Recognizing the Psychological Impacts of Inequity on Black Healthcare Workers

By Maimah Karmo – Founder/CEO Tigerlily Foundation

Over the past year, the world has focused a lot on the impact of racism and health equity.  The Black population faces inequities in broad strokes, and many companies have made significant efforts to address this issue in terms of representation in the workforce.  While the important work of representation and equality in the workforce is happening, it is equally important to address the psychological impact of COVID-19 on Black healthcare providers during this time. In addition to the stress related to work associated with caring for patients during COVID-19, where Black patients were dying at higher rates, they also had to focus on the lack of supplies, facilities, equipment, and in-time treatment in communities of color.   

According to the New York Times, while Black communities make up only a small portion of the population, living in communities of color – due in large part to generational socioeconomic factors that contribute to more chronic health issues, put Black people at higher risk, particularly for COVID-19.  An article by Greenlining highlighted that when you consider redlining, and environmental racism, Black people and the healthcare workers who support them live in neighborhoods that have some of America’s dirtiest air, contaminated drinking water, and food deserts. 

So, while many may be feeling emotionally fatigued with the consistent and heightened focus on disparities and racism; millions of people around the world are relieved that we seem to be nearing the end of the pandemic; and people are excited about unmasking; going on vacation and getting back to normal life, we can’t forget about Black healthcare workers – who remain on the front lines in the communities that are still facing disproportionate challenges with COVID-19 and overall health – and particularly their mental health.  These Black healthcare workers cannot take a vacation from the stark realities of their daily lives.  Life as they know it has never been, nor will not be for a long time – normal. 

While navigating COVID-19 was certainly challenging, Black healthcare workers were exponentially impacted. The tips below were developed to support the needs of Black healthcare workers in the professional world.  

  1. Being a Healthcare Worker Living in a Black Body Brings Unique Challenges

Not only are jobs in healthcare already stressful, but the added pressure of being Black and a professional in a space that is not reflective of you or understanding of the emotional factors that impact your life, can cause additional stressors that result in premature aging and increase health vulnerability. This effect, known as weathering, is a term coined by Arline Geronimus, a public health researcher and professor at the University of Michigan’s Population Studies Center, which refers to the build-up of the stress of racism over a Black person’s life that can lead to premature biological aging, that disproportionately impacts health outcomes.   

Constant exposure to stress can result in a higher allostatic load – the cumulative wear and tear on the body due to adapting to adverse physical or psychosocial situations.  A higher allostatic load increases cortisol and adrenal levels, as the individual is in fight-or-flight mode constantly.  Micro-aggressions, fear, trauma, and racism impact the lives of Black people, and healthcare workers – the people who spend their lives caring, not only for their families, but for people as a profession – are in danger, if we do not address their needs. 

There is a dire need to increase Black representation in healthcare as it improves patient outcomes for diverse populations, boosts employee morale and allows people to feel safer at work. Experiencing life as a Black person in society can bear traumatic experiences and can amplify emotions when feeling isolated in a space that lacks representation.  Black people makeup thirteen percent of the population, yet only represent five percent of doctors and ten percent of nurses. We cannot afford to ignore this.  

At every turn inside and outside of work Black professionals are forced to confront and/or relive racial trauma that affects our personal wellbeing. Burnout can be a result of these societal pressures. Not to mention that during COVID, Black doctors were likely to be practicing in Black communities therefore, increasing their exposure to COVID and having to watch its effects on the Black community. And while Black healthcare workers care for others, we must develop ways to ensure that we care for them as well.  

  1. Acknowledge Injustice

It is important to give focused support to Black healthcare workers – during times of COVID, racial unrest, traumatic occurrences – and every day, as inequities exist whether visible or not.  It is important for senior leadership to acknowledge traumatic racial events and their effects through a statement of solidarity, and go beyond that statement, so that the impact moves from performative to authentic, meaning that the organization’s leadership truly feels from the heart, the impact on its Black employees.  I had the opportunity to speak with Kawanda Foster, MPH, Ph.D., who experienced such shocking and toxic racism in her early days doing benchwork in the lab at the hands of leadership, that it drove her away from science.  As the only Black woman in the room, she was held to a different standard, discrimination, criticism, derogatory statements, and micro-aggressions at the hands of her Principal Investigator.  Reporting this aggression could not only impact her lab position, but her career.   Now a Senior Consultant at Booz Allen Hamilton, Kawanda shares her story and receives tremendous support from the leadership – she is heard by the executives, supported and shares her story in other circles.  Hopefully, her story will translate to change, ensuring that talented young investigators are not turned away, but spurred onto excellence in science and research.

  1. Try to Understanding the Black Experience 

The Black experience in society is a unique experience. The trauma of racism is unfortunately part of that experience whether inflicted intentionally or not. Black professionals brace for the moment of impact for when we are inevitably hit with a dose of reality and reminded in some way (whether through a microaggression or “macroaggressions”) reminding us that we do not belong. These thoughts and ideas are fostered through society, from childhood through adulthood and have made their way into the professional space.   

Dr. Monique Gary, a fellowship-trained breast surgical oncologist and Medical Oncologist and Medical Director of the Grand View Health/Penn Cancer Network Cancer Program in Sellersville, Pennsylvania, recalls her experiences with discrimination throughout life. When asked if she has faced discrimination in her career, her response was “yes – at nearly every point. In training and professional life.” She recalls well-meaning teachers discouraging her from pursuing the sciences because of the level of difficulty and their assumption that she should pursue something “easier”.  She also recalls a painful experience when a patient whose life she was trying to save, turned down care from her due to her race. Discrimination whether through words or actions has been a part of her experience.  To this day, Dr. Gary remains the only African American female breast surgical oncologist in the state of Pennsylvania.  When she walks down the corridors of her hospital center, she does not see her reflection in the providers around her, who can relate to the internal pressures, microaggressions or code switching she may have to do in the workplace to fit in.  Understanding the perspectives of Black healthcare workers and learning how current events impact them is a critical part of developing support in the workplace.  

  1. Provide a Safe Space and Offer Support 

The creation of safe spaces is important when supporting Black healthcare workers.  We recommend that you create these safe spaces in partnership with a racial trauma specialist that can help to facilitate healing conversations. A safe space should not be a one-time activity, but rather a series of events or a program that is embedded in the DNA of your organization. Additionally, consider on-site therapy, life coaching and wellness programs. Bringing on Black professionals as the providers for these services can be transformational for Black healthcare workers.  

  1. Invest Where It’s Needed

While a lot of corporations are investing in larger organizations, they often overlook the smaller non-profits or community hospitals and programs that are already least funded and at risk.  Budget cuts affect healthcare workers, who are in critical need, and these budget cuts tend to happen in lower income areas with higher minority populations. When considering how to make your money work where it is most impactful, consider funding facilities and resources for patients and the providers.  This can create a world of change and help to positively impact the mental health of Black healthcare workers.   

Our healthcare workers are important, and while they care for patients, it is up to the organizations that they work for to care for them while at work.  Authentic allyship is key, seeing the humanity in the struggles of others and being expressive in your communication of support goes a long way.  Caring for our healthcare heroes because they have given their lives to do something bigger than themselves.