A Brief History of Healthcare Discrimination: What Company Leaders Should Know
Originally published 1/27/22, Updated on 9/27/22
The past two years have been an unfortunate but much-needed reminder of the social and racial inequities baked into almost every institution in our country. The healthcare industry is no different. There’s a long history of institutional discrimination in healthcare, and socioeconomic factors play a huge role in the quality of care that patients receive. That goes for the benefits we offer our employees too.
For years, we’ve been marginalizing employees by failing to offer benefits that are as diverse as our workforce. But it doesn’t have to be this way. Employers can step up and offer a more inclusive benefits package that addresses the needs of every employee.
The impact of discrimination in healthcare
Unfortunately, the United States has a long-standing history of discriminatory healthcare practices. Discrimination destroys trust in the health system, which translates into no or lower-quality care. Stereotypes based on false beliefs have driven an imbalance in health coverage between specific groups of employees. And a lack of multi-lingual care means we’ve failed to provide non-English speakers with adequate healthcare coverage. Our failure to provide culturally competent care means historically underrepresented groups receive lower-quality health services, including for cancer, prenatal care, HIV, and a host of other conditions.
1 in 5
adults have experienced discrimination in healthcare
Racial discrimination in healthcare
Black and brown bodies have been ignored, undertreated, and actively harmed by our healthcare system throughout history. Among countless examples, Black women were exploited for unethical testing and experimentation when gynecology emerged in the United States. And in the mid-20th century, a U.S. Public Health Service study revealed that Black men who suffered from syphilis went untreated because they were given sham treatments rather than antibiotics.
Today, institutional racism continues to plague our healthcare system. Black Americans are more likely to die of heart disease and cancer than their white counterparts, and are three times more likely to die during childbirth. And there’s been a stark difference in outcomes for people of color suffering from COVID-19. Black people and Latinx people face more than triple and nearly double the risk of death compared to white people.
In recognition of these and countless other examples of healthcare discrimination that still exist, the CDC acknowledged racism as a public health threat.
Gender bias in healthcare
Again, women of color have long experienced mistreatment in the American healthcare system. In a mass whitewashing effort, Puerto Rican, Mexican and Native American women have all been subjected to sterilization throughout our history.
Today, implicit bias plays a role in how we address (or fail to address) women’s health needs. Doctors are less likely to believe women who express physical symptoms, attributing their pain to “hysteria” or mental health problems. Medical testing has historically only been performed on men, meaning there’s a significant gap in our understanding of women’s bodies and their reactions to drugs, holistic treatments, surgery and more.
LGBTQ discrimination in healthcare
The most well-known example of LGBTQ+ healthcare discrimination is the AIDS epidemic during the 1980s-1990s. A spread of misinformation, lack of funding, stigma and more means we didn’t provide queer indidividuals with the healthcare they needed.
But lack of healthcare access in the LGBTQ community is much more far-reaching. Today, queer folks are more likely to report refusal of care, verbal and physical harrassment at the doctor’s office, and denial to provide family support services. When it comes to transgender healthcare discrimination, the statistics are even worse: 12% of transgender individuals said a doctor or other health care provider refused to give them health care related to gender transition, and 23% said a doctor or other health care provider intentionally misgendered them or used the wrong name.
Obesity discrimination in healthcare
Weight bias has increased by 66% in the last decade, and public conversations about an “obesity epidemic” in the United States drive misconceptions and misdiagnoses at the doctor’s office.
One study shows that medical professionals are more likely to view obese people as lazy, weak-willed, or lacking self-control. Another study found that doctors are likely to attribute all health problems to obesity, at the risk of missing non-weight-related symptoms and illnesses. What’s more, 52% of women say that their weight has been a barrier to receiving appropriate healthcare, and contributes to a delay in seeking out preventative care.
Disability discrimination in healthcare
While federal mandates protect individuals with disabilities from being discriminated against, bias and lack of knowledge continue to prevent them from getting the care they need.
According to the World Health Organization, many service providers have limited knowledge and understanding of disability rights, and have inadequate training and professional development about disability. Our system hasn’t invested enough in the resources necessary to properly educate medical providers on how to communicate with and care for individuals with disabilities. In many cases, our healthcare system simply isn’t accessible enough—from the way doctor’s offices are built to the expenses that come with receiving quality care.
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Inequities in health insurance
Health outcomes for underrepresented groups improve when they have better options for health insurance coverage. But the bad news continues: there’s inequity there too.
For example, non-white Americans are much more likely to be uninsured than white Americans. Another survey found that a quarter of firms still don’t offer health insurance coverage to same-sex spouses. When it comes to caregiving, LGBTQ+ parents struggle to take parental leave, because the Family and Medical Leave Act (FMLA) doesn’t cover all employers or employees.
1 in 4
insurance providers don’t offer coverage for same-sex couples
How leading employers are addressing healthcare inequity
Fortunately, some employers are stepping up to remove barriers to healthcare and promote health equity at their organizations. According to a Jellyvision survey we ran in November 2021:
of employers say they’re more focused on DEI initiatives than they were a year ago
For example, Grand Rounds Health and Doctor On Demand have built a care concierge and healthcare navigation platform designed to improve health equity for Black Americans. They’ve joined with the Black Community Innovation Coalition, a group of companies including Accenture, Best Buy, Genentech, Medtronic, State Farm, Target, and Walmart.
