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Medical racism refers to the patterns of discrimination and bias in healthcare that disadvantage people of color. Its history in the U.S. is stark: for example, the Public Health Service’s Tuskegee Syphilis Study (1932-1972) involved doctors withholding penicillin from hundreds of Black men, deceiving them into thinking they were receiving treatment. Similarly, in the 1970s, the Indian Health Service (IHS) admitted to having sterilized thousands of Native American women without informed consent. These and other abuses from segregated hospitals in the Jim Crow era to eugenics-based sterilization laws have left deep scars. Health experts note that today’s racial gaps in care reflect “longstanding structural and systemic inequities rooted in historical and ongoing racism and discrimination”. Such inequities have undermined trust: even today, many Black and Native Americans know of these abuses, so a majority express mistrust of the health system.
Legacy of Abuse and Underfunding
The Tuskegee experiment remains a potent symbol of medical racism. As one retrospective noted, “few medical experiments are more ignominious” than the 40-year study in which effective therapy was intentionally withheld from Black men with syphilis. Other dark chapters include the forced sterilization of Native American women under IHS and state eugenics programs (the U.S. government conceded that 3,406 Indigenous women were sterilized by IHS doctors without consent from 1973-1976). These events fostered justified suspicion in affected communities.
Beyond specific abuses, structural neglect has shaped outcomes. The federal government’s treaty obligations to provide health care for American Indians and Alaska Natives (AI/AN) have long gone unmet, resulting in chronically underfunded services. For decades, IHS facilities have operated with far fewer resources than general U.S. medicine. For example, in 2023, the per-patient spending through IHS was only ~$4,078, roughly half of what Medicaid spends and a third of the national average. There is no dedicated funding for physician training at IHS, contributing to a 29% vacancy rate for doctors. As an Indigenous medical student advocate observed, “It is a unique paradox that the Indian Health Service receives no congressional funding for graduate medical education (GME) yet has the highest rate of physician vacancies of any federal health organization”. Over time, such underinvestment has depressed life expectancy and worsened chronic diseases in Native communities.
Continuing Disparities Today
Though overt segregation is history, racial bias in medicine persists. Black Americans and Native Americans still report poorer care and outcomes than whites. Research confirms disparities in treatment and trust for Black patients: they show Black and Latino patients receive less pain management than similar white patients, and a large 2024 survey found over half of Black adults say the U.S. health system was “designed to hold Black people back”. In that survey, 55% of Black respondents recounted negative experiences with doctors, commonly that their pain was dismissed or not taken seriously. Such findings echo concrete outcomes: for instance, Black women suffer maternal mortality at rates nearly three times higher than white women (69.9 vs. 23.1 deaths per 100,000 births in 2021). Discrimination and implicit bias in care contribute to these gaps. As one public health report noted, U.S. minorities “experience a lower quality of health services” and are less likely to receive routine procedures than whites.
Native Americans likewise face stark gaps. Today, AI/AN people have higher rates of diabetes, heart disease, and other chronic illnesses, and an overall life expectancy over 5 years below the U.S. all-race average. Tribal communities often live in rural “health care deserts,” where hospitals and specialists are scarce. One analysis found 40% of Indigenous people live in rural areas, intensifying risks: for example, nearly 25% of AI/AN births occur where no obstetric care is available. These access barriers are compounded by underinsurance: KFF reports nearly one in five non-elderly American Indians or Alaska Natives lack health insurance, more than double the rate for whites. Historical abuses and cultural differences fuel mistrust of mainstream medicine, deterring some AI/AN patients from seeking care. A Commonwealth Fund investigation into maternal health found that a “legacy of health system abuses” and insufficient cultural competence have led many Native women to forgo prenatal care. In 2020, fully 24% of AI/AN mothers received inadequate prenatal care (compared to 10% of white mothers), illustrating the real harm of distrust and under-resourced services.
Experts emphasize that these racialized outcomes are not due to genetics or personal behavior, but to systemic issues: from provider implicit bias to socioeconomic inequities. For example, CDC researchers cite evidence that biased stereotypes during doctor visits (whether conscious or not) lead to worse care for minorities. National surveys show Black and Native patients report feeling devalued by clinicians, which undermines trust and adherence. A recent study even found that simply being stressed or unwell can amplify a healthcare worker’s hidden biases, potentially worsening care for minority patients during busy or high-pressure situation
Combating Medical Racism
Addressing medical racism requires multi-level action. Community empowerment is key: community-based care models such as tribal health clinics, mobile units, and programs run by local health workers can extend access and build trust. For instance, expanding culturally-aligned services like community midwifery has been shown to improve maternal outcomes. Indeed, Native experts recommend training more Indigenous healthcare workers: medical and nursing schools on tribal lands (e.g., Montana’s Grow Our Own program, or Cherokee Nation’s medical school) can “provide opportunities for diversity” and produce a workforce that inspires confidence.
Medical education must also transform. Many institutions are incorporating anti-bias training and structural competency courses into their curricula. The Institute of Medicine has long urged cross-cultural training, and today, schools are creating diversity offices and DEI initiatives. In-service clinicians benefit from workshops on implicit bias and cultural humility. Increasing diversity among healthcare providers by recruiting more Black and Native doctors, nurses, and staff is likewise crucial. Educational pipelines can help: encouraging nurses to advance through bridge programs, such as ADN to NP programs, can quickly grow the number of nurse practitioners in underserved areas and improve care continuity.
Policy change is also required. Congress and healthcare institutions must close funding gaps. Advocates emphasize fulfilling treaty obligations by boosting IHS budgets so that Native clinics can hire specialists and operate modern facilities. Legislators can also expand insurance coverage and enforce civil rights laws to reduce access inequities. Data collection should improve: better tracking of race/ethnicity in health records can make disparities visible and spur targeted action.
Finally, cultural competency must pervade every level of care. Healthcare systems should partner with community leaders to ensure services respect patients’ languages, traditions, and needs. Embedding community health workers, translators, and patient navigators can bridge gaps. Institutions should collect and heed patient feedback on discrimination. By combining grassroots solutions with structural reforms, the United States can begin to dismantle the medical racism that has persisted for centuries and move toward a truly equitable health system.