Combatting Racism

What Is Systemic Racism in Healthcare?: Causes, Impacts, and Solutions 

January 17, 2025

By HealthCity Editors

Sick man sitting on the bed at the hospital and feeling depressed - healthcare and medicine concepts

Systemic racism in healthcare manifests as deeply ingrained racial bias and discrimination that creates disparities in access, treatment, and outcomes. See how BMC is working to effect change.

Black women in Massachusetts face twice the risk of dying during pregnancy or within a year after giving birth compared to white women. This stark disparity persists regardless of education level, state healthcare quality, or age—and it’s just one example of how systemic racism shapes health outcomes in America. 

Systemic racism in healthcare manifests as deeply ingrained racial bias and discrimination that creates disparities in access, treatment, and outcomes. While individual prejudice plays a role, the problem runs deeper, woven into the very fabric of our healthcare system that stems from historical injustices up to the contemporary practices of today. 

Systemic and structural racism: What’s the difference? 

Though often used interchangeably, these two distinct forms of racism reinforce each other, creating and deepening persistent racial inequities across society: 

Systemic racism is the broadest, umbrella term, showing how multiple systems—from education to housing to healthcare—work together to maintain racial inequities. The effects of historical redlining, for instance, continue to influence both wealth distribution and health outcomes today. 

Structural racism refers to the structures—laws, policies, and entrenched norms and practices—that work as the “scaffolding” of the systems, according to a study published in HealthAffairs. An example would be healthcare algorithms that inadvertently prioritize white patients over patients of color or requiring photo ID for certain medical services—a requirement that disproportionately affects communities of color.  

Another common term is “institutional racism,” which may be used as a synonym for either form of racism above, though it’s also commonly used to describe racism that is specific to an institution.  

The impact of systemic racism on health outcomes 

The Centers for Disease Control and Prevention (CDC) has consistently highlighted racial and ethnic disparities in health outcomes, reporting that Black Americans are more likely to die from heart disease, stroke, cancer, diabetes, and chronic kidney disease than white Americans. Like in Massachusetts, nationally, Black birthing people, are about 3 times more likely to die from a pregnancy-related death than are white birthing people.

These outcomes are examples of both systemic and structural racism. When it comes heart disease and diabetes, as examples, racial health outcome disparities are not solely rooted in a patient’s experience in an exam room. These gaps in outcomes are rooted in intersecting systemic factors that have been building, often, over generations

For instance, due to a history of discriminatory lending practices, including redlining, underserved communities have less access to high-quality healthcare, are more likely to be environmentally vulnerable, and have access to fewer resources, such as fresh, nutritious food and stable housing. 

Research has shown that areas designated as red (“definitely declining”) amid redlining had high proportions of Black Americans and, even recently, had 13 times higher rates of shooting compared to other areas, 17% of residents lived below the poverty line, 3.6% were uninsured, 38% were publicly insured, and 17% had less than a high school degree. 

In the exam room, the data behind protocols is often determined through clinical trials, from which people of color have been historically excluded. And there is implicit bias in treatment decisions and protocols, which has impacted maternal health equity through decision-to-incision times in C-sections, for example. 

How to address systemic racism: Boston Medical Center’s approach 

Addressing systemic racism requires a multifaceted approach that involves challenging existing power structures, promoting diversity within the healthcare workforce, implementing equitable policies and programs, and raising awareness about racial biases through cultural competency and cultural humility training for staff. All of which enables our health institutions to provide culturally sensitive and inclusive care that helps foster trust and improve patient-provider relationships, ultimately leading to better health outcomes for diverse populations. 

The most crucial pathway to closing gaps in health outcomes due to systemic racism is to partner with the communities you are trying to reach. 

Boston Medical Center’s Health Equity Accelerator exemplifies how healthcare institutions can effectively address racial disparities. Under Dr. Thea James‘ leadership, the program achieved remarkable results: a 39% reduction in racial disparities for a key diabetes marker in Black men and a 19% decrease in pregnancy-related hospital readmissions. 

The program’s success stems from its unique approach of combining data analysis with direct patient input to create solutions. The results demonstrate how addressing racial disparities through patient-centered care and standardized protocols can lead to meaningful changes in health outcomes for communities of color. It is with that approach that we can make meaningful challenges to systemic racism in healthcare. 

Dr. James captures the program’s philosophy with this quote: “When you see data that shows a poor outcome, traditionally what you’re taught is to go into a room and try to solve the problem with the experts. But you can’t solve the problem without the subjects of the data being in the conversation.”

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