





































ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

 

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IS IT ALL IN OUR HEADS? 

AN INVESTIGATION INTO 

AMERICAN AND  

HISTORICAL LEGACIES OF 

RACISM AND SOCIAL 

FRAMEWORKS THAT  

PERPETUATE RACIAL  

INEQUALITIES IN  

TWENTY-FIRST CENTURY 

HEALTHCARE SYSTEMS 
 

MEGHANA NAMPALLY 

 

✵ ABSTRACT 
Racial bias in the healthcare system, origi-

nating from the eminent founders of science and 

medicine, has numerous adverse effects on black 

populations and continues to have harmful conse-

quences today (Byrd and Clayton, 2001). From poor 

clinical decision-making to preventing people of 

color from entering prominent fields in medicine, 

racism is ubiquitous in medicine and healthcare 

(Byrd and Clayton, 2001). The impact of racial bias 

on patient care is of great interest with many studies 

illustrating the detrimental impacts of bias on minor-

ity groups, specifically in black communities. How-

ever, there is additional research that concludes ra-

cial bias does not play a role in patient care or in 

medicine (Dehon et al., 2017). The lack of acknowl-

edgment within academia concerning racial dispar-

ities in healthcare and science further oppresses 

black voices. With my research, I investigate the ex-

tent to which various biased social frameworks in 

healthcare, medicine, and science negatively im-

pact black individuals. I also address major historical 

events during the creation of the modern-day 

healthcare system and how these events perpetuate 

racism today. Focusing on the twenty-first century, I 

demonstrate that systemic historical and social 

events during this period eternalize racism in the 

modern-day American healthcare system. 

 

KEY TERMS: paternalistic racism, competitive racism, 

race-conscious professionalism, psychologizing 

racism 

 

1 INTRODUCTION 
Confronting racial inequalities in healthcare 

requires examining the historical legacies of aca-

demia and of federal policies. Neil Lewis Jr., an as-

sistant professor of communications research in 

medicine at Weill Cornell Medicine, describes “that 

you can’t understand, much less change, people’s 

health behaviors without reckoning with larger so-

cial structures and systemic forces” (Blackwood, 

2021).  

Beginning in the nineteenth century, resi-

dential segregation excluded people of color from 

obtaining adequate healthcare. This enabled and 

sustained “structural racism in other forms, includ-

ing… the unjust distribution of high-quality health 

care” (Bailey et al., 2021). Exacerbating the effects 

of residential segregation, academic discrimination 

against colored communities preserves outdated 

racist attitudes and ideologies (Bailey et al., 2021) 

while also perpetuating distrust between marginal-

ized communities and healthcare services (Dula, 

1994). Another facet of this bias in academia can be 

seen in the underrepresentation of minorities in sci-

ence and healthcare.  

In Dr. Michael Byrd and Dr. Linda Clayton’s 

paper “Race, Medicine, And Healthcare In The 

United States: A Historical Survey,” they delineate 

two different forms of racism: Paternalistic Racism 

and Competitive Racism (Byrd and Clayton, 2001). 

The former is the view that black people are imma-

ture, child-like, and inferior — dispositions that are 

tolerated unless they deviate from socially accepta-

ble roles (Byrd and Clayton, 2001). In the latter, 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

 

emancipated slaves were seen as competition for 

scarce resources (Byrd and Clayton, 2001). These 

act as the foundations for the modern-day concept 

of race-conscious professionalism, wherein black in-

dividuals in prestigious medical and academic fields 

feel a dual obligation to succeed (Powers et al., 

2016). The idea of psychologizing racism, as de-

scribed in “A socioecological psychology of racism: 

making structures and history more visible,” is the 

concept where one overly focuses on individual bias 

while neglecting the systemic and historical racism 

behind various institutions (Trawalter et al., 2020). 

This recognition of excessively analyzing the role of 

individual accountability rather than moving to un-

derstand global structural forces at work is signifi-

cant as it elucidates the true depth of racism in per-

petuating racial disparities. 

