The Stigma of Healthcare

The Stigma of Healthcare: An Analysis of the Effects of Social Stigma on Medical Care in the United States

The Stigma of Healthcare:An Analysis of the Effects of Social Stigma on Medical Care in the United States

By PJ Beaudry

To begin, I would like to tell you a story; it begins when two people walk into their local

hospital clinic. One, a white woman named Claire in her late twenties, is a single mother of two

who is trying to raise her children on the meager salary she earns working in the public library in

their city. Recently, she was forced to apply for and received Medicare. The other is a Hispanic

man named Edgar in his mid-thirties. He is a relatively successful businessman who is able to af-

ford his own healthcare for himself and his family, who came with him from Guatemala thirteen

years ago. Their children were born in the United States, and he and his wife applied and quali-

fied for United States citizenship. He has private health insurance. These two walk into the

clinic, barely making eye contact before sitting apart in the waiting room, not knowing that they

are suffering from the same disease, let’s say leukemia. They both are seeking answers to why

they have been feeling unwell lately, and eventually, when they find out, they will both seek

treatment. However, Claire and Edgar, from the moment that they walk into the clinic, will be

treated quite differently, by the receptionist, the nurses, and even the doctors. The question is not

whether this difference exists, but why it exists, and that is the question that I sought to answer in

my research.

Obviously, these characters and their stories are invented, but to a meaningful end.

Claire and Edgar have been brought into existence to illustrate the type of situation that hundreds

of human beings experience every day when they meet with health care professionals in the

United States. Camara Jones, in her discussion of racism published in 2000, said that “Institu-

tionalized racism is often evident as inaction in the face of need.”1 Certainly, racism is one of the

1 Jones, Camara P. “Levels of Racism: A Theoretical Framework and a Gardener’s Tale.” American Journal of Public Health 90 (2000): 1212.

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sources of the disparities that have been proven to exist in the modern medical system, but it is

just one of three. Thus, this quote can be applied to race/ethnicity as well as gender and socioe-

conomic bias, such that, at least in this case, “racism” can easily be replaced with “sexism” or

“socioeconomic discrimination”. The implication of this idea is that, based on what I call “social

stigma” applied to individuals based on these factors, individuals receive varying treatment in

both the medical and social senses of the word.

Glenn Lowry, an economist and author well versed in racism in America, developed the

idea of “racial stigma” in his book The Anatomy of Racism. He defines racial stigma es-

sentially as “dishonorable meanings socially inscribed on arbitrary bodily marks”.2 For race, it is

obvious that these “arbitrary bodily marks” refer to the color of one’s skin, the shape of one’s

nose, how one’s hair falls, and numerous other nuances that form the basis of our characteriza-

tion of individuals. The question becomes, however, how could this idea transcribe to gender

and socioeconomic class? The visible marks are somewhat more difficult to find, and yet it has

become clear to me that these social stigma do exist, so they must be present enough for us to

make judgements with them in mind. With gender, social stigma is often manifested through

much more underlying characteristics that come to mind when one immediately assumes the ex-

istence of and considers biological differences between men and women. Essentially, men look

at women and view them as fair, fragile, the mothers of our future, and often, as somehow

weaker than they are, based on such biological differences assumed to be inherent. This is where

the idea of “dishonorable meanings” being attributed to “arbitrary bodily marks” comes into

play. Additionally, if one looks at a woman and believes that she is fundamentally different, we

often continue this assumption into the psychological realm, which can lead to the tendency to

2 Loury, Glenn C. The Anatomy of Racial Inequality. Cambridge, MA, Harvard University Press, 2003. P. 59.

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believe that women’s minds, due especially to their supposed fragility, may be clouding their

judgement and causing them to overestimate or exaggerate their symptoms. It is proven that

medical conditions are assumed to be more psychosomatic in women, but we will discuss this

more later. It is much more difficult to discuss the idea of social stigma concerning socioeco-

nomic class, but I believe I have uncovered the answer. These days, when fashion and manner-

isms are made so important by cultural influences, one can view a person and make judgements

regarding their socioeconomic status based simply on what they are wearing and, if more time is

invested, on how and about what they speak. Thus, these qualifications form the basis of the so-

cial stigma we attribute to them. In any world where quality costs and everybody knows what

quality means, be it quality of education or clothing or jewelry or otherwise, such judgements

can be made with relative ease. Such stigma are no less meaningful for healthcare professionals,

and in their line of work these sources of stigmatization are often backed up by such things that

only doctors and nurses can fully understand and judge, such as who one’s insurance provider is

and where their primary care facility is. Often, these additions have less social and more medical

effects, as insurance and access to quality care frequently play crucial roles in what doctors will

choose to inform their patients about, but again, we will discuss this further later.

