People tend to blame Black mothers for their lack of access, and even those who do feel sorry for them (a form of empathy) may still think it’s because of the individual choices they made. However, the lack of access afforded to Black mothers in these poorer neighborhoods, as well as the lack of empathy given to Black mothers under these conditions, have roots in racism.

We as a society often blame victims for their circumstances. The Protestant Work Ethic says that hard work is rewarded (Wilkins & Kaiser 2014). Therefore, if you are disadvantaged, people tend to believe that your lack of opportunity and access is due to a lack of hard work, making people less emphatic towards that group. However, due to systemic racism, everyone starts off on different playing fields, so “hard work” looks different for everyone, and different groups have more opportunities and access to the tools to be successful than others. Why do we blame victims for their circumstances? We tend to be less empathetic towards outgroup members (Hudson et al. 2019). Therefore, those who able to make differences in improving the circumstances of these groups, those in power, are less empathetic to victims’ circumstances. In regard to the disadvantages faced my various minority groups, this lack of empathy is due, in part, to the stereotypes that White people have for minorities. The general stereotypes of Black and Latinos as being lazy, incompetent, and unintelligent make it easier for those in power to place blame on these groups for their shortcomings, as opposed to on the system that is working against them.

People are less likely to support and protect Black neighborhoods (Bonam et al. 2016). This is due to the fact that the physical spaces associated with Black Americans have been subject to negative racial stereotypes, such as “impoverished, crime-ridden, and dirty”. This leads to outgroups feeling less connected to Black spaces and therefore less likely to support and protect them (Bonam et al. 2016). Example: It was found that White people reported less opposition to building a chemical plant near a Black neighborhood than a White neighborhood (Bonam et al. 2016)

Environmental racism is another example of this lack of protection of Black neighborhoods. Environmental racism refers to the ways in which communities of color, particularly Black communities in regard to the Unites States, face more harm from environmental factors than White communities, from proximity to power factors and plants to higher exposure to emissions from mobile pollution sources like trucks (Berkovitz 2020). Black neighborhoods typically have lower property values, making the land in these neighborhoods cheaper for industrial companies to purchase, resulting in the greater pollution we see in these areas. Due to the lack of political power among the Black community, as well as the lack of empathy from those who do have the power to make change, these harmful sources of emissions and pollution are concentrated in communities of color with less political power to fight against them. These large amounts of emissions and air pollution contribute to the adverse health outcomes and the health disparities we see between Black and White Americans (Mikati et al. 2018).

Another factor influencing the lack of supermarkets in Black neighborhoods is the negative stereotypes that plague these areas. This lack of supermarkets doesn’t allow Black residents access to healthy and affordable food, leading to a lack of proper nutrition, which is another contributor to adverse Black health outcomes. Therefore, predominantly Black neighborhoods tend to be food deserts, having significantly less supermarkets and lower access to healthy foods than neighborhoods with a lower proportion of Black residents (Gordon et al. 2011)

This leads to the racial disparities we see in pain assessment and treatment, as well as accuracy in treatment recommendations (Hoffman et al. 2016)

Alongside the biased health professionals, the invisibility and stereotypes of Black women play a role in their health as well. In this sense, invisibility refers to “the lack of individuation of or lack of differentiation between group members” (Sesko & Biernat 2009). A study by Sesko & Biernat (2009) found that the faces of Black women tend to go unnoticed (less likely to be identified correctly) and their voices unheard (more likely to have statements misidentified), relative to White women and Black and White men. Also, as previously mentioned, Black women are often stereotyped as being more “masculine” (strong, assertive, independent) and less “feminine” (emotional, passive, dependent) than White women (Sesko & Biernat 2009). What does this have to do with treatment and health outcomes you might ask? The interaction between the invisibility of Black women and the stereotype of being “masculine” aids in the perpetuation of differences in pain assessment and treatment. By seeing Black women as masculine, it is implied that Black women have higher pain tolerances than White women. Black women being “invisible”, as well as being viewed as masculine, allows for physicians not to take reports of pain or discomfort from Black women as seriously, and so does the hierarchical structure of doctor → nurse → patient, as those higher up on the chain are less likely to take those lower down seriously.

Non-Black physicians with higher levels of implicit racial bias have larger physician-patient talk time ratios than physicians with lower implicit bias levels, indicating that physicians with more negative implicit racial attitudes talked more during a medical visit than those with less negative racial attitudes (Hagiwara et al. 2013). In dominating the conversation, physicians are unable to properly listen to the needs of Black patients, nor are they able to work alongside patients in making decisions about their health care.

Physicians tend to display implicit preferences for White patients over Black patients, and more frequently associate White patients with being cooperative and compliant. Thus, biased physicians are more inclined to assume an authoritative role and exert more control during interactions with Black patients (Hagiwara et al. 2013).

I think that it is interesting that non-Black physicians view Black patients as less trustworthy, more argumentative, and less likely to listen to their recommendations because Black patients view non-Black physicians the same way. The Black community has a long history of being mistreated by health professionals, with the most famous example being the Tuskegee experiment. Over the course of 40 years, the “participants” of this experiments were lied to and prevented from seeking life-saving treatment for syphilis or its complications, resulting in the death of over 100 Black men. This active denial of treatment and deception on the part of the researchers and physicians in Tuskegee has played a significant role in the lack of trust towards non-Black physicians, which leads to the lack of trust non-Black physicians have towards Black patients, furthering the vicious cycle of mistrust. The presence of these racial disparities, however, do not lie solely on the biases of health professionals, but rather the deep-rooted narratives about the Black body, as well as systemic racism (Trawalter et al. 2020). Increasing patient trust is not the answer to reducing these disparities, but rather challenging these narratives and dismantling systemic racism. Also, reducing physician biases alone will not increase patient trust – however, reconciliation for a long history of abuse may aid in moving this process along (Trawalter et al. 2020).

A study conducted by Orchard & Price (2017) found that the Black-White gap in birth outcomes is larger in counties with the highest levels of racial prejudice. This is true when looking at both implicit and explicit racial prejudice, but the strength of the relationship between racial prejudice and the Black-White gap is strongest when looking at explicit racial prejudice (Orchard & Price 2017). Since these biases are so prevalent in the communities in which these health professionals live, they are constantly surrounded by them, making it difficult for them not to bring these biases into their work.