In this paper, I consider three different his-

torical and social domains that perpetuate racial in-

equalities in the twenty-first century. The first is the 

role of academic discrimination in fueling fear and 

distrust in the healthcare system. Here, I also exam-

ine the consequences of this bias through the un-

der-treatment of black patients, and through the 

disproportionate number of physicians treating 

people of color. I then examine the significance of 

redlining in racial segregation. Redlining is the use 

of racial demographics to assess which communi-

ties would receive investment (Bailey et al., 2021). 

The ramifications of this practice manifest as areas 

with increased pollutants, which worsen healthcare 

outcomes in colored communities (Li and Yuan, 

2021) and demonstrate pollution inequity (Abra-

ham et al., 2021). Finally, the lack of representation 

in academic and healthcare settings is analyzed us-

ing the framework of race-conscious professional-

ism. Academic discrimination, redlining, and un-

derrepresentation in healthcare and academic insti-

tutions are interrelated realms that perpetuate and 

eternalize racial inequalities in the modern-day 

healthcare system because of their historical and so-

cial contexts in the United States. 

 

2 ACADEMIC DISCRIMINATION  
Racial inequalities exacerbate distrust be-

tween scholars and people of color. A prominent 

example of this is the Tuskegee Syphilis Study. Dur-

ing this study, black men were infected with Syphilis 

without their consent (Trawalter et al., 2020). After 

this information was disclosed to study participants, 

decreased healthcare usage was seen among black 

men, which led to increased mortality rates (Trawal-

ter et al., 2020). Trawalter et al. illustrate that “the 

disclosure of the study in 1972 is associated with a 

decrease in healthcare utilization, presumably due 

to decreased trust in the medical community, and a 

commensurate increase in mortality among [black] 

men” (Trawalter et al., 2020). This event is of histori-

cal significance when discussing the perpetuation of 

racial discrepancies in healthcare as there is a his-

tory of treating black people as inferior in the aca-

demic community. 

It is important to note that the distrust 

demonstrated by the Tuskegee Syphilis Study is not 

an isolated event in academic history. James Marion 

Sims, the “father of modern gynecology,” rose to 

prominence for creating a surgical remedy for the 

obstetric fistula based on his experimentation on 

black, enslaved women (Cronin, 2020). During his 

experiments, he failed to use anesthetic ether on the 

individuals he experimented on, despite having ac-

cess to such resources (Cronin, 2020). However, 

Sims did use anesthesia on his wealthy, white pa-

tients (Khabele et al., 2021). The use of Sims’ work in 

modern medicine represents the exploitation of 

slaves and suggests a potential cause for the mis-

trust black individuals have toward academia 

(Conteh et al., 2022).  

The results of this distrust between medical 

professionals and marginalized communities can be 

seen in the racial proportion of physicians to under-

privileged, colored communities. Dr. Miriam Ko-

maromy and her colleagues found that in areas with 

five times as many black residents, the number of 

black physicians was commensurate with the num-

ber of residents (Komaromy et al., 1996). This dis-

proportion in race illustrates that colored communi-

ties mainly trust physicians of their own race and 

ethnicity, as well as black physicians feeling the 

need to practice in communities with large popula-

tions of their own race and ethnicities. This is rein-

forced by “the fact that the physician's race or ethnic 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

 

group predicted whether he or she would care for 

greater-than-average numbers of black or Hispanic 

patients” (Komaromy et al., 1996). This further sup-

ports the idea that racial disparities are perpetuated 

by mistrust in healthcare settings. Race was a con-

tributing factor to where individuals would practice; 

therefore, individuals of the same race as their pri-

mary care provider feel more comfortable receiving 

aid from members of their own race.  