Ultimately, in doing research about the state of the medical environment in America, it

becomes obvious that, when the discrimination that surfaces could not simply be chalked up to

the conscious beliefs of people, professionals’ ideas about others and how these ideas are mani-

fested in the way that they treat their patients are clearly based on such stigma. Thus, be they

stigma that result from someone’s gender, race or social status (hence the term “social stigma”),

they clearly play a tremendously important role in their experience at their local source of care.

Doctors and others will invariably look at a patient as they sit on the examination table or lie in

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the bed and make decisions for them regarding cause, treatment, payment, or simply the type or

magnitude of interaction that they will have based on the color of the patient’s skin, where their

parents or grandparents are from, what kind of insurance they have, what neighborhood they live

in, or hundreds of other factors depending on what they the doctors deem relevant or important.

It is these factors that will become the stigma, and it is from these social stigma that discrimina-

tion in the healthcare system arises. When framed in such a way, it is easy to see how individual

patients could view such treatment as racist, sexist, or socially discriminatory, and few would ar-

gue that it is not, though it may be an unconscious form of these. Keep this idea in mind as we

delve deeper into these three forms of inequality, because often what we do unconsciously can be

the most dangerous.

It is important to understand, however, that in all but the most extreme cases, the discrim-

ination that exists regarding patient care is often completely unintentional. Few doctors are bla-

tant racists, sexists or otherwise, or else they would not become doctors. They are (for the most

part, we would hope) good people who are interested in medicine and in helping people. Thus,

such discrimination “emerges, time and again, by way of beliefs and interpretations of medical

practitioners who believe they are doing the best for their patients.”3 They view their patients in a

certain way, the way of “social stigma”, as any other person in society would, and they make

judgements like what procedures to inform them about, what treatments might be the most ap-

propriate for them, and even what disease may be making them sick. They are human beings

like any of us, and their brains categorize just like ours do. Unfortunately, when their success is

measured in the quality of life in their patients, their shortfalls can become very obvious to us,

especially when they seem to correlate with gender, ethnicity or socioeconomic status. Simply

3 Ruiz, M.Teresa and Louis M. Verbrugge. “A Two Way View of Gender Bias in Medicine”. Journal of Epi-demiology and Community Health (1979-) 51.2 (1997): 108.

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put, though there is discrimination evident in the medical system, medical professionals have no

higher a percentage of discriminatory activity than does society as a whole, and our examination

of such discrimination in the health care system could be considered a microcosm for the kind of

judgements we all make in society at large. Thus, do not think that the people in whose hands

we frequently place our well being will base their performance on anything more than their de-

sire to do their best for us. It is, however, obvious that racism, sexism and socioeconomic dis-

crimination are evident, as stated before, and it is the question of why and what does this mean

for us that I will address.

Certainly, racism is one of the forefront problems under discussion in social circles nowa-

days. In a time when many believe we solved the problem of racism in during the civil rights

movement of the 1960s, there are perhaps millions of others that feel we have only scratched the

surface. With regard to healthcare, it quickly becomes evident that the latter is a more accurate

description of the situation. In fact, race and/or ethnicity (depending on how you define or relate

each term) are undoubtedly the most important of our three forms of discrimination in terms of

their impact on care. No discussion of inequality in the American healthcare would be complete

without discussing the tremendous effects of stigma attributed to “visible minorities”.4 There are

many forms that racial discrimination takes in the American medical system, but in terms of our

idea of social stigma, two emerge as particularly worrisome: the issue of the importance of cul-

tural sensitivity and how it is applied, and the obvious presence of disparities in treatment op-

tions, execution, and outcome. We will discuss cultural sensitivity first, and it is important to un-

derstand that there are essentially two positions one can align oneself with regarding cultural sen-

sitivity: the belief that is important and should be embraced, and the belief that it only furthers

4 Spitzer, Denise L. “In Visible Bodies: Minority Women, Nurses, Time and the New Economy of Care”. Medical Anthropology Quarterly 18.4 (2004): 494.

