Black and female: those were the first two words that came to my mind as I heard her story. Lying down in a cold, clunky hospital bed, she was visibly upset. Ironically, the woman wasn’t distressed by the neurological problems that initially brought her to the medical institution of a developed nation. Instead, the African American patient was utterly disturbed by the blatant disrespect that she was treated with, by a Caucasian medical professional.
The day before I visited her, she had gotten a lumbar puncture, a medical test performed to remove fluid from the spine. While the healthcare worker performed the procedure, she was experiencing a significant amount of pain. Although she verbally addressed her notable discomfort as she underwent the spinal tap, the medical professional disregarded the severity of her pain as well as the importance of listening to her voice. Despite the fact that the injection of local anesthetic at the puncture site is expected to be the only painful part of the process, there is never a valid excuse to ignore a patient’s complaints without properly explaining the risks associated with the procedure.
I was irritated, furious and concerned to learn that some of the members of the medical community had, in my eyes, failed her. Nevertheless, I wasn’t surprised. I had no proof that race could have influenced her treatment, but I also had little to no doubts that it did. Biases don’t necessarily need to be explicit. It has been extensively shown that, for years, racial bias in pain perception and management has become ingrained within the healthcare system. When compared to Caucasian patients, research has proven that the liability of receiving an appropriate dosage of medications to treat pain is lower for African Americans.
Although I cannot empirically substantiate that this patient’s experience was a direct result of the systemic racism intertwined within every aspect of American society, which does not exclude healthcare, the evidence that supports racial disparities in pain management is broad. Could her treatment have been different had her skin been lighter? Was the standard of care contingent on the race of the patient? Did the color of her skin, or the gender she identified with, influence the healthcare worker’s interaction with the woman? Did the health practitioner properly explain the importance of the patient’s position during the performance of the procedure? I couldn’t categorically respond to these questions. Mainly, because, as a white woman, I have not undergone such lived experiences. Furthermore, I wasn’t on-site at the moment of the occurrence, and I must recognize that this a limitation with regards to my opinion on the subject.
However, I couldn’t help but wonder: could these racial health disparities also be present in my homeland, Puerto Rico, where the idea that racism doesn’t exist, as a result of the racially mixed discourse, prevails in both classrooms and households? I’m afraid you and I both know the answer to my question. Black Puerto Ricans, too, are subject to racial health disparities. A recently published study suggests that dark-skinned Puerto Ricans are not exempt from racial discrimination in the Caribbean island.
Boricua scholar Isar P. Godreau and economist José Caraballo-Cueto emphasized the idea that skin color is directly related to health outcomes with their research work Colorism and Health Disparities in Home Countries: The Case of Puerto Rico. Their study aimed to investigate the extent, if any, to which skin color influenced health outcomes for Puerto Ricans, living in the Boricua archipelago, who self-described as being of dark skin tones. To address this aim, researchers used data from the Puerto Rican Behavioral Risk Factor Surveillance System (PR-BRFSS); a yearly health survey conducted in the island. Furthermore, they assessed, through phone interviews, how colorism, the racial prejudice against individuals with darker skin tones within the same ethnic or racial group, affected self-described health in a randomly selected sample of Puerto Rican respondents. Specifically, participants self-reported their skin color according to a six-point scale that ranged from very light (1) to very dark (6).
According to their findings, over 200,000 dark-skinned Boricuas report a worse health status compared to more than 400,000 light-skinned Puerto Ricans. The results of this study indicate that “Latinos are not exempt from the health effects of being exposed to racial discrimination and skin color privilege in their home country,” as the research paper claims.
The University of Puerto Rico at Cayey based academics found that the darkest-skinned group experienced “a greater disadvantage” than lighter-skinned individuals, and were the affected the most by racial discrimination, which leads to adverse health effects.
Godreau and Caraballo-Cueto argued that the impact of structural racism leads to reduced access to housing, educational quality, healthy food options and insurance, which, ultimately, predispose people to poor health outcomes. “We interpret self-perceived skin tone as an indicator of an individual’s vulnerability to these social stressors and systemic effects,” they concluded.
The economist hopes that the study sheds light on the racism that pervades Puerto Rican society, and affirms that public policy must be enforced to prevent its continuance. On the other hand, Godreau believes that racism is a social problem that fails to be institutionally acknowledged in the island. “We hope that more scholars will continue to study the impact of colorism on health among Puerto Rican and other Latino populations as increasing evidence indicates they are not immune to the pernicious effects of color stratification in their home societies,” the academics wrote in their published work.
As long as the matter remains unrecognized by the State, racial discrimination will continue to disproportionately affect the health of darker-skinned Puerto Ricans. Viewing and speaking of racism as a public health crisis shouldn’t be a controversial topic, particularly for the medical community. Racism in medicine extends from the United States to Puerto Rico. Let’s start with speaking up against the foundations that reinforce its existence. Let’s listen to Black voices. Let’s address the problem. Let’s name it.