Academic discrimination against black indi-

viduals additionally stems from promoting biased 

teachings in medical schools, specifically in the per-

ception of pain. In a 2016 study to determine racial 

attitudes, medical students held beliefs that black 

patients feel less severe pain than that of white pa-

tients (Bailey et al., 2021). This bias leads to overt 

disparities in treatment regimens as “[black pa-

tients] are less likely than white [patients] to receive 

pain medication and, when they do, they receive 

less” (Trawalter et al., 2012). The disparity in treat-

ment between white and black patients by physi-

cians and students contributes to the distrust that 

black patients feel as these false beliefs perpetuate 

the care of “greater-than-average numbers of black 

or Hispanic patients'' by physicians of the same race 

(Komaromy et al., 1996). This undertreatment of 

black patients because of academic bias intensifies 

the skepticism and suspicion of medical practices, 

ultimately leading to disparities in healthcare as 

seen through the disproportionate number of black 

physicians practicing in communities with large 

populations of similar ethnicities.  

 

3 REDLINING IN RESIDENTIAL SEGRE-

GATION 
Redlining makes use of racial compositions 

to assess investment opportunities for communities 

(Bailey et al., 2021). It involves the conscious dis-

crimination against black people from obtaining fi-

nancial resources that would aid them in acquiring 

adequate housing as well as other necessities (Bai-

ley et al., 2021). Redlining impacts the proximity to 

which individuals receive adequate education, nu-

trition, recreation, and medical care services as 

“neighborhoods influence the collective resources” 

these individuals receive (Li and Yuan, 2021). Seg-

regated neighborhoods face greater barriers to re-

cruiting and retaining physicians, which limits indi-

vidual access to healthcare services (White et al., 

2012). These neighborhoods have limited re-

sources (e.g. diagnostic imaging services) which 

also contribute to healthcare disparities (White et 

al., 2012).  

Due to disparities in resources, “women 

whose residential neighborhood[s are] character-

ized by a lower quality-built environment are also at 

increased risk of adverse perinatal outcomes such 

as preterm birth” (Anthopolos et al., 2014). Further 

augmenting the impact of redlining, historically dis-

advantaged neighborhoods have “a higher risk for 

COVID-19 infection in ZCTAs with present-day eco-

nomic and racial privilege” (Li and Yuan, 2021). 

Here, Li and Yuan (2021) illustrate a greater risk for 

COVID-19 infection in present-day redlined areas. 

This mirrors the impact of poor-quality environ-

ments due to previous residential segregation, as 

this leads to an increased risk of “adverse perinatal 

outcomes” (Anthopolos et al., 2014). Therefore, 

modern-day redlined zones illustrate the perpetua-

tion of racial inequalities in healthcare outcomes 

through limiting the number of resources marginal-

ized communities can gain access to due to the pro-

gression of “racially segregated communities [be-

coming] economically segregated, resulting in the 

large-scale disinvestment often characterizing ma-

jority non-white neighborhoods” (Anthopolos et al., 

2014). This ultimately leads to overt consequences 

such as “preterm birth through poor-quality built en-

vironment [and] poor-quality housing stock” (An-

thopolos et al., 2014). Clearly, Anthopolos, Li, and 

Yuan illustrate that standard of care is impacted by 

geographic factors. 

Redlining has influenced racial inequalities 

in healthcare outcomes through increased expo-

sure to pollutants and other toxins, which further il-

lustrates the lack of investment in black communi-

ties. This disparity is demonstrated as “better HOLC 

neighborhood grades are associated with lower lev-

els of airborne carcinogens and higher levels of 

tree-canopy coverage (which mitigates air pollu-



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

 

tants and heat)” (Bailey et al., 2021), whereas pre-

dominantly black communities face “pollutant expo-

sure through proximity to neighboring industrial 

plants or landfills, water leakage, mold, lead paint, 

pest infestation, and poor ventilation” (Abraham et 

al., 2021). This demonstrates pollution inequity as 

white individuals create most of the fine-particulate 

pollution due to their overconsumption of goods; 

however, black and Latinx minorities face the conse-

quences and inhale this pollution (Abraham et al., 

2021).  