Together, these companies will focus on what they call “zones of impact including maternal fetal health, cardiometabolic disease, primary care access, behavioral health, and more.” Now, Black Americans can “pick up the Doctor on Demand app and be met with a navigation service that is culturally competent and a network prepared to help them navigate through the system and advocate for their specific needs.”
Merck for Mothers is another employer-driven program that aims to fill the gaps, with the goal of “strengthening health systems to sustain the delivery of high-quality maternity care services that benefit women and their communities.” Merck partners with other pharma companies and businesses, governments, nongovernmental associations, patient groups, entrepreneurs, and more to reduce the risk that mothers lose their lives while giving birth. To date, Merck has improved the safety of pregnancy and delivery for 13.1 million women globally and given 78 million people access to higher-quality healthcare facilities.
of employers added more mental health resources to their benefits package in 2021
of employers increased the amount of family leave they offer in 2021
of employers added gender affirmation support to their benefits package in 2021
10 benefits that support a more diverse workforce
Half of the US population has health insurance through their employer, but too many companies still don’t have the options that diverse workforces need. But you can take steps to balance inequity. Consider offering these 10 inclusive benefits, which are likely to support the traditionally underserved groups in your workforce.
1. More comprehensive parental leave
Only a handful of states and Washington, DC, offer paid leave for parents, but employers can step in to fill the gap. Paid leave can improve health outcomes for parents and their children, including reductions in low birth weight, infant mortality, and parental stress. A more comprehensive parental leave policy can also increase financial stability, particularly for low-income workers and people of color, and raise the chance that women will return to the workforce.
As you plan your leave benefits, think about how the “traditional” family structure has changed and how you can best support it. Beyond maternity leave, consider adding paternity leave as well as leave for domestic partners, foster parents, and anyone acting in the role of a parent.
2. Family-building benefits
Family-building benefits have expanded in recent years beyond fertility tests and in vitro fertilization. They now often cover egg freezing, adoption, surrogacy, and more. But many of these benefits address the needs of heterosexual couples only. Instead, think about how to make this benefit more inclusive for nontraditional couples.
3. Domestic partner benefits
A more inclusive workplace starts by acknowledging that your benefits should support families of all kinds. Make sure to include domestic partnerships in your benefits plans. Check your leave policies to ensure they give domestic partners, including cohabiting partners, the same privileges as married individuals.
4. Mental health resources
Employees from underrepresented groups can feel stress from exclusion, bias, and microaggressions in the workplace. Offering mental health benefits, such as an employee assistance program with a robust number of free sessions or a digital mental health app can help these groups access the support they need, remove the stigma from seeking mental health services, and improve employees’ mental wellness.
5. Gender affirmation support
Traditional benefits plans may not offer gender affirmation benefits. A failure to cover gender affirmation surgery, hormone replacement therapy, and counseling services can add to the marginalization of transgender people. Offerings like these ensure transgender individuals feel valued and welcomed so they can be their authentic selves at work.
If your workforce resides in an area with affordable, reliable internet, telemedicine can extend healthcare to people who may be reluctant to visit a doctor. For example, individuals with limited English skills may find it difficult to find a physician who speaks their native tongue. But with telemedicine, they have greater access to people outside their community who may be able to help.
To take your offering to the next level, check your network to make sure your providers reflect the demographics of your workforce, and ensure you have high-quality providers in a range of specialties to address all the potential needs of your workforce.
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7. Home-based care
Home-based health care offers older workers, those with disabilities, and those who live in rural areas better access to preventative healthcare. Plus, home-based testing can allow individuals to screen for cancer, diabetes, hypertension, COVID-19, influenza, and more at home—and it’s cost-effective for everyone involved. All of these measures can reduce long-term healthcare costs because they can help avoid the need for advanced and emergency treatments.
8. Health risk assessments and screenings
Assessments and screenings identify risk factors and potential needs, so you can better address them with resources and your offerings. But more importantly, assessments give individuals a snapshot of their current health and a projection of what problems they may face in the future. These tools are particularly useful for high-risk populations that may be reluctant to see their doctor for an annual checkup.
9. Wellness programs
Underrepresented groups are often those most likely to engage in unhealthy behaviors, such as eating fast food and smoking. Plus, these individuals are also more likely to be affected by burnout or poor work-life balance. While gym memberships and fitness trackers are nice perks, access to a broader variety of resources can encourage employees to engage in activities to support their physical and mental health.
10. Financial wellness programs
More than half (58%) of Black and Latinx households don’t have enough savings to cover three months of expenses at the federal poverty rate. Financial wellness programs can step in by helping these groups through education, guidance, and matching programs. Some employers provide general financial education resources, while others offer personalized coaching. Some even match contributions to student loans or provide tuition assistance. These programs can help underrepresented communities plan for their financial futures and start closing the wealth gap.
The more diverse your workforce, the more diverse your benefits should be
Many organizations are tied to their traditional benefits packages. But talent pools today aren’t homogenous. Employers should take the needs of all—not just some—employees into account as they construct their benefits program. By doing so, they’ll be able to better engage their employee population and attract future talent.