In North Carolina, around 40% of the population lives in rural areas, or regions where the population is under 2,500. And given that rural America is not particularly privileged in having access to proper medical treatment, it is to observe how many, particularly minority groups, don’t seek out support either. Although this discrepancy can be attributed to various reasons, one dominating factor is the inherent racial disparity in healthcare. Individuals who are part of an underrepresented ethnic groups (especially, Hispanic, black, and immigrant populations) are much less likely to seek out medical attention or get treated due to lack of trust which cycles back to even more racial discrimination in the medical field.
The history of healthcare taken from the lens of racial minorities reveals how often these groups are overlooked. The main observed reason for the lack of trust in the medical system can be explained starting with misdiagnosis. In one instance, Lata Chatterjee, medical student and intern at JHU realized she had monoluceousis and thus visited her university’s health clinic to be diagnosed. However, even with multiple visits, her doctors were not able to find the right solution to her condition. According to Chatterjee, “the health clinic was convinced I had a tropica disease…” as she was a first-generation immigrant from rural India. Something as simply diagnosed as mononucleosis, which can be easily identifiable through a simple test, she was accused of having, “…African disease, Indian disease, every kind of disease…” Given multiple misdiagnoses, circling around health centers for days out of confusion, Chatterjee finally realized her condition on the basis of self-diagnosis. Looking back, she recalled thinking “They’re going to kill me.” Taking her story as a whole brings into the perspective how her mistreatment during her treatment was attributed to her immigrant. Given the time-frame this occurred, 1980s, there was a surge in immigrant populations, especially from Asian countries leading to an inherent bias certain groups even by the US medical system. Even as someone with a medical background and part of the same institution, she found herself helpless to her own treatment process and states how this experience only worsened her trust in the American medical system. (Chatterjee, 2018)
The necessity of discussing racial healthcare disparities in NC comes from the higher prevalence of rural areas as compared to northern states even though both have very similar populations in urban areas. So then, how come North Carolina also shares more stories on racial injustices? A viable explanation would be to attribute this to systemic issues. Historically, minority groups have faced even more discrimination in rural NC due to difference in views. Carol Fields, retired nurse, shares her experience from living in urban California to moving into Clinton, NC. She expresses how both areas viewed discrimination in different lens. Whereas California, people “…could either say, “Yes, this is discrimination,” or “No, it’s not discrimination,” having a similar experience in NC, where someone “…might’ve been discriminated against or mistreated simply because of their ethnicity or their religion…it wouldn’t matter.” (Fields, 2019). What is dismissed as a mere normality in NC is taken as an issue and problem-solved in other parts of the US drawing more attention to how these rural areas facing larger gaps in healthcare between racial groups. As Fields, emphasizes the idea of a lost of “power” when she came to the US, this difference in views itself makes it significant to understand how these hidden societal norms attribute to the growing disparities in healthcare
This development into a lack of trust for the US medical system had more effects than just one case of mistrust. Given the historical background of the US being used to racial discrimination in the medical system, ethnically underrepresented groups are the most hesitant to take action towards receiving medical check-ups, even during times of necessary treatment. In 2021, racial minorities were 68% less likely to have healthcare insurance than their white counterparts, with this number being even higher in past years that this study was conducted. (Lee et. al., 2021) Coming from a rural background correlates will accordingly having a low-income and thereby avoiding unnecessary expenses. Therefore, in minority groups that turn to more informal treatment methods out of mistrust for the healthcare industry, there is a correlation of greater healthcare risks as well. Considering situations where someone is unwell, blacks or hispanics from low-income communities are less likely to seek medical attention out of fear of being exploited. Similar to Chatterjee’s accounts on having to undergo multiple visits and numerous tests, it is impractical for one to visit for simple check-ups. However, doing so can lead to numerous problem of its own. To what is attributed to access to healthcare, and health literacy, “Lumbee American Indians and African Americans suffer a 2-fold greater risk of diabetes and hypertension and a 2-fold greater risk of death from chronic kidney disease compared with other racial and ethnic minorities across the state.” (Richman, 2019) It is these same groups that present less involvement with the medical care system that report higher rates of disease and illnesses and are more likely to have more severe side effects from these conditions. They are less likely to be taken seriously for their pain when they do report it, less likely to get hospital beds, given vaccination, or proper screening all adding to this repeated hesitancy in acquiring medical treatment. (“Disparities in Health Care Quality Among Racial and Ethnic Minority Groups”, 2011)
Rural areas fall most victim to healthcare disparities as the populations that live in these areas lack the trust to reach out for help in case of medical emergencies. This mistrust in NC roots from a systemic understanding of discrimination between people of color and their white counterparts. This system leads them to engage with insurance less subsequently giving these same groups higher risk of heart diseases and diabetes among others. Even though there is hope in helping patients retain a sense of “power”, as Fields quotes, in their own health, like improved education and encouragement for minority groups to pursue in these areas, times of crises prove how change is required at a systemic and base level in order to bridge this gap of healthcare disparities.
Allen, Nick, and Lata Chatterjee. “Y-0084 Interview with Lata Chatterjee.” Southern Oral History Program, https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28325/rec/82. Accessed 10 Mar. 2023.
“Disparities in Healthcare Quality among Racial and Ethnic Minority Groups.” Agency for Healthcare Research and Quality, Apr. 2011, https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhqrdr10/minority.pdf.
Laura Richman, Jay Pearson, Cherry Beasley, John Stanifer, Addressing health inequalities in diverse, rural communities: An unmet need, SSM – Population Health, Volume 7, 2019, 100398, ISSN 2352-8273, https://doi.org/10.1016/j.ssmph.2019.100398.
Lee, DC., Liang, H. & Shi, L. The convergence of racial and income disparities in health insurance coverage in the United States. Int J Equity Health 20, 96 (2021). https://doi.org/10.1186/s12939-021-01436-z
Muratori Holanda, Thais et al. “Trends in COVID-19 Health Disparities in North Carolina: Preparing the Field for Long-Haul Patients.” Healthcare (Basel, Switzerland) vol. 9,12 1704. 8 Dec. 2021, doi:10.3390/healthcare9121704
Smith, Shelby, and Carol Fields. “Y-0097 Interview with Carol Fields.” Southern Oral History Program, https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28503/rec/94. Accessed 10 Mar. 2023.