African-American clinic patients' reactions to racism may affect their health outcomes

October 2005 issue of the Journal of the American Geriatrics Society -----

Ninety-five percent of older African-American clinic patients reported at least some exposure to racism during their lives in a study by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.

The study authors say that the ways in which patients react to racism may affect their health outcomes.

The authors also suggest that medical professionals need to be more aware of their African-American patients’ day-to-day experience of racism and the effect that experience might have on their level of trust in the health care system, which in turn might affect how closely they follow medical advice. The study was published online on October 7 in the “OnlineEarly” section of Journal of the American Geriatrics Society.

“Consistently, African-Americans have been found to have worse health outcomes than whites,” notes lead author Sandra Moody-Ayers, MD, a staff physician specializing in geriatrics at SFVAMC. “Now we’re starting to think about the mechanisms. What are the causes of that health disparity? Is trust an issue? Although this study does not ask these questions directly, it’s leading in that direction.”
The study analyzed perceptions of societal racism among 42 African-Americans aged 50 and older with type 2 diabetes who regularly attended the primary care and endocrine clinics at Yale-New Haven Hospital in New Haven, Conn. Study participants reported their experiences of perceived racism using a modified version of the McNeilly Perceived Racism Scale originally developed at Duke University.

The results show that women and people of lower socioeconomic status tended to respond to racism “passively,” according to Moody-Ayers, with responses ranging from “praying” to “accepting” to “forgetting.” Men and people of higher socioeconomic status tended to respond “actively,” which the researchers characterized as either “speaking up” or “trying to change things.”
“This is significant because other studies have shown that when racism is dealt with in a passive, internalized way, there seems to be some impact on health. So that will be something for researchers to look at in the future,” says Moody-Ayers, who is also an assistant professor of medicine at UCSF.

The other significant finding, she says, is that study participants who rated their own health as “fair/poor” tended to respond passively, while those who rated their own health as “good/excellent” tended to respond actively. According to the authors, the study is the first to show an association between responses to racism and self-rated health. 

Moody-Ayers cautions that the study has a number of shortcomings, including a small sample size and the fact that it was conducted solely among African-Americans.

“Nonetheless, it’s indicative,” she says. “I think doctors sometimes tend to see patients in terms of their symptoms and complaints, and our goal becomes simply to diagnose and treat. And we forget the rest of the patient - the experiences in life, and how these experiences might impact on the doctor-patient relationship, including whether someone trusts you enough to follow your recommendations.”

Moody-Ayers suggests that physicians can immediately begin to take steps to counteract perceived racism. “For instance, the doctor could ask patients, ‘Are there any concerns that I need to know? Have any of the staff treated you in an inappropriate way?’”
In her current research, Moody-Ayers is studying the impact of race and adverse life experiences on the quality of end-of-life care and on communication between doctor and patient at the end of life.

The other authors of the study were Anita L. Stewart, PhD, of UCSF; Kenneth E. Covinsky, MD, MPH, of SFVAMC and UCSF; and Sharon K. Inouye, MD, MPH, of Yale University.

The research was supported by grants from the National Institute on Aging, the National Institutes of Health, and the Agency for Healthcare Research and Quality that were administered by the Northern California Institute for Research and Education, and by the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine.  Moody-Ayers is the recipient of a VA Career Development Award in Health Services Research and Development

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