Black women in healthcare face entrenched racism on a daily basis, from the death by a thousand cuts of microaggressions to the longstanding barriers to leadership positions, Brenda I. Anosike, MD, MPH, said recently at the IDWeek 2022 conference.
“The things that are out of my control are that I’m Black and I’m a woman,” said Anosike, director of pediatric antimicrobial stewardship at Montefiore Children’s Hospital in New York City.
The SARS-CoV-2 pandemic exposed what many have termed “systemic racism” in healthcare delivery. Anosike’s point is that this goes beyond patients to include caregivers.
The Association for Professionals in Infection Control and Epidemiology (APIC) has become increasingly engaged in the issues grounded in systemic racism in healthcare.
APIC has formed a Health Inequities and Disparities Taskforce, a formal committee that will explore areas such as possible racial and ethnic disparities in patients who acquire healthcare-associated infections (HAIs). (See Hospital Infection Control & Prevention, November 2022).
“Evidence suggests that Black women in medicine are not assuming leadership roles at high and visible rates, despite decades of interventions,” Anosike said.
Citing the multiple discussions of such issues in healthcare, she told the IDWeek audience, “You may say to yourself, ‘I’ve heard it all before, I’ve read it before, I’ve discussed it before.’ The problem is that it starts to impact people of color until there’s a disproportionate lower rate of those assuming leadership roles compared to their white counterparts.”
According to the Bureau of Labor Statistics, Black women have the least statistical parity in leadership positions across the labor force, she said. Essentially, a lack of representation leads to decisions being made about Black women without their input.
“The absence of those voices — that perspective, that lived experience — has potential downstream effects that can be quite significant in the realm of missed opportunities for innovative ideas and solutions, challenges with recruitment and retention, decreased healthcare outcomes, diminished access to equitable and quality care, and lack of career development and advancement,” Anosike said.
People of color in the medical arena can find mentors or sponsors to advocate for them, but they reach a bottleneck at certain point in their career “where you’re seeing less and less individuals who can pave that way for you,” she said. “And this dovetails into the lack of diversity and representation. If you don’t see anyone who looks like you, you’re often isolated in many respects.”
This isolation engenders a lack of confidence, as individuals remain in the dark about the “unwritten rules, the hidden bureaucracy” of that work culture. This can create some aspect of the “imposter syndrome,” as even those who do advance feel unworthy or unqualified for the role.
When you are “not offered opportunities that your counterparts would otherwise be offered, [it] suggests you may not be a person who is as competent as your counterparts, although you have equal training, fortitude, and motivation,” Anosike said.
An Innocent Aside?
Microaggressions are a more subtle and persistent problem, flying by in everyday conversation and going largely unnoticed by those not on the receiving end.
“This is a concept that we think about and you say, ‘That is not me. This is not something that I would do,’” she said. “But I want you to challenge that thought.”
Microaggressions have been defined as everyday verbal and nonverbal subtleties, with intent or unintentional. These can be interactions, behaviors, or attitudes that communicate a certain bias, Anosike says. “They can potentially have harmful or unpleasant psychological impacts on the targeted individual, typically those who are in marginalized groups.”
She gave examples that included: “You are so articulate,” which suggests some surprise that this person would be. “You speak English really well,” to someone who was born and raised the United States. Others include “Your name is interesting. Where did you get your medical training?”
The microaggressor may see only innocent intent, whereas the recipient feels degrading effect.
“It’s commonplace,” she said. “They’re coming from a standpoint of being uninformed and unaware of the actual impact on the person who is on the receiving end of their comments or microaggressions.
While those who say or ask such things may move breezily onto the next conversation, there is a cumulative effect on those who hear similar “innocent” comments all too frequently.
“There’s a degradation of the individual, and that individual has an internal conflict that develops as: How do I respond? How do I react? Am I overly sensitive or not?” she says. “This internal conflict continues to play out and it can manifest as reactions, including distrust, fear, perhaps anger.”
It is important to emphasize that the microaggressions are not about hurt feelings, she emphasized.
“It’s rather that these feelings make an individual feel devalued, alienated, isolated, unappreciated, unvalidated — repetitively,” Anosike said.
Some microaggressions stem from implicit bias, which refers to the attitudes, beliefs, and stereotypes that we unconsciously bring to our world view.
“We all have them,” she said. “It’s an accumulation of the way we were brought up — our lived experiences, interactions, and it occurs without our awareness. It’s unconscious.
“The key here is that it’s invisible to the person, but it is often very recognizable to other parties.”
