Why My White Privilege Makes Me Angry
You, Me & Vaccines Article 12: Vaccine Hesitancy and Ethnic Minorities
I have something very uncomfortable to admit today: I`ve been privileged while being a patient in the healthcare system. I`ve been treated really well. I`ve had my concerns about vaccines and every other medical issue listened to with care. I`m white, cisgender, female, young, and live in a wealthy country (Ireland). I genuinely used to believe that this was the norm. That this was the standard for everyone. When I read stories of ethnic minorities facing stigma in healthcare, I really internalised the frustration and anger they felt. And I came to realise that it was never luck or compassion that gave me a leg up in my healthcare. It was white privilege. This was a very harsh truth to admit to myself. However, what about those who aren't privileged enough to have concerns heard?Even well known ethnic minorities are not immune to this. The famed tennis player Serena Williams experienced post-birth complications; as well as it being revealed that Williams had been tested for performance-enhancing drugs over two times more than that of other elite American female players.
This kind of experience is far from uncommon in ethnic minority communities. It is particularly true for black women. Health outcomes are also worse for minorities for a variety of other conditions. According to the CDC website, “Black, Hispanic, and American Indian and Alaska Native (AI/AN) people have had consistently higher rates of severe flu outcomes, including hospitalisation and ICU admission from 2009 to 2019.” Compared with white patients, ethnic minorities have higher age-adjusted fly hospitalisation rates, as well as ICU admission rates. The website also states that “People died in the hospital from flu at similar rates across all races and ethnicities during 2009-2019. Disparities in flu outcomes were greatest in the youngest age groups, particularly among children (0-4 years old).”
Clearly, there are systemic biases affecting health outcomes of ethnic minorities. Therefore, it is unsurprising that charged experiences are what will drive decision making when asked to trust health providers about vaccines. What are the reasons for vaccine hesitancy among ethnic minorities? What experiences have they had when asking healthcare providers about vaccines? How can we do better as a society? Those are the questions I am going to focus on in this blog post.
Historical trauma is a key factor cited. Regardless of where you live, historical events always shape culture. When this principle is considered in light of health-related injustices to minorities in the past, it's a no-brainer that it can lead to a culture of vaccine hesitancy. Probably the most famous example of a historical event is the Tuskegee syphilis study of 1932. According to the CDC website, the USPHS, working with the Tuskegee Institute, undertook a study to record the natural history of syphilis. 600 Black men were recruited, 399 with syphilis, 201 without. Informed consent was not collected. Participants were told they were being treated for “bad blood”. By 1943, penicillin was the treatment of choice for syphilis and becoming widely available, however study participants were not offered treatment. In 1972. The study was deemed to be “ethically unjustified”, and the study`s end was announced in November 1972. Later in 1973, a class-action lawsuit was filed on behalf of the study participants and their families, resulting in a $10 million, out-of-court settlement in 1974. On May 16, 1997, President Bill Clinton issued a formal Presidential Apology for the study.
Another key aspect is their personal experiences with asking questions about vaccines to their healthcare providers. I mentioned Serena William`s story, however I also mentioned that many working class minorities experience mistreatment. However unlike Serena, they often do not have the agency or financial means to advocate for themselves.
3.1 Acknowledging that the issue exists
As with anything, it is a multifactorial issue. However, the beginning of addressing any issue is acknowledging that it exists. This is where I`m going to start. The best way to acknowledge that a problem exists is simply observing it in your everyday life. Look for indicators of racism on a practical everyday basis. Are there many people of colour employed where you work? If not, why do you think this is? If so, do you spend less time talking to them? Less time helping them with projects etc? It's important to be honest with yourself here. Establishing the habit of journaling your experiences can help you figure out where there are patterns in your behaviour. Have other people help you too. Colleagues, friends etc can all hold each other accountable and create more inclusive environments. Don`t even limit this to your work environment. Expand it to cashiers, waiters, etc. Do you treat these people better if they`re of the same ethnicity as you? Do you engage with those from different ethnicities differently? Why?
3.2 Patient-provider ethnic congruence
Increasing the probability that they will see a physician with a similar ethnic background and/or experiences is shown to improve health outcomes. This has been termed “patient-provider racial and ethnic congruence”. However, the vast majority of doctors in the US are white. This includes medical students all the way up to senior faculty members at academic institutions. Until this is resolved, there is another way to increase patient-provider ethic congruence. Introduce more minority members of staff forming part of a team-based model of healthcare. As racism is a systemic issue, it is a cultural issue by extension. Having a diverse workforce can create this cultural shift that is desperately needed.
Although this is a good start, we also need to expand the systems already in place to further support patients of colour. Funding services like those mentioned above will make healthcare more accessible to many more people of colour. This will in turn, make clinics more inclusive environments. Further, expanding access to Medicare and other social healthcare programmes can help these communities get access to the treatment they need. For instance, employing more community health workers of colour can address this problem twofold. First, it makes community health workforces more diverse. This allows a more inclusive culture at the community level. Second, it means there are culturally competent health professionals in communities. Meaning access to better quality healthcare for more minorities. This further feeds into a culture that embraces diversity.
Disparities in healthcare are costing ethnic minorities their lives. We`ve all been complicit in it and allowed it to continue. So we`ve all got a role to play in eliminating it.