Exposing the impact of racism — not just race — on health outcomes
Despite the growing body of evidence showing that social forces like income, housing, and educational attainment have a greater bearing on health outcomes than behavior or genetics, healthcare leaders remain reluctant to identify racism as a root cause of racial health inequities. In an April 18 article in the New England Journal of Medicine, Rush Medical College student Kristen Pallok with Dr. David Ansell and Dr. Fernando De Maio — from Chicago’s Center for Community Health Equity — use the experience of a 60-year-old African-American woman’s breast cancer fight to illustrate how institutionally and culturally embedded racial hierarchies prevent people of color from meeting their basic needs.
“Racism is often assumed to be interpersonal discrimination. But here we see how societal levels of disinvestment and increased poverty manifest themselves at the institutional level into resource allocation that meant African American women living in neighborhoods of concentrated disadvantage did not have the same opportunities to be healthy as white women,” noted lead author Pallok.
The article details the experience of 60-year-old, uninsured African-American woman who visited the emergency department of a Chicago hospital concerned with a breast lump. Since her prior mammograms had been normal, the emergency medicine physician suspected an infection and discharged her with antibiotics without follow-up care or diagnostic testing. When the lump persisted and further imaging indicated breast cancer, a general surgeon removed the lump and recommended a mastectomy without telling the woman the cancer stage nor referring her to an oncologist.
But an on-site navigator from the nonprofit Metropolitan Chicago Breast Cancer Task Force was able to intervene. She reviewed the abnormal mammograms, referred her to a breast surgical oncologist at an academic medical center who then diagnosed the patients with stage III infiltrating ductal carcinoma that was able to be successfully treated without a mastectomy. “This came just in time to stop me from having my breast cut off,” the woman noted.