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Healthcare Inclusivity: The Great Oxymoron

The healthcare industry is one of the most debated concerns in this country and that was before a global panasonic. Varying issues ranging from accessibility to healthcare, implicit and explicit biases as well as lack of trust in the healthcare system inclusively plague many patients who, in their most vulnerable state, seek medical care. Those without these concerns must still circumvent preventable medical errors in order to receive the optimal care worthy of our collective and technological advancements. Usually, people who receive this level of care have two things in common. They are white and male. A utopian dream or a medical facility completely staffed by hundreds of Rosies from the Jetsons is the closest women, intersex, and the global majority will get to receiving unbiased healthcare if we don’t advocate for ourselves now.

Everyone deserves the same access and treatment to healthcare. Naturally, a person’s gender and heredity play crucial roles in the type of care someone needs over their lifetime. However, the healthcare system in this country has traditionally been based on the developments, research and experiments conducted by white men, because they were the only ones allowed to take part in the distinguished role of doctor or physician. Subsequently, many previous research studies included males and focused entirely on the ailments of that gender and continuously assumed their findings will translate across the board spectrum of all humans.

Treatment of Women

This way of thinking is the catalyst to the previous and increasing disparities in healthcare between genders that serves to negatively affect the medical treatment given to women. Even if we take away the fact that men, particularly white men, deem it acceptable to legislate the female body, healthcare providers still manage to exist within a paradox based on antiquated cultural ideologies that believe women, simply due to their gender, are more vulnerable to disease and death than their male counterparts, while simultaneously thinking the solution to this can be found in their own knowledge of the male human body rather than listening to their female patients. Ironically, women are on average are more likely to seek medical care, more resistant to disease and debilitating conditions than men due to lifestyle habits and lower alcohol consumption.

In other words, the implicit or explicit biases that contribute to gender disparity in healthcare are the same as every other form of inequality in this country. The standard of care given in medicine is perceived through knowledge and accessibility to that information. Although the primary leading cause of death for both men and women of all races is heart disease, a Harvard study concluded education and awareness for women on the subject is considerably lower due to research being primarily conducted on men. The same study also showed the typical symptoms of heart disease are based on those experienced by men and healthcare providers often misdiagnose women because their symptoms manifest differently. Consequently, women are less likely prescribed preventative medications and lifesaving procedures. Thus, the power of awareness, knowledge and accessibility, like most power that perpetuates inequality, resides within the boys club.

Treatment of Intersex Individuals

Specifically, implicit bias of intersex individuals demonstrates how powerful the component of awareness is within the healthcare system. The term intersex applies to those whose physical sex characteristics at birth or the onset of puberty present differently than the orthodox idea of male and female anatomy. Since the medical field of the mid twentieth century primarily comprised of one particular group of people, the standard of what it meant to be born a boy or a girl depended solely on their implicit bias.

Beginning in the 1960s as unproven psychologist recommendations increased, as many as 1 in 5,000 newborn babies braved non-life threating operations to internal and external genitalia that were simply based according to the implicit beliefs of how traditionally genders should appear. A number of times parents were involved with doctors in assigning the infant’s gender, but often this decision was made without the consent of postpartum parents and obviously without the awareness of the person affected.

The number of unnecessary surgical procedures on newborns has decreased in recent years with the assistance of advocacy groups who by their own efforts have brought awareness to this issue. Mainly because the doctors who were so aware of what it means to be male or female were unaware and completely oblivious to the fact that these surgeries would result in inaccurate gender assignment, loss of sexual sensation, sterilization, scarring, chronic pain, and chronic incontinence.

Don’t feel bad if this is your first time hearing or learning about intersex people or that the rate of intersex individuals is comparable to that of natural redheads. The implicit desire by previous and current healthcare providers to keep this topic under wraps further demonstrates the power and importance that awareness plays for those within the profession and how it prevents an inclusive approach to what encompasses over 60 conditions.

If everyone were aware of this occurrence, then this issue would be a collaborative effort between physician and patient based on objective reasoning and no longer a subjective methodology based on playing God. Luckily, institutions such as the Ann & Robert H. Lurie Children’s Hospital of Chicago and Boston’s Children’s Hospital declared in 2020 that they would no longer participate in intersex surgeries on those too young to give their consent. However, it is of worth to note that the male dominated field of medicine still favors biological men to the point where higher success rates of gender assignment surgeries occur more so in male to female procedures simply because of the antiquated view that believes it is easier to make a hole rather than a pole.