Li and Yuan further illustrate pollution ineq-

uity as the government and society’s “devoid of in-

vestment” in black communities leading to “the in-

stitutionalized segregation of capital (e.g., loans and 

investments) from black people [which] shaped the 

socio-spatial arrangement of goods and services 

[e.g. medical care] in the USA” (Li and Yuan, 2021). 

The fact that white individuals do not face the same 

consequences as their black counterparts demon-

strates the disadvantage and inequality that these 

marginalized communities endure, ultimately lead-

ing to more adverse health outcomes such as 

asthma and low birth rates (Li and Yuan, 2021). Li, 

Yuan, and Bailey et al. illustrate that the racial ine-

qualities between black and white individuals be-

cause of racial segregation keep people of color in 

disadvantaged and disinvested neighborhoods. 

These past policies continue to perpetuate racial 

disparities in healthcare since white individuals do 

not experience this increased risk of illness. Clearly, 

redlining and racial segregation promote racial dis-

crepancies in healthcare. 

 

4 UNDERREPRESENTATION IN 

HEALTHCARE AND ACADEMIA  
The absence of minority groups in 

healthcare positions and academic settings illus-

trates the depth of racial inequalities in society. This 

lack of representation can be seen in the recruit-

ment and retention of black faculty, as a study con-

ducted in 2010 demonstrated that “among faculty 

members who had been hired in 2000, blacks were 

less likely to have been retained than any other de-

mographic group” (Ansell and McDonald, 2015). 

This exclusion of black professors and faculty from 

academia is also perpetuated through “poor educa-

tion and school quality; lack of role models; financial 

cost of education and training; and persistent bias, 

stereotyping, and racism” (Powers et al., 2016). The 

paucity of black representation in academic and 

healthcare settings leads to the existence of racial 

inequalities in healthcare in the form of extrinsic fac-

tors such as “persistent bias, stereotyping and rac-

ism” (Powers et al., 2016). These factors lead to “only 

2.9% of all faculty members at U.S. medical schools 

[being] black” (Ansell and McDonald, 2015). This 

contributes to the disproportionate ratio of black to 

white physicians by creating environments in which 

black medical students lack black role models, re-

sulting in fewer people of color in these fields.  

The effects of underrepresentation in aca-

demia and healthcare can be illustrated through the 

idea of “race-conscious professionalism” where Af-

rican Americans understand the implications of their 

professional success in race politics and marginal-

ized communities (Powers et al., 2016). This leads to 

black physicians experiencing a dual obligation to 

reach professional excellence in order to protect 

their communities. The two-fold responsibilities that 

black physicians experience are not limited to the 

present day; many of the first formally trained physi-

cians used their scientific credibility and community 

leadership to build hospitals to care for black com-

munities, while also bolstering the African-American 

professional class (Powers et al., 2016). Race-con-

scious professionalism gives insight into the intrinsic 

obstacles that black physicians face as “most have 

experienced or witnessed, firsthand, inequalities in 

the access to, and quality of, health care” (Powers et 

al., 2016). Since many black physicians have experi-

enced the disparities that their communities are fac-

ing, they feel an obligation to aid their communities, 

which leads to a disproportionate number of “black 

and Hispanic physicians locat[ing] their practices 

[to] areas with higher proportions of residents from 

underserved minority groups (Komaromy et al., 

1996). The lack of black representation in academia 

and healthcare perpetuates racial inequality as it 

leads to increased pressures placed on minority 

physicians to practice in marginalized communities 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

 

who have also “witnessed inequalities in the access 

to, and quality of, health care” (Powers et al., 2016), 

resulting in “black and Hispanic physicians consist-

ently car[ing] for disproportionately high numbers 

of [black and Hispanic] patients” (Komaromy et al., 

1996). This burden is a direct result of the lack of in-

clusivity in science and medicine for black individu-

als, which leads to incommensurate physician de-

mographics. Confining colored physicians to prac-

tice in underprivileged areas to protect and advo-

cate for their own racial and ethnic groups pre-

serves racial inequality as this responsibility is 

placed solely on colored minorities while their white 

counterparts are liberated from this accountability.  

