Systemic Racism in Healthcare: Implications for Older Adults

Abstract

Systemic racism, defined as a set of institutional policies and practices that perpetuate racial inequalities, profoundly impacts healthcare access and outcomes for marginalized older adults. This report examines how systemic racism manifests in healthcare, focusing on provider shortages, medical education, resource allocation, and discriminatory practices such as redlining. By analyzing these factors, the report underscores the urgent need for comprehensive policy interventions to dismantle systemic racism within healthcare institutions.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

1. Introduction

Systemic racism is a pervasive force that influences various aspects of society, including healthcare. In the context of older adults, particularly those from marginalized racial and ethnic backgrounds, systemic racism contributes to significant health disparities. These disparities manifest in limited access to quality healthcare, suboptimal health outcomes, and experiences of discrimination within healthcare settings. Understanding the mechanisms through which systemic racism operates in healthcare is essential for developing effective strategies to promote health equity among older adults.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

2. Manifestations of Systemic Racism in Healthcare

2.1 Provider Shortages

Healthcare provider shortages in communities predominantly inhabited by Black, Indigenous, and People of Color (BIPOC) are a direct consequence of systemic racism. Studies have shown that neighborhoods with higher Black populations are 67% more likely to lack sufficient healthcare providers compared to predominantly White neighborhoods. This shortage leads to reduced access to care, longer wait times, and diminished quality of services for older adults in these communities.

2.2 Medical Education

The Flexner Report of 1910, which reformed medical education in the United States, inadvertently introduced policies that excluded minority groups, including African Americans and women, from medical training. This historical exclusion has had lasting effects, resulting in a predominantly White medical workforce and perpetuating racial disparities in healthcare delivery. The underrepresentation of minority groups in medical education contributes to cultural insensitivity and biases in patient care.

2.3 Resource Allocation

Systemic racism influences the allocation of healthcare resources, often to the detriment of marginalized communities. Hospitals and clinics in predominantly BIPOC neighborhoods frequently receive fewer resources, leading to outdated equipment, understaffing, and inadequate facilities. This inequitable distribution exacerbates health disparities and limits the ability of healthcare providers to deliver quality care to older adults in these areas.

2.4 Discriminatory Practices: Redlining

Redlining, a practice where services are denied to residents of certain areas based on racial or ethnic composition, has historically restricted access to quality housing and healthcare for Black communities. The legacy of redlining has resulted in neighborhoods with limited access to healthcare facilities, contributing to poorer health outcomes among older adults residing in these areas.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

3. Impact on Health Outcomes for Marginalized Older Adults

3.1 Chronic Health Conditions

Older adults from marginalized racial and ethnic backgrounds experience higher rates of chronic health conditions, including hypertension, diabetes, and cardiovascular diseases. These disparities are linked to systemic factors such as limited access to preventive care, socioeconomic challenges, and environmental stressors associated with systemic racism.

3.2 Mental Health

Experiences of discrimination and marginalization contribute to mental health challenges among older adults. Perceived racism has been associated with increased rates of depression, anxiety, and other mental health disorders. The cumulative stress of navigating a healthcare system that often marginalizes them adversely affects the mental well-being of older adults from BIPOC communities.

3.3 Healthcare Utilization

Systemic racism affects healthcare utilization patterns among older adults. Studies indicate that older Black and Hispanic adults are more likely to report problems paying for healthcare compared to their White counterparts. This financial barrier leads to delayed or forgone care, resulting in worsened health outcomes over time.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

4. Addressing Systemic Racism in Healthcare

4.1 Policy Interventions

To dismantle systemic racism in healthcare, comprehensive policy interventions are necessary. Recommendations include:

• Increasing Medicaid and Medicare Reimbursement Rates: Adjusting reimbursement rates to ensure that providers serving high proportions of Medicaid-eligible and BIPOC older adults receive adequate compensation, thereby improving the quality and availability of care in these communities.

• Reforming Pay-for-Performance Programs: Designing pay-for-performance programs that consider the unique challenges faced by providers serving underserved populations, ensuring that these programs do not inadvertently penalize providers for factors beyond their control.

• Implementing Culture Change in Healthcare Settings: Promoting person-centered and culturally sensitive care models that address the diverse needs of older adults, alongside improving staff wages and benefits in facilities serving high-proportion BIPOC populations.

4.2 Educational Reforms

Addressing the underrepresentation of minority groups in medical education is crucial. Initiatives should focus on:

• Recruitment and Retention: Developing programs that attract and support students from underrepresented backgrounds in medical schools, ensuring a diverse healthcare workforce that reflects the communities served.

• Curriculum Development: Integrating cultural competency and anti-racist training into medical curricula to equip future healthcare providers with the skills necessary to deliver equitable care.

4.3 Community Engagement

Engaging communities in the development and implementation of healthcare policies and practices ensures that interventions are culturally relevant and effectively address the specific needs of marginalized older adults. Community-based participatory research and partnerships can facilitate trust-building and the co-creation of solutions.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

5. Conclusion

Systemic racism is a significant determinant of health disparities among older adults from marginalized racial and ethnic backgrounds. Its manifestations in healthcare, including provider shortages, inequitable resource allocation, and discriminatory practices, necessitate a multifaceted approach to achieve health equity. By implementing targeted policy interventions, educational reforms, and community engagement strategies, it is possible to dismantle systemic racism within healthcare systems and improve health outcomes for all older adults.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

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