Treatment of Black Women

Although implicit biases are fundamental to the lack of inclusivity and awareness given to those outside the medical field, explicit biases fueled by incorrect and archaic knowledge continue to plague Black females seeking healthcare. Unfortunately, much of the treatment Black women receive currently is based off the inhumane beliefs and experimentations of enslaved African people.

White doctors, especially males, are to Black women what white police officers are to Black men. It is commonplace that some white police officers have a tendency to view Black individual males and Black men in groups as gang members. Similarly, white doctors have a tendency to hyper sexualize Black women as well as view them as less intelligent due to ideas created during the enslavement of Africans and their descendants. Dr. Colene Arnold, a gynecologist who specializes in pelvic pain disorders, recounted a study that found Black women are less likely to be diagnosed for endometriosis than white women when experiencing pain, and instead, misdiagnosed as having pelvic inflammatory disease, which is typically sexually transmitted.

The slavery-era belief that Black people were hypersexual and simultaneously less intelligent than white people also continues to impact the care that Black women receive currently. Keisha Ray, an assistant professor at the McGovern Center for Humanities and Ethics demonstrated this idea by asserting, “When we look at patient testimonies, particularly from Black women, we’re seeing that these typical tropes are used…that they are hyper sexualized and that if they have some sort of illness or pain, that it’s likely self-inflicted in a sense that they did something wrong,” (Rao, 2020). In modern day terms this is equivalent to a 12 year old Black child being shot and killed by those sworn to “protect and serve” for playing with a fake, imitation gun because Black men are “known” to be gang members (rest in paradise Tamir Rice).

One can only deduce then that much of the medical treatments of Black women have absolutely nothing to do with their symptoms, medical history, or even their current physical condition but solely on unproven stereotypes. Dr. Arnold furthered her comments by asserting, “With Black women there is an assumption that they don’t know their bodies, that they don’t understand, that they’re not educated about their bodies.” The noticeable error of these misconceptions is that Black women are punished and treated in terms of what is stereotypically “known” and believed about what they lack while those with years of education do not have to account for their blatant outdated prejudices. This is especially disheartening when education data conclusively shows Black women are the most educated group in America.

I’m not a doctor but even I can see how humans who bleed for five to seven days a month every month for decades and not die would have different health concerns than those who don’t. Furthermore, I understood how this bloody phenomenon affects not only the reproductive system but also the endocrine, digestive, integumentary and nervous systems before it ever happened to me merely by living with my mother and two older sisters. So why does it take four year of undergrad, four years of medical school and three to seven years of residency to consider those who have the astonishing ability to carry and deliver an entire human being also have the capability of knowing when their bodies don’t feel right and this is also independent of their race?

So how did these unjust and explicit biases begin? Many consider the gynecological work of Dr. James Marion Sims during the 19th century as one of the main culprits. The Alabama physician conducted numerous experimental surgeries without anesthesia or consent on enslaved African women, which unfortunately resulted in the continued misconceptions of how Black women experience pain. Meanwhile, Sims preformed the same surgeries on white women with anesthesia under the unethical premise that enslaved women, due to their everyday arduous workload, were strong enough to endure those procedures naturally.

It seems unfathomable that a clear unethical idea birthed from colorism could root itself in an entire profession for over 150 years. Sad to say but it has and it’s not the only one. “A 2016 study found that nearly half of first year and second year medical students believed that Black people have thicker skin than white people, and perceived Black people as experiencing less pain than white people” (Rao, 2020). This reprehensible belief, created by another 19th century physician and wealthy plantation owner named Thomas Hamilton whose experiments involved torturing an enslaved Black man named John Brown, created blisters all over his body in an effort to prove Black skin went deeper than white skin.

The experiments conducted by these men during the days of slavery might have an ounce of validity considering the lack of commonsensical acumen and irrational credence of superiority that rivals only Dr. Moreau. However, there is no logical explanation for its existence today with all the technological, medical and psychological advancements of the 21st century. “A 2019 study published in the American Journal of Emergency Medicine analyzed data from 14 previously published studies on pain management and found that Black patients were 40% less likely to receive medication for acute pain compared to white patients and 34% less likely to be prescribed opioids,” (Rao, 2020). The only good thing that ever came out these unwarranted torturous experiments is that Black people can in no way ever be attributed to or blamed for the opioid crisis.