 

5 DIFFERENTIATING SYSTEMIC BIAS 

FROM INDIVIDUALISTIC BIAS  
While I have argued that racial inequalities 

in healthcare must be viewed from a systemic lens 

through observing past historical and social abuses, 

there are also those who argue that an individualis-

tic lens is more suitable. Sabin et al. illustrate priori-

tizing the individualistic perspective as “physicians 

[holding] strong implicit associations for black pa-

tients as being ‘less cooperative’ and demonstrating 

that this implicit bias was related to quality of care” 

(Sabin et al., 2009). They support viewing racial ine-

qualities as an individual’s responsibility because 

this has direct consequences in clinical decision-

making. This can include treatment plans for pa-

tients, as with the use of thrombolysis for coronary 

symptoms. For example, in Green et al’s study to 

measure implicit bias in physicians about race, phy-

sicians that favored white patients more than black 

patients were more likely to treat their white patients 

with thrombolysis for coronary symptoms (Green et 

al., 2007, as cited in Sabin et al., 2009). Therefore, 

physicians who maintain strong implicit biases con-

tribute to inappropriate, adverse courses of treat-

ment toward black patients, resulting in disparities 

that can explicitly be seen in the fact that “relative to 

[white] Americans, [black] Americans experience 

higher rates of diseases, disability, and premature 

death” (Trawalter., et al 2012).  

Although examining the impact of physician 

implicit bias on clinical decisions is important in 

evaluating racial disparities, solely relying on indi-

vidual accountability negates the impact of greater 

systemic and structural forces. The significance of 

evaluating systemic elements when discussing ra-

cial inequalities can be seen in “the systematic dis-

investment… within segregated black neighbor-

hoods [which] has resulted in under-resourced facil-

ities with fewer clinicians, which makes it more diffi-

cult to recruit experienced and well-credentialed 

primary care providers and specialists and thereby 

affects access and utilization” (Bailey et al., 2021). 

Therefore, when examining the influence of sys-

temic factors such as the disinvestment in black 

neighborhoods, it transcends the quality of care. 

Because access to resources is limited in black com-

munities, this leads to fewer physicians and difficulty 

in obtaining a higher standard of healthcare. This 

showcases the greater depth and effect behind the 

nature of care that black neighborhoods receive.   

Viewing racial disparities in terms of barriers 

such as redlining and race-conscious professional-

ism is more effective in understanding racial ine-

qualities because it provides reasoning for the per-

vasive disadvantages that black people face, inde-

pendent of individual actions. Regardless of physi-

cian bias, black patients “consistently have much 

higher rates of premature, preventable death and 

poorer health throughout their lives” (Bassett, 

2015). This can be attributed to greater forces that 

are deeply entrenched in institutions and policies 

rather than interpersonal interactions, as this ena-

bles a holistic framework for addressing the obsta-

cles and adverse outcomes that are ubiquitous in 

black communities. In addition, global factors are 

significant because the “ongoing exclusion of and 

discrimination against people of African descent 

throughout their life course, along with the legacy of 

bad past policies, [continues] to shape patterns of 

disease distribution and mortality” (Bassett, 2015). 

This further reinforces that the “higher rates of dis-

eases, disability and premature death” (Trawalter et 

al., 2012) in black demographics are not limited to 

implicit bias. This only provides a partial picture of 

the factors that perpetuate racial inequalities as 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE IV 

 

these consequences continue to exist past individ-

ual interactions.  