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the idea that differences are something to be noticed and which argues that the idea of cultural

sensitivity only adds to the problem of social stigma.

In the world today, there are many fewer people who are outright racists than there are

people who simply lack a sensitivity to the cultural diversity expressed in others. People do not

blatantly discriminate, but rather unconsciously judge others based on how another person is

“different” than them. All too often, difference, or change, is scary to them, and when someone

is scared by something they tend not to like it, and they certainly do not embrace it. Often, these

perceived differences are principally based on what Loury defines as “racial stigma”, or what I

am defining as social stigma. That is to say, they make these judgements without truly getting to

know the person at all, simply on the basis of physical or social features. What this truly comes

down to is a lack of sensitivity for the plethora of cultures and attitudes that collide in today’s

America, and this problem extends into the medical field with concerning results. Often, this

communicates to individuals in three ways: a lack of information regarding ethically specific

complications, procedures or diseases, significant disparities in the doctor-patient relationship

and how it plays out, and a language or cultural barrier that can severely affect treatment. All

three of these problems were raised in a study conducted in 2003 in several Florida-based health

clinics known for their diverse patient populations. The study involved asking questions of three

focus groups of men and women, one being composed of solely African Americans, another of

just Latino Americans, and the third of just European Americans. After considering the re-

sponses to the questions (which were the same in all three groups), it became clear that while the

European Americans felt that cultural sensitivity was not lacking in their clinics, the groups com-

posed of defined minorities came to the conclusion that there were problems with cultural sensi-

tivity, especially in the group composed of Hispanics. For example, many African Americans

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commented that there was little information available regarding diseases and disease prevention

specific to them, and many Hispanics commented on a severe lack of doctors and support staff

who were able to fully understand what their patients were trying to express when the patient’s

primary language was Spanish. Clearly, the language barrier translated to a severe hinderance in

care according to those who could best judge this hinderance. Both the African Americans and

Latino Americans were dissatisfied with the way that they were treated by the support staff

specifically, commenting that often they felt ignored, dismissed, or that they were forced to wait

longer than their white counterparts. The overall findings from the study emphasized the

tremendous importance of sensitivity to minorities and cultures in the medical environment, a

topic which is focused on very little in the training of doctors and support staff, and the impor-

tance of individualized patient-professional relationships based on what makes the patient feel

most comfortable and taken care of.5

Perhaps even more profound evidence of a lack of cultural sensitivity came not from the

United States but from Canada, but is still highly applicable to the United States as it transitions

into a system of market-based medicine with a more universal system of healthcare coverage. A

study was conducted that interviewed what the Canadian government defines as “visible minor-

ity” women who felt that they were racially discriminated against when they were treated in ma-

ternity wards of several inner city hospitals, as well as the nurses who treated them. The basis of

the study was the reformation of the Canadian healthcare system, which occurred when the sys-

tem was forced to bureaucratize operations when the economy experienced a downturn while

medical expenses soared. This forced nurses working the hospitals and clinics to both budget

and justify their time spent with patients, which in turn forced many of them to have to make de-

5 Tucker, C.M., et al. “Cultural Sensitivity in Physician-Patient Relationships: Perspectives of an Ethnically Diverse Sample of Low-Income Primary Care Patients”. Medical Care, 41.7 (2003): 859-870.

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cisions about which patients they would spend more or less time with. The study found that the

majority of nurses made the decision to spend less time with these “visible minority” women

based on the belief that they would present difficulties that would slow their operations and

waste their precious time. Often, these judgements were based on the same social stigma as well

as on a blatant lack of cultural sensitivity that was unfortunately omitted from their training.

What these misunderstandings often led to was a denial of special rights afforded to minority

families by the Canadian government involving rituals and services surrounding childbirth in dif-

ferent cultures. These rituals were not only glossed over or denied by the nurses, but mothers

sometimes felt scorned or were made to feel as though they were inconveniencing nurses, plac-

ing them in the uncomfortable situation of choosing whether to follow their faith and/or cultural

requirements and be maltreated or to conform and be given better treatment.6 Even more trou-

bling is the fact that after having conformed to the nurses demands and sacrificing their personal

comfort or rituals, they were equally as likely to be treated better as for the discrimination to con-

tinue. This idea proves the varying importance of behaviors versus simple “arbitrary bodily

marks”, or essentially the difference between discrimination and prejudice in the nursing staff.

