Health education is a broad amalgamation of several different majors and career pathways. It may be related to paths of study such as Biology, Chemistry, Kinesiology, Pre-Medical pathways, and Nursing. Health related educational pathways are typically concerned with physical human health. Due to the variety of inequalities and instances of racism within healthcare, it is reasonable to find potential correlations between health education and healthcare careers. Not only is this reasonable, it will likely prove to be life-saving, as improved education will lead to improved health outcomes for marginalized groups.
Healthcare providers are required to take the Hippocratic Oath, as a sign of their dedication to patient care and their profession. One of the core tenets of this oath is to treat all patients with care to one’s best ability, and to remain an active member of the society they live and practice in (Marks, 2021). Following the murder of George Floyd, all facets of society practiced introspection and reflection on what needs to be improved. This introspection was also practiced by healthcare professionals whose ability to treat all patients with care according to their oath has been compromised by systemic racism. Practicing this introspection is the first step in rectifying systemic inequalities and prejudices within the field, such as a lack of education regarding people of color. In a majority of learning experiences, the patient type used is white which can be detrimental when attempting to treat skin conditions. One example is a condition known as Erythema Migrans, which is a sign of early stages of Lyme Disease. Students learning about the rash in textbooks or in labs most frequently see it displayed on white skin, and this shortcoming makes it difficult to identify the condition in darker skin tones with greater levels of melanin (Khan and Mian, 2020).
This lack of education regarding different racial demographics can often lead to diagnostic errors and improper treatment of patients of color. In turn, such errors can have drastic health concerns. When analyzing the previous example, there is often a delayed Lyme disease diagnosis in black patients, and a higher proportion of these diagnoses are made at later stages of the disease, and this later diagnosis leading to greater rates of arthritis than white patients (Khan and Mian, 2020).
BMI is an acronym which stands for Body Mass Index, and is a value calculated by dividing an individual’s weight by their height. BMI uses this proportion to measure levels of body fat, and is frequently used in medical settings to track health. However, BMI as a metric maybe more flawed and dated than most perceive. The BMI metric was first introduced by Adolphe Quetelet almost 200 years ago. Quetelet was an academic in Sociology, Astronomy, Statistics, and Mathematics; however, he was not a medical practitioner nor a physician. Quetelet was most known for his work into studying “L’homme moyen,” or rather, the average man, who Quetelet viewed as the ideal form of man (Friend, 2019). Much like Sir Francis Galton, who will be discussed in the Psychology and Statistics sections of this book, Quetelet’s work led to further justification for the eugenics movement.
Furthermore, even Quetelet did not see BMI as a measure of individual health; for him,it was a way of measuring populations for statistics, not to measure individual health (Friend,2019). BMI also fails to detect cases of obesity with high levels of accuracy. In Black, White, and Hispanic women, the BMI detected under 50% of obesity cases, and the BMI overestimates health risks for Black people, while also underestimating health risks for Asian people (Friend,2019). These inaccuracies have large scale negative consequences on their respective demographics, such as misdiagnosis and improper health care based on said misdiagnosis.
Medical education can also reaffirm preexisting stereotypes and preconceived beliefs that take physical shape during clinical visits. Before appointments, it is standard to complete medical questionnaires, which include and begin with questions involving race, age, and gender. It is not uncommon for practitioners to diagnose and prescribe specific conditions based on racial stereotypes. One example is when a Black child reports bone pain. A Black child reporting bone pain is often associated with sickle cell disease (Khan and Mian, 2020). Even if such stereotypes are based on historical disease prevalence, it is dangerous to make assumptions based on this history. This can lead to drastic consequences such as misdiagnosis and possible malpractice. It is imperative to consider all possible causes and to ensure that stereotyping does not further increase unconscious biases.
Nurses are a critical part of the healthcare system, as they typically have more time with patients than doctors. However, nursing education is not immune to and perpetuates the same structural inequality that permeates other healthcare disciplines. Nursing actually began as an occupation dependent on the exploitation of enslaved labor. In the early 1800’s, enslaved African American women provided the majority of nursing aid on plantations (Nursing has along History, 2021). Disparity and unjust treatment still runs rampant today, both when pursuing education and after graduation in professional work. Some forms of these offenses include dissuasion from the field, assumed incompetence, wage gaps, stolen credit for accomplishments by peers, and denial of advancement opportunities (Nursing has a long History, 2021). This does not even begin to address offenses such as microaggressions and overt racism from fellow colleagues and even patients that nurses of color are tasked to heal(Shah, 2020).
Just like the profession of nursing, nursing programs in academia face the same lack of diversity. Nursing educators are also predominantly white, as less than 1% of deans and chief nursing officers are from racially diverse backgrounds (Leading Nursing Organizations, 2021). Similar to the majority of a neoliberal society, color blindness is preached as a core tenet within healthcare education. However, rather than respect and accept the unique intricacies of diverse ethnic and racial populations, color blind philosophies instead ignore the uniqueness and differences of people of color. According to Blythe Bell, 2020, ideals such as color blindness and perceived equal treatment also exist in nursing students’ perceptions and beliefs. Bell also noted that such narratives are present in her recently graduated nursing cohorts, a group of predominantly white women in their early twenties (Bell, 2020). Furthermore, rather than address potential problematic behavior that occurs based on color and race, color blindness helps society ignore and even deny racism, colorism, and other structural inequalities. Within healthcare and nursing, this is portrayed as treating everyone “the same” and with “equal respect” (Bell, 2020). However, this ignores the effects of primary socialization, the effects of living in a racist society, and thoughts and behaviors such as implicit bias and racial microaggressions. And like other blanketed statements, this serves to hide and erase race,racism, gender, class, and other characteristics that have historically led to disparity in marginalized groups.
Without filling the gaps in healthcare education with regard to a legacy of structural racism, and without providing in-depth holistic learning and equal representation, inequalities within health-care training experiences, treatments, and outcomes will only continue. As healthcare is such a broad and important field of occupation, education, and society, it would be possible to write another book solely on structural racism within healthcare and health education. Therefore, we encourage further research into specific occupational and educational pathways to further supplement this introduction into the discipline.
