BIPOC students as students, but also as medical practitioners.
In response to the COVID-19 pandemic, VT PoC launched the Vermont Health Equity Initiative, which set up vaccine clinics focused on BIPOC and immigrant communities. By creating a space for culturally sensitive care, many community members of color were vaccinated when they may have otherwise not been. The fact that Vermont was the fastest state to reach an 80% vaccination rate is a testament to the importance of cultural understanding in healthcare.