Clearly, the situation is highly discriminatory, and perhaps worst, is based on a complete “whit-

ing out” of ethnic differences in favor of Eurocentric social norms.7

Of course, it is important to realize that, while many may view cultural sensitivity as a

positive step, many others may view the very idea as a source of social stigma. I believe it is im-

portant to discuss both ideas, as both are applicable in individual cases and it is vital to under-

stand which side a person takes in the discussion in order to treat them properly. The idea that

there are inherent cultural differences that must be respected is an idea that brings with it the im-

6 Spitzer, Denise L. “In Visible Bodies: Minority Women, Nurses, Time and the New Economy of Care”. Medical Anthropology Quarterly 18.4 (2004): 490-508.

7 Spitzer, Denise L. “In Visible Bodies: Minority Women, Nurses, Time and the New Economy of Care”. Medical Anthropology Quarterly 18.4 (2004): 498.

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plication that we must first identify and understand these cultural differences before we can pos-

sibly begin to respect them. Thus, many people will revert to the very social stigma I am trying

to point out are negative to make such identifications. For example, when a patient walks into a

clinic seeking care, for a doctor to be properly sensitive to that person’s culture, he must make

judgements about their culture based on the “arbitrary bodily marks” that are obvious to them.

In this way, cultural sensitivity can seem as though it is something that is actually enforcing the

practice of social stigmatization and thus, inequality. This clearly poses a problem that many

would consider offensive, but the problem is a dynamic one in that minorities clearly want their

ethnicity to be respected but not to be assumed. It becomes a case of being stuck between a rock

and hard place in which doctors choose to either be viewed as culturally insensitive or judgmen-

tal. This may sound like a “damned if you do, damned if you don’t” type situation, but the im-

portant thing to realize is that different people will view the situation in different ways, and it is

identifying the proper way to treat each person that is important. This idea is also highly applica-

ble to the study regarding cultural sensitivity that we discussed earlier, in which whites valued a

more collaborative relationship whereas minorities often said that they were more comfortable

submitting to their doctor and being simply told what to do.8 There are serious implications to

this finding as to why these attitudes are so different, and it is certainly an idea that could form

the basis of a body of research by itself. Essentially, the idea of cultural sensitivity is a problem -

atic one, and it is an issue whose importance must be judged on an individual basis to treat a pa-

tient properly to their standards, because each patient will view the issue differently. Thus, it is

crucial as both a medical professional and as a person in our melting pot society to understand

both angles.

8 Tucker, C.M., et al. “Cultural Sensitivity in Physician-Patient Relationships: Perspectives of an Ethnically Diverse Sample of Low-Income Primary Care Patients”. Medical Care, 41.7 (2003): 859-870.

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Clearly, the importance and level of application of cultural sensitivity in medical facilities

poses a significant hurtle to overcoming inequality in the American healthcare system, and these

are just two examples of what can happen when social stigma form the basis of patient-profes-

sional relationships. However, these problems lead to the second manifestation of how racism

can affect medical care: obvious disparities in treatment options, execution, and outcome. For ex-

ample, consider again the case of the treatment of “visible minority” women in Canadian hospi-

tals, where decisions made by the nursing staff for the purposes of time management (based on

the perception of difficulties posed by linguistic or cultural barriers) are easily interpreted as

racism by such women when “easier” white women are favored. Women feel rushed, maltreated

or even dismissed entirely, even when they speak perfect English or are only different from the

people who fit the Eurocentric norms (deemed “easy”) by to the color of their skin. 9 Consider

also studies which conclusively prove that minorities receive shockingly sub-par care in several

critical areas including kidney transplants, cardiac procedures, psychotic care, and pain control,

often because they are not properly informed of treatments or suggested for surgeries that whites

would immediately be made aware of and encouraged to pursue.10 As if that is not enough to

convince you, consider the specific case of diabetes. It is a known fact that minorities have much

higher prevalence, seriousness and mortality rates regarding diabetes, but before a study was

conducted in 2003, little attention was paid to why this fact existed. The study found that many

of these differences can be traced to disparities in the quality of care for minorities versus whites.

