Tiffany Green on racial inequities in delivering health care

Tiffany Green:
But we need to have a conversation about why people are afraid to go to health care providers, why health systems don’t always provide a trusted environment, and how we can address the earned distrust that these systems have created, and how those have contributed to these worse outcomes. My grad student, who I’m very proud, Fiona Weeks, has collected some really great data showing, looking at people’s birthing experiences. And what I see a common pattern of, even though there are racial disparities in these outcomes, is that we don’t practice patient-centered care. And that doesn’t mean that we, that doctors’ expertise and nurses’ expertise and other health care providers’ expertise doesn’t matter. But we need to rethink systems that don’t center patient desires and patient needs and feel the need to explain to patients why certain decisions are being made by a medical team. And I think we need a lot, I hate to be the researcher and say, “We need a lot more research on that,” but I think we really need to really dig deep and have a better understanding of the decisions that health care teams, not just doctors, but health care teams are making and how they impact not just patient outcomes, but patient disparities. And we don’t understand that. And I think the conversation that we’ve been having about racial inequities in these outcomes is I think well-meaning, but drastically oversimplified. It sort of has this conversation, “well, doctors are racist.” Yes, they are. We demonstrate that in our own research that doctors have the same implicit and explicit biases. But we also find that these biases are relatively elevated among non-MD health care professionals. And so what that tells me is that we need to understand team composition. We need to understand how team composition and behavior affects treatment and whether those differences in treatment ultimately affect these population health disparities. And I wanna be clear, I am not saying that racism doesn’t matter. I am saying that we need to have a very clear understanding of how it matters in these environments and the relative contribution of that to the racial disparities that we see in morbidity and mortality among pregnant people.