Author: Byron G. Mobley II

As technology continues to advance, hospitals and healthcare providers have gained the ability to utilize artificial intelligence (AI) and algorithms to automate many of the complex decisions that were once only capable of being made by human beings. AI is now used to detect and diagnose diseases, screen patients, and develop various treatment protocols. While the purpose of AI was intended to streamline and simplify decision making and detection processes for hospitals and providers, it has inadvertently created health inequities for Black patients. A study published by Science in 2019 revealed that predictive healthcare algorithmic software discriminates against Black patients by distributing medical resources to white patients over Black ones.

            The study analyzed data from Optum’s algorithmic AI, a health services company, which programmed its AI to predict which patients were most in need of additional care. The color-blind AI system ranked patients solely according to how much they have paid for health care in the past. Because the algorithm did not account for race when predicting which patients were most in need of healthcare services, the fact that Black patients  have less health access to healthcare, and thus pay less for healthcare services, was overlooked. The study revealed that Black patients had substantially worse health despite paying $18,000 less for healthcare services per year compared to their white counterparts. The discrepancy in the amount that Black patients paid for healthcare compared to white patients is the result of Black patients having less access to healthcare services. Of the patients that Optum’s algorithm indicated were in need of additional care, only 17.7% were Black whereas researchers indicated an unbiased proportion would have been 46.5%.

            While Optum’s AI is only one of many algorithmic artificial intelligence products that disproportionally disadvantaged Black patients, finding and acknowledging the present biases is the first step towards correcting them in both AI and human behavior. While excluding race-based criteria may seem like a step towards health equity, racial equality calls for the acknowledgement that there are differences between racial groups. Small changes can be made to ensure that AI software is without bias. Measuring patients’ needs by avoidable costs or higher burdens of chronic conditions eliminates racial biases found in the original AI software as these measurements are more inclusive of Black patients’ struggles. Biases in AI algorithms are not inevitable. By recognizing the biases in AI, we can start to develop new technology that accounts for the different ways in which Black patients are disproportionately treated in healthcare settings.

The rise of COVID-19 reveals many disparitieswithin the United States. Along with mask requirements, lockdowns, and efforts to promote social distancing, our Nation has seen an unprecedented upswing of protests, civil unrest, and riots. While the United States is no stranger to marches and rallies from its most marginalized groups, the 2020 Black Lives Mater Movement is arguably the largest movement in United States history. With numbers ranging between 15 and 26 million people participating in demonstrations all over the country, the notion of rectifying race relations in the United States forged to the forefront of this year’s zeitgeist.

In May 2020, during the same week that multiple news media platforms broadcasted George Floyd’s murder, the American Public Health Association issued a news release asserting that racism is a public health crisis that requires immediate attention. Accepting racism as an urgent public health crisis requires an evaluation of the innumerable ways in which racism effects the health and livelihood of Black people in the United States. Racism not only plays a major role in the U.S. criminal justice system but also effects Black people’s access to education, housing, employment, and medical care.

Though Black people only make up approximately 13% of the U.S. population, they account for 28% of the people killed by police in 2020. Black people are more likely to develop heart disease, diabetes, and mental illness, and Black babies are more than twice as likely to die during their first year of life than white babies. Additionally, the life expectancy of Black people is typically a decade or more shorter than their white neighbors just blocks away. These health disparities are partially created from the stress of being oppressed, marginalized, and targeted for violence. Studies have also shown that experiencing racism and discrimination on a constant basis can cause wear and tear on the body, leading to additional health concerns. Thus, systemic racism not only negatively affects individuals’ social standing but also their overall health.    

Deeming racism a public health issue would be a first step towards repairing race relations in the United States. In May 2019, Milwaukee, which some consider the most segregated city in the country, became the first city to declare racism as a public health crisis. Additionally, on September 3, 2020, Representative Ayanna Pressley (D-MA) introduced the Anti-Racism in Public Health Act. This bill would create programs within the Centers for Disease Control and Prevention (CDC) focused on preventing violence by law enforcement and allocate funds for collecting data and supplying grants focused on researching anti-racist public health interventions and the impact racism has on health.

Moreover, on November 16, 2020, the American Medical Association (AMA) adopted a new policy which declared racism a serious public health threat. This new policy recommends medical education programs to recognize race as a social construct and not a biological determinant. The AMA’s new policy also pushes clinicians and researchers to include the experience of racism and social determinants of health when labelling disease risk factors in hopes of advancing equity in medicine.

Despite the Trump Administration’s claim that systemic racism does not exist in the United States, systemic racism is an issue that has existed since the birth of this nation. In order to achieve health equity between races, policymakers and medical leaders must address social injustice and systemic racism. Effective polices, such as the Anti-Racism in Public Health Act and the AMA’s declaration of racism as a public health threat, create better data and visibility of the health concerns that non-white people face in the United States. Bringing awareness to these issues will generate the tough conversations that we need to combat the longest and strongest pandemic that this country has seen: racism.