For example, African Americans were given far fewer tests for risk factors such as low-density

lipoprotein (LDL) levels and those for complications like the onset of blindness, and thus had a

higher prevalence of these complications. In addition, much higher rates of cardiovascular dis-

9 Spitzer, Denise L. “In Visible Bodies: Minority Women, Nurses, Time and the New Economy of Care”. Medical Anthropology Quarterly 18.4 (2004): 498-501.

10 Van Ryn, Michelle. “Research on the Provider Contribution to Race/Ethnicity Disparities in Medical Care”. Medical Care 40.1 (2002): 1140-1151.

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ease in minorities related to diabetes are explained by their having not been told of many of the

options available as well as to significantly lower treatment rates. The final nail in the coffin, of

course, is the fact that too often, minorities simply do not have access to the highest quality treat-

ment facilities. Finally, consider the experiences of minorities in primary care facilities, where

they are often maltreated on first contact, are forced to wait longer for appointments or have dif-

ficulty getting one, and are often forced to go to hospital clinics as their source of primary care.11

Clearly, the evidence for ethnicity-based discrimination in the medical sphere is irrefutable and

expansive, but it is the implications of such discrimination that is truly important, especially as

our healthcare system undergoes reformation, but we will talk about that later. For now, there

are two more sources of inequality in medical care to talk about.

A problem that is just as significant as racial discrimination in health care but is signifi -

cantly less discussed and studied is the problem of gender bias. Certainly, gender equality has

made many more positive strides than has racial equality in the past century, but the simple fact

is that the former is still present in our society as a whole and thus, is still present in our medical

system. Such bias is based on two essential factors: assumed equality between genders and as-

sumed differences. Each presents its own set of complications that can severely hinder women

in terms of treatment and in their experiences interacting with healthcare professionals. How-

ever, it may be difficult to fathom how gender bias could take the form of two such opposing

problems. It is important to understand that the issue boils down to convenience. Essentially,

medical professionals interchangeably believe that men and women are fundamentally the same

and fundamentally different based on which belief is most convenient or applicable to serve their

purpose in a given situation. This is not to say that doctors are manipulative; they simply work

11 Shi, Leiyu. “Experience of Primary Care by Racial and Ethnic Groups in the United States”. Medical Care 37.10 (1999): 1068-1077.

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with what their training and support tells them: that sometimes men and women can be assumed

the same and other times they can be assumed to be dramatically different. Thus, both of these

problems can and do exist simultaneously, as the evidence clearly shows.

When talking of assumed similarities, the conversation essentially boils down to research

and presentation. The common assumption in the medical field is that men and women experi-

ence the same risks for the same diseases, and that they present with the same symptoms. In

most cases, this is not the case, and the assumptions lead to a high degree of inaccuracy in diag-

nosis, which often occurs more frequently for the women than the men because the assumed pre-

sentation and risk factors are based on male norms developed in research with all-male partici-

pants. Interestingly, research is so lopsided because, in an attempt to protect pregnant women

(and often even women who are not pregnant) from the potentially harmful effects of pharma-

ceutical research or research measuring the effects of innovative treatment techniques, they are

excluded from the study. This of course leads to a problematic lack of information regarding

women specifically, so they are assumed to be in the same boat as men. Additionally, women

are often viewed on the same level as men with many different outside factors that can effect

their health. “Because of the medical orientation, we know little about how men and women vol-

untarily adopt some risk behaviors and risk exposures, their different perceptions of symptoms

and expression of complaints, how their milieux of social support affect health and health behav-

ior, and their behavioral strategies for adjusting to health problems.”12

For assumed differences, the most problematic assumptions focus on the role of psychol-

ogy in the presentation of diseases between men and women. Doctors and support staff are fre-

quently more skeptical of women than of men who present with the same disease because their

12 Ruiz, M.Teresa and Louis M. Verbrugge. “A Two Way View of Gender Bias in Medicine”. Journal of Epidemiology and Community Health (1979-) 51.2 (1997): 106.

