Most of us struggle to recall even a singular instance where we are in need of medical aid and were hindered or constrained from receiving it. However, one can easily overlook this so-called “universal” right of access to healthcare, when we realize the unsettling number of people who can recall numerous instances of not receiving the standard medical care they were promised. Access to healthcare is frequently glorified as a universally granted benefit, a right we subconsciously assume everyone around us possesses. However, particularly for racially marginalized groups in the United States, the country’s healthcare system is more of an intricate and stress-inducing obstacle course, rather than a simple visit to the nearest clinic. While insurance coverage and hospital infrastructure might suggest equality, the daily battles with the U.S. healthcare system faced by these racial minorities unveil an entirely contrasting reality. The harsh truth is that healthcare access is deeply stratified along racial constraints—not solely in regard to direct discrimination, but more specifically due to deep-rooted systemic racism and personal bias that comes with the hidden concept of socially-assigned race. From institutional neglect in rural communities to patient-provider mistrust shaped by racially motivated presumptions, constraints to healthcare are fundamentally shaped by race, perpetuating toxic cycles of inequity and harm.
One of the most tangible manners in which racial barriers restrict access to healthcare is through deep-rooted structural racism, unfortunately and especially in geographically marginalized and predominantly Black or Latinx communities. Stephanie Atkinson, a nurse from Sampson County, NC, offers a compelling example of this dynamic. When her mother needed a hip replacement, she had only one option. “In Clinton, there’s only one orthopedic doctor. There’s not options to shop around,” she says¹. Her mother’s pain, compounded by a slow and inaccessible healthcare infrastructure, eventually led to depression when it became clear she would not be returning to work. Stephanie recalls how she had to intervene at appointments to translate the medical jargon her mother pretended to understand. Without Stephanie’s medical literacy and advocacy, her mother’s care would have been both limited and confusing. This localized account exemplifies a broader national pattern. As outlined in The Lancet’s report on structural racism, racial health inequities are driven by “mutually reinforcing systems… that in turn reinforce discriminatory beliefs, values, and distribution of resources”². Rural Black communities are frequently excluded from targeted healthcare investments. Specialist shortages, limited diagnostic equipment, and overburdened community clinics reflect systemic decisions about which communities are deemed worthy of comprehensive care. In short, where you live and what race you are become determining factors in the kind of medical attention you receive—and even whether you receive it at all.
Even when healthcare is technically available, patients of color often face another, quieter barrier—one that’s not listed on any intake form or prescription bottle. It’s the way they’re perceived the moment they walk through the clinic door. This subtle but powerful form of racial bias, known as socially-assigned race, refers to how others interpret your race based on what they see—your skin tone, your features, your accent. And it can shape everything about your experience in the exam room. Sabra Hammond, a physician assistant who cares for migrant and low-income patients in rural North Carolina, sees this every day. She describes how many of her patients are afraid to share basic truths about their lives. “They won’t say, ‘I’m undocumented,’” she explains. “And they’ll clearly need medications, but I don’t always know where they’ve been or what they’ve taken.”³ You can hear the frustration behind her words—but also the compassion. She’s trying to help, but trust is hard to build when the system itself feels risky. This mistrust is not imagined—it’s backed by research. In a national study on socially-assigned race, Tracy MacIntosh and her colleagues found something remarkable: people of color who were perceived by others as white were less likely to report discrimination and more likely to receive preventive care like vaccines. Those who were seen as minorities, on the other hand—even if they shared the same ethnic background—faced more barriers, more skepticism, and less care⁴. It’s not just your racial identity that matters; it’s how others read you. A glance, an assumption, a stereotype—these can all ripple into real differences in health. And this perception doesn’t just live in the eyes of doctors and nurses. It seeps into patients, too. Stephanie Atkinson, a nurse in Clinton, NC, remembers going with her mother to medical appointments. Her mother would nod along as doctors spoke, smiling and agreeing—even when she didn’t understand a word. “She’ll say yes even when she doesn’t understand,” Stephanie says. “Which I think is part of a lot of people who navigate the healthcare world, like they feel like they shouldn’t question when somebody tells them something.”⁵ It’s not hard to imagine why. For generations, people of color have been taught—through history, through experience—that pushing back in a medical setting can mean being ignored, dismissed, or worse. From the horrors of the Tuskegee Syphilis Study to the ongoing crisis in Black maternal mortality, there’s a long legacy of harm. So sometimes, the safest response feels like silence. This is what makes healthcare inequity so difficult to see and so hard to solve. It’s not just about who has insurance or whether there’s a hospital nearby. It’s about the invisible weight people carry into the clinic—the weight of being misunderstood, misjudged, and unheard.
To understand how ingrained these patterns are, we can turn to Zinzi Bailey et al. in The Lancet, who argue that structural racism “offers a concrete, feasible, and promising approach towards advancing health equity”⁶. Their report emphasizes that without a structural analysis of racism in health, interventions will continue to fall short. For example, expanding Medicaid or providing free vaccines will only have limited impact if patients don’t trust the system or if they can’t travel to the clinic. Furthermore, a particularly revealing account from Sabra Hammond that is highly relevant is where she discusses strategies to reach patients with low health literacy. “I use a lock-and-key metaphor to explain diabetes… sugar is the fuel, but insulin is the key,” she says⁷, instead of bombarding her patients with overwhelming medical jargon. While creative, even the effectiveness of these metaphors depends on trust, language access, and follow-up—as resources not guaranteed in migrant or undocumented communities. Hammond admits that she often doesn’t know if her explanations worked unless the patient returns months later.
Due to the deep-rooted nature of these biases and healthcare restraints, solutions to these conflicts must operate at several levels. First, investment is urgently needed in rural health infrastructure especially in communities of predominantly marginalized populations. This means funding for not just an increased number of providers, but also patient education efforts, transportation networks, and more services for translation. Second, medical education reform is essential. Providers must be trained to recognize both their own biases and the structural forces shaping their patients’ experiences. Finally, we must expand research and policy that treats race as a social determinant of health, rather than a risk factor. Access to healthcare is not a neutral process. It is embedded in histories of segregation, shaped by present-day economic disparities, and reproduced through the way patients are perceived and treated. As the stories of Stephanie Atkinson and Sabra Hammond reveal, racism in healthcare is not always dramatically visible. More often, it is quiet and structural, built into daily clinic schedules, geographic availability, and the unspoken assumptions that govern every provider-patient interaction. If we are to build a more just healthcare system, we must begin not just by opening the clinic door, but by asking who it opens for—and who is still waiting outside.
Footnotes:
- Stephanie Atkinson, interview by Maddy Kameny, June 25, 2018, Southern Oral History Program, University of North Carolina at Chapel Hill at Wilson Library, UNC Chapel Hill, transcript, p. 12 .
- Zinzi D. Bailey et al., “Structural Racism and Health Inequities in the USA: Evidence and Interventions,” The Lancet 389 (2017): 1455
- Sabra Hammond, interview by Maddy Kameny, June 27, 2018, Southern Oral History Program, University of North Carolina at Chapel Hill, transcript, p. 9 .
- Tracy MacIntosh et al., “Socially-Assigned Race, Healthcare Discrimination and Preventive Healthcare Services,” PLOS ONE 8, no. 5 (2013): 2 .
- Atkinson, interview, p. 12 .
- Bailey et al., “Structural Racism and Health Inequities,” 1455
- Hammond, interview, p. 10 .