How The Statement “I Don’t See Color” Perpetuates Racism in Healthcare

July 20, 2021   |   Evidence in Integrative Healthcare

“I don’t see color.” This misguided concept was succinctly clarified by Layla Saad when she wrote about the misbelief that “…if [we] do not see color, [we] will not do anything racist or benefit from racism…[however] the problem does not go away because [we] refuse to see it.”1Saad LF. Me and white supremacy : combat racism, change the world, and become a good ancestor. Napreville, Illinois: Sourcebooks; 2020.

This fallacy does a disservice to the community and is dangerous to patients. The salient issue on race and racism in healthcare, deservedly, has been in the healthcare news spotlight for the past year and was explored in a recent special issue of The American Journal of Bioethics.2Wilson YYJ, B. L.; Smith, P. T. (Ed). Racial Injustice and Meaning Well: A Challenge for Bioethics [Special Issue]. Am J Bioeth. 2021;21(2):1-101. The opening editorial spoke directly to the complacent and complicit nature within healthcare and was aptly titled: Racial Injustice and Meaning Well: A Challenge for Bioethics3Wilson YY. Racial Injustice and Meaning Well: A Challenge for Bioethics. Am J Bioeth. 2021;21(2):1-3.. In this opening piece, Dr. Yolanda Wilson sets the stage for contemplation from the members and providers in all aspects of medicine, from bench to bedside (e.g. from laboratory research to clinical practice).

“…for far too long, the dominant assumption has been that explicitly addressing racism was either not within the domain of bioethics or that it did not require any special attention because bioethical concerns with antiracism were already subsumed under the four guiding principles in a race-neutral way [4 principles: Respect for autonomy, Beneficence, Non-maleficence, and Justice].”

Although the entire special issue is worthy of contemplation, two articles in particular are worth mention:

  • Racism and Bioethics: The Myth of Color Blindness by Clarence H. Braddock III4Braddock CH, 3rd. Racism and Bioethics: The Myth of Color Blindness. Am J Bioeth. 2021;21(2):28-32.
  • Race Based Medicine, Colorblind Disease: How Racism in Medicine Harms Us All by Ruqaiijah Yearby5Yearby R. Race Based Medicine, Colorblind Disease: How Racism in Medicine Harms Us All. Am J Bioeth. 2021;21(2):19-27.

In Racism and Bioethics: The Myth of Color Blindness, Dr. Braddock clearly and eloquently articulates that “We must see and acknowledge race, and in so doing we will acknowledge the harms of racism.” Highlighting findings from the Institute of Medicine (2003) report on Racial and Ethnic Disparities in Health Care6Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666-8., it is made clear that a large body of evidence demonstrates that health care decisions are adversely impacted by implicit/explicit bias, particularly against Black patients. It is with this in mind that he posits, “We most certainly should abandon the notion that color blindness is an ethically superior approach or the goal to which to aspire, because it is not.”

 The second article, Race Based Medicine, Colorblind Disease: How Racism in Medicine Harms Us All expands on the myth of colorblindness, to suggest that racism in medicine harms everyone, not “only” those who are racially marked as nonwhite.7Yearby R. Race Based Medicine, Colorblind Disease: How Racism in Medicine Harms Us All. Am J Bioeth. 2021;21(2):19-27  For example, when racism in medicine underlies research, access, diagnosis, and treatment, patients across racial groups can experience missed diagnoses and delayed care. This concept is epitomized by two quotes from her article:

“Biological race is not supported by genetic findings…or linked to the genes that affect health, yet it continues to be used as a factor in health disparities research, medical guidelines, and standards of care to denote superiority.”

“No socially constructed race has superior health outcomes compared to any other group in all measures; however, race remains a factor in health disparities research. This harms us all because it perpetuates the falsehood that Whites are superior, prevents medicine from addressing health disparities experienced by all racial groups, and obscures the true cause of poor health outcomes: racism.”

How do these concepts directly impact clinical practice?

Given that the potential impacts of racism on the health of patients are innumerous, consider examples from two key domains: sleep and obesity. Stressors from the COVID-19 pandemic have had a negative impact on sleep quality; what about the additional impacts of racism? The findings from a 2020 survey show that daily racial/ethnic discrimination is experienced by the majority of black women and is directly correlated with poorer sleep.8Gaston SA, Feinstein L, Slopen N, Sandler DP, Williams DR, Jackson CL. Everyday and major experiences of racial/ethnic discrimination and sleep health in a multiethnic population of U.S. women: findings from the Sister Study. Sleep Med. 2020;71:97-105 As another example, findings from a US population-based survey indicate the odds of being overweight/obese are increased in persons experiencing racism.9Shariff-Marco S, Klassen AC, Bowie JV. Racial/ethnic differences in self-reported racism and its association with cancer-related health behaviors. Am J Public Health. 2010;100(2):364-74. The data suggest rates of overweight/obesity are 18% higher for those who sometimes experience racism and almost double (33%) for those who experience racism often or all the time. When providers espouse “colorblindness”, the opportunity to discuss the implications of racism on patients’ health is missed.

Provider ethics implore an allegiance to the oath of respect for autonomy, beneficence, non-maleficence, and justice. With this in mind, the following resources have been compiled to assist providers in learning to better serve diverse patient populations and communities.

The existence of racism within medicine and society, both historically and present day, is not up for dispute. The only question is how we, as [providers], will lead in confronting the health implications of it. -AMA President Gerald Harmon, MD. (June 2021)