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claims are more frequently perceived as psychosomatic (psychological disorders that present

with physical symptoms). Clearly, these assumptions, as the case was for racism and will be so-

cioeconomic discrimination, can easily be traced to social stigma. Women, as discussed before,

are too often viewed as fragile or something to be protected, and thus are deemed unusable in

medical research. They are also viewed as fragile mentally, and this often leads to the conscious

decision by doctors that their claims are less serious. In fact, a psychiatrist colleague of the au-

thor of the study admitted that when he and his fellow psychiatrists receive a call from the emer-

gency room when someone who is admitted having tried to kill themselves, they repeatedly re-

spond quicker when the patient is male. Ironically, this friend, in the beginning of the article,

was quoted as saying there was no way that gender bias could exist in the modern medical sys-

tem.13

The final way that inequality is manifested in the America’s medical system that we will

discuss is one that has largely become the focus of the newly passed healthcare reform: socioeco-

nomic discrimination. The costs of medical treatments seem to be increasing exponentially as

they advance, and there is frequently a conflict between “what is just and what is profitable”14

(emphasis in original). This has severe implications for the people who find it more and more

difficult to afford the rising costs of healthcare, though they are often the ones who need it the

most. Most commonly, when it comes to patient-professional interaction, these implications take

the form of decisions by medical professionals to omit potential procedures or tests on the basis

of their belief that the patient will not be able to afford to pay for it or them, that they will not ad-

here to the requirements, or that they will not make the best use of their newfound health. Of

course, these determinations are highly discriminatory and have undoubtedly led to the mistreat-

13 Ruiz, M.Teresa and Louis M. Verbrugge. “A Two Way View of Gender Bias in Medicine”. Journal of Epidemiology and Community Health (1979-) 51.2 (1997): 106.

14 Rylko-Bauer, Barbara and Paul Farmer. “Managed Care or Managed Inequality? A Call for Critiques of Market- Based Medicine”. Medical Anthropology Quarterly 16.4 (2002): 476.

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ment of countless individuals. One study sought to illuminate and interpret the importance of pri-

mary medical providers concerning disparities in medical treatment and found that often social

behaviors and characteristics are improperly attributed to the poor or marginalized, especially

with regard to adherence. For example, many healthcare professionals were found to believe that

the poor or underprivileged enjoy a less stable support network, and thus will be less likely to

continue with long, difficult regimens of treatment. Others were found to base many of their de-

cisions regarding patients on basic human tendencies to categorize, which often led to inappro-

priate stereotyping that affected care based on this idea of social stigma. In this case, as I ex-

plained before, the stigma often takes the form of what kind of insurance the patient has (be it

Medicare, Medicaid, or private) and who their primary care facility is (be it a hospital or outpa-

tient clinic), which is unfortunate because often these factors are not due to the people them-

selves but the limitations that the system puts on them, such as their employers not offering ben-

efits and/or their inability to afford the rising cost of privatized health care at outpatient facilities.

This form of stigmatization can have a huge impact that is largely unstudied, but often relates to

the type of experiences discussed above, such as doctors not properly informing patients of ex-

pensive procedures or tests that could help them, leading to higher levels of complications or

mortality rates.15 Interestingly, a second study, focusing specifically on the likelihood of being

put on the kidney transplant list and then actually receiving a kidney based on socioeconomic

status found that while disparities do conclusively exist in the form of far fewer underprivileged

people being placed on the transplant list and even fewer receiving kidneys, the number of dis-

parities seemed to decrease when other factors (such as attitude, availability, proper information

provided) were accounted for. Of course, this involved an equalization of the giving of informa-

15 Shi, Leiyu. “Experience of Primary Care by Racial and Ethnic Groups in the United States”. Medical Care 37.10 (1999): 1068-1077.

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tion regarding the option of a kidney transplant as opposed to dialysis, the omission of which is

often the most common form of socioeconomic discrimination on the basis of the factors stated

above. The same study did find, however, that when theoretical measures to reduce the effects

of socioeconomic inequality were applied, far more transplant spots and, eventually, kidneys

would be given to underprivileged individuals (defined in the study as the poor, old and those of

minority status).16 As such, socioeconomic status clearly plays a well defined and troubling role

in medical treatment techniques that is often to the detriment of those who are forced to grapple

with it and is almost entirely based on frequently inaccurate judgements based on our ever

present social stigma.

Thus, having discussed the roles of racist, sexist and socioeconomic social stigma, we can

all accurately acknowledge that discrimination in health care does in fact exist. With this conclu-

sion in mind, the next logical step would be to ask, where do we go from here? We know the

problem exists, and short of trying to fix it completely we will wonder what implications its exis-

tence has for the middle and upper class whites among us who do not have to worry about such

things. The nature of racism, sexism and socioeconomic discrimination in the healthcare system

has profound implications, especially when the new universal healthcare reform is considered.

