Ohio survey details views on racial bias in healthcare settings; hospitals aim to address how unequal treatment can affect care - UHCAN Ohio

CLEVELAND, Ohio — Yvonka Hall hoped a nutritionist could provide answers about her unexplained weight gain despite her healthy eating habits.

But the nutritionist was more focused on his computer than her. He didn’t ask questions; just gave his opinion. Stop drinking Pepsi, and you’ll lose weight.

“I’m sitting there thinking, is he talking to me?” recalled Hall, who doesn’t drink soda, or eat pork or beef, but does have thyroid disease. “I said, ‘Is there something in my chart that says I have an addiction to soda?’

Hall’s experience was far from unique, according to a new statewide survey on bias in health care commissioned by a group of organizations promoting antiracism. People of color — especially women — said they often felt disrespected. Nearly 60% of Black women and 52% of white women reported their symptoms had been dismissed, as compared to 41% of Black males and 20% of white males. Many respondents said they skipped follow-up doctor appointments because of perceived unfair treatment.

The informal survey, conducted by four Ohio health equity nonprofits, was shared through newsletters, email and social media with whoever might be interested. Surveys were also collected at community festivals in Toledo.

“Now we had the validation of what we knew,” said Hall, executive director of the Northeast Ohio Black Health Coalition, a social justice organization. “People were saying — particularly African-American women — that I feel discriminated against when I go into medical settings.”

National studies reinforce the findings of the Ohio survey. Blacks reported being discriminated against or unfairly judged by health care providers almost three times more often than whites, and twice as often as Hispanics, according to a 2021 analysis by the Robert Wood Johnson Foundation.

Hall and other leaders of Ohio health equity organizations recently met with representatives from University Hospitals, the Cleveland Clinic, MetroHealth System and Southwest General Health Center.

The health systems were asked to support the goal of eliminating bias in healthcare settings, Hall said.

Local healthcare systems said they are trying to do better, by implementing diversity, equity and inclusion training and taking steps to diversity their workforce. The meeting participants agreed to future talks.

But a recently published Cleveland Clinic study suggested there were no significant differences in rates of mortality or length of ICU stay between racial or ethnic groups hospitalized for COVID-19 at Clinic facilities.

As a Black woman Dr. Tosin Goje, a Clinic OB/GYN, said she empathizes with patients who feel disrespected. But, sometimes patients might not appreciate the excellent care they received because of how they were treated, she said.

Goje and other Clinic employees recently took part in unconscious bias training. During one activity, participants were shown a photo of a Black woman wearing shorts and a T-shirt, and a white man with tattoos. Participants were asked for their first thoughts about these images.

Later, it was revealed that the Black woman was an entrepreneur, and the tattooed man was a NASA scientist. Some participants admitted that they jumped to negative conclusions about the people in the images because of implicit bias.

“Sometimes you need to learn that you don’t just allow your brain to make a decision for you, based on how somebody looks,” Goje said. “Instead, listen to that person, not just what your brain flashes.”

‘Now we had validation’

The start of the COVID-19 pandemic prompted several Ohio organizations to talk about inequities in health care, and their causes.

MetroHealth System earlier declared racism as a public health crisis. And last year, Black infants died at a higher rate than white infants, according to preliminary 2021 Cuyahoga County numbers.

The informal survey was conducted by the Cleveland-based Northeast Ohio Black Health Coalition, and three Columbus-based organizations — UHCAN Ohio, the Ohio Unity Coalition and the Multiethnic Advocates for Cultural Competence.

The informal online and paper survey collected responses from about 1,000 people starting in June. About 600 responses came from people contacted by the Northeast Ohio Black Health Coalition, Hall said. A report based on survey findings was released Jan. 13.

Here are additional findings:

* About 42% of Black respondents said they were denied care or received inferior care.

* Black females (61%) and Black males (59%) reported race as the most common perceived reason for discrimination, while white females (7%) and white males (10%) rarely reported race.

* About 20% of Black males reported, “People act as if they are afraid of you” in medical settings.”

Enlightened Solutions co-founder Chinenye Nkemere was struck by how closely the health equity organization’s findings mirrored the bias found in her nonprofit’s report. “Project Noir: Cleveland is Failing Black Women” collected stories from 450 Black women in Northeast Ohio about harassment, discrimination and abuse in health care, education and the workplace.

“It is good to have studies that really explore the serious, urgent healthcare problems that specifically our region is experiencing, and that black women in general are experiencing,” Nkemere said about the health equity organization’s survey.

Nkemere understands why people who feel disrespected choose to not to return for follow-up care.

“If you get poor service at a restaurant, you absolutely will not go back to that restaurant,” she said. “Why would we think that somebody that has chronic healthcare problems would want to go back to the same exact doctor, the same exact health care system, to receive the same exact terrible, dismissive and racist care?”