 

6 CONCLUSION 
Perpetuating racial inequalities are the re-

sult of direct and indirect social and historical factors 

pervasive in academia and healthcare systems. The 

academic prejudice against black communities pro-

motes distrust in medical services, leading to the un-

dertreatment of black patients and the inordinate 

number of black physicians practicing in these ra-

cialized neighborhoods. This academic prejudice is 

further supported by the underrepresentation of mi-

norities in academia and the responsibility placed 

upon black scholars to excel in their fields. Moreo-

ver, structural mechanisms that continue to preserve 

racial disparities surpass academia and science and 

can be observed in residential segregation, which 

leads to unequal access to healthcare services and 

negative health outcomes in black patients. These 

systemic forces depict the extensive nature of racial 

bias in medicine and society in the United States as 

these are not limited to individual interactions. The 

decisions made by individuals are based on histori-

cal and cultural bias. The ubiquity of the impact of 

structural racism is supported through the act of 

psychologizing racism, where the excessive analysis 

of one’s own prejudice, discrimination, and stereo-

types towards people of color invalidates the expe-

riences of black minorities (Trawalter et al., 2020). 

This results in minimizing the true effect of institu-

tional bias and injustice. It is important to validate 

the role of various systemic elements when examin-

ing the barriers placed upon black communities ra-

ther than focusing on individual biases.   

Recognizing the social and historical con-

texts behind modern-day healthcare practices gives 

us insight into racial inequalities and disparities in 

academia and medicine. Moving forward, reform 

requires the recognition and reconciliation with the 

past abuses against black individuals while also con-

tinuing to educate on historical and social policies. 

This entails medical schools educating on past his-

torical injustices against black communities and the 

consequences of these abuses in modern-day med-

icine.  

Additional initiatives to combat underrepre-

sentation in academia should be proposed and en-

forced to dismantle systemic and structural racism 

most effectively in healthcare and beyond. This re-

quires implementing programs that consider the so-

cial and historical contexts unique to the black ex-

perience.  

Understanding the frameworks that perpet-

uate racial disparities today allows for a greater ap-

preciation of black experiences as it elucidates 

long-standing obstacles that validate distrust in ac-

ademia and medicine, prevent access to healthcare, 

and demonstrate underrepresentation in academia. 

Enduring change can only stem from accepting that 

systemic racism is not rigid and absolute but can be 

remedied through actively educating and disman-

tling biased policies and institutions∎ 

 

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ample of Racial/Ethnic Residential Segregation. 

Health Services Research, 47(3pt2), 1278–1299. 
HTTPS://DOI.ORG/10.1111/J.1475-6773.2012.01410.X 

 

 

 

 

 

Meghana Nampally is a fourth-year undergraduate student at Rutgers Uni-

versity-New Brunswick. She is majoring in Cell Biology and Neuroscience 

with a minor in Psychology. She plans to pursue a Ph.D./MD program after 

Rutgers and hopes to practice in underrepresented areas.  

 

Meghana’s research was inspired by the racial disparities that are often 

overlooked in the medical field. As a future healthcare professional, she 

wanted to educate herself and others on the inequalities that people of 

color face in medicine and in academia. Her research began as a final pro-

ject for her English 201 class; however, she wanted to continue educating 

herself on these inequities, leading to her Aresty Undergraduate Research 

Journal submission. 

 

 

 

https://doi.org/10.1097/HRP.0000000000000345
https://doi.org/10.1177/0310057X20966606
https://doi.org/10.1111/acem.13214
https://doi.org/10.1017/S0963180100005168
https://doi.org/10.1016/j.jmig.2020.10.027
https://doi.org/10.1056/NEJM199605163342006
https://doi.org/10.1007/s12552-021-09338-z
https://doi.org/10.1097/ACM.0000000000001074
https://doi.org/10.1353/hpu.0.0185
https://doi.org/10.1016/j.copsyc.2019.06.029
https://doi.org/10.1371/journal.pone.0048546
https://doi.org/10.1111/j.1475-6773.2012.01410.x