The new legislation calls for a public option that provides an inexpensive alternative for those

who are unable to afford the rising costs of private healthcare, such that a much wider group of

people will be able to sleep soundly at night knowing that they are covered in case of illness or

injury. This plan sounds just lovely on paper, but based on all the research and ideas stated

above, it is not necessarily one that will be effective in combating the disparities that exist based

on these factors and the social stigma that they themselves are based on. Essentially, more is not

16 Ozminkowski, R.J., et al. “What if Socioeconomics Made No Difference? Access to a Cadaver Kidney Trans-plant As An Example”. Medical Care 36.9 (1998): 1398-1406.

15


always equivalent to better, quantity is not always analogous to quality. For example, the treat-

ment disparities between minorities and whites with diabetes proved that even if people of all

ethnicities are provided with the ability to receive tests or treatments for complications, doctors

will still make decisions not to suggest the tests or treatments on the basis of social stigma.

Therefore, it becomes obvious that inequality (both as it applies to healthcare and the world in

general) is a tremendously complicated, multifaceted problem that must be combated with a sim-

ilarly multifaceted attack. A perfect example of this need comes again from the example of the

Canadian healthcare system, in which healthcare is universal but women of “visible minority”

are severely discriminated against due to the outcomes that universality bring: a need for in-

creased efficiency, accountability and bureaucratization in the new “economy of care”.17 This

new standard will certainly come to apply to the American healthcare system as it becomes more

government-mandated and an ever increasing number of people opt for the “public option”, cre-

ating a need for increasingly “market-based” medicine that we may discover will uncomfortably

push the boundaries of medicine as a business and not something based on improving the lives of

individuals in terms of health.18

In the grand scheme of things, it would be very pretentious of me to think that I hold the

key to solving the problem of inequality in all its forms in the American healthcare system. I

would hope that my (eventual) career as a doctor is not marked by such a regard for social stigma

that impairs my judgment and thus negatively affects the treatment of my patients. However, I

can never forget the importance of what I have learned in researching this topic, and what it

means for the individuals that play the game every day and work within the system to ensure that

they stay healthy. Perhaps the most important thing to understand about the nature of the prob-

17 Spitzer, Denise L. “In Visible Bodies: Minority Women, Nurses, Time and the New Economy of Care”. Medi-cal Anthropology Quarterly 18.4 (2004): 490-508.18 Rylko-Bauer, Barbara and Paul Farmer. “Managed Care or Managed Inequality? A Call for Critiques of

Market- Based Medicine”. Medical Anthropology Quarterly 16.4 (2002): 476.

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lem of racial, sexual and socioeconomic bias is that it is largely unconscious, as my idea of social

stigma suggests, and thus it is a very difficult issue to tackle. Ideally, simply making people

aware of the problem would encourage them to be more conscious of their tendency to apply

such social stigma and thus, would begin to fix the problem from the ground up. However, our

standards of qualification are deeply engrained in human nature, and increasing awareness is

simply not good enough, as Loury clearly depicts in his treatise specifically about racial inequal-

ity in America. Clearly, reforming and widening the scope of healthcare is the most concrete and

achievable form of improvement, but we cannot assume that the problem has been fixed, which I

hope this study has proven is not the case. While increasing awareness may not be affective on

its own, I believe it must be part of the solution, along with a dramatic increase in training for

doctors and other healthcare professionals concerning this problem so that they may acutely read

situations and properly respond to them in a way that lessens rather than furthers the effects of

social stigma. Additionally, requirements should be put in place regarding the information pro-

vided to patients with regard to treatment options and testing to hopefully eliminate the effects of

bias on the communication between doctors and their patients, as well as regulations that im-

prove accessibility to such treatment and testing options, especially to minorities, women and the

poor, who are clearly the one’s being negatively affected by the existence of such bias. What

each and every one of us has to ask ourselves is if we are going to be happy with what has al -

ready been done, whether or not a lack of access is more damaging than stigma, if we should sac-

rifice perfection for progress, or if we could have both. In the end, we are simply playing a game

of chess against the inequality that exists in the fabric of human nature, and we must react one

move at a time to work toward eliminating it.

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The Stigma of Healthcare

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Transcript of The Stigma of Healthcare