Why Representation Matters in Health Care

By: Rachel Werner

If you find it difficult to speak beyond a superficial level with your current doctor, you are not alone. The face of the American health care system remains predominantly Caucasian—a fact that may be hindering patients from establishing trusting relationships with medical providers. A 2018 U.S. News & World Report revealed, “roughly 6% of physicians and surgeons are Black, even as African Americans continue to struggle with a range of negative health outcomes compared with whites.”

University of Wisconsin-Madison nursing student, Nina Koroma, can personally affirm how difficult it can be to prioritize wellness when diversity is lacking at such an extreme level. “One of my big pushes to go into medicine was because I truly feel that representation matters. Even before I decided I wanted to go into the medical field, I made sure to always ask clinics and hospitals if my provider could be a person of color. And unfortunately, in Madison, the answer would often be “we do not have any.” Then once I entered the accelerated BSN program, I started to see how deep the deficits go. A lot of these deficits occur because there is just not enough representation in terms of workers, educators, students and policy makers in the health field,” she explains. “My advice for women of color trying to obtain services is to do their research. Nowadays, so many practitioners as well as clinics have websites, which may include reviews.”

Barriers such as these are not localized to a particular region in the United States. In fact, racial bias in regard to health outcomes is so alarming across the country that the federally funded Healthy People 2020 initiative established achieving health equity, eliminating health disparities, and improving the health of all groups as an overarching goal. “Health equity is defined as the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.” Additionally, the initiative includes creating social and physical environments that promote good health for all as an overarching goal.

A tangible example of the urgency of this issue is a shocking statistic released earlier this year by the Centers for Disease Control and Prevention, “Black women are three to four times more likely to die from pregnancy-related causes than white women - and this disparity increases with age.” And Koroma has seen in her practicum work the results of how negative social constructs directly affect populations, specifically underrepresented minorities. “African American women are often ignored and their pain dismissed with the assumption that they do not feel the same pain or are lying about their symptoms,” she says. “This often leads to more complications, higher risk pregnancies and more fatal outcomes.”

“Culture affects health by playing a major role in how one both receives and gives care. From the patient’s perspective, it affects one’s decisions in compliance; lifestyle choices; diet; comfort level in medical facilities; available resources—and most importantly—their overall perception of health,” she states. “The largest goal for practitioners is to find ways to help improve a client’s life. That goal is made exponentially more difficult when there is a disconnect between the provider and client.”

Koroma also suggests to make sure you know the reason(s) for any tests, procedure or treatments. Do not be afraid to ask questions. A provider should always explain what they are doing—and why. If he/she does not, BE VOCAL - remind the clinician you are owed informed consent. She affirms, “cultural competence not only means that you understand someone else’s culture, but that you are also willing to learn about it. In my experience, not enough providers have that skill—nor try to develop it. It is very important because it not only allows the patient to receive the best care that fits them, but it also expands the health care provider’s knowledge. Additionally, it improves the work environment of medical facilities because it creates an atmosphere where people from diverse backgrounds can work in an inclusive environment and learn from each other.”

Encourage friends, family and youth in your community to consider careers related to health and wellness. Increasing the number of African Americans in the medical, nutritional, fitness, therapeutic and psychiatric workforce is one of the most effective ways to build a more approachable health care system.

Why is representation in health care important to you? Tell us in the comments below.