Acknowledging the History of Black Health Care: Current Biases, Disparities, and the Importance of Diversity in the Next Generation of Providers

In her two decades of working in emergency medicine, Jacqueline Ward-Gaines, MD, assistant professor of emergency medicine at the University of Colorado School of Medicine, has devoted much of herself to almost every patient scenario imaginable and seen dozens of cohorts graduate medical school and complete their residencies. Consequently, she has also come face-to-face with disparities and biases that exist in health care.

Throughout her career, Ward-Gaines has seen some progress in minority representation among health care providers but knows there’s more work to do. Her goal is to open doors for residents and faculty to learn how to address bias and disparities in the workplace and understand the importance of recruiting diverse talent into the health care profession.

Ward-Gaines leads the diversity, equity, and inclusion (DEI) efforts for the CU Department of Emergency Medicine and directs the Denver Health Emergency Medicine Residency DEI committee. For Ward-Gaines, DEI-driven education is about creating health equity. It’s why honoring those who have come before her during Black History Month is important for health care and beyond.

Acknowledging the history of Black health care 

“Acknowledging Black history means acknowledging the United States of America’s history; one doesn’t exist without the other,” she says.

Ward-Gaines notes that it wasn’t until 1964 when Black patients were widely admitted to hospitals, immediately following passage of the Civil Rights Act. Before then, hospitals were deeply segregated.

“It’s easy to think that was a long time ago and that we’re far past the point of discrimination,” she says, “but many of our patients today were alive during the segregation era.”

Some Black patients admitted to hospitals today are the same patients denied access in the past. And many experienced discrimination years after the Civil Rights Act was passed.

Ward-Gaines stresses the importance of health care providers acknowledging how history can affect every patient and their previous experiences with health care, particularly elderly Black patients who may distrust the health care system.

“I’ve heard from some providers who feel nervous about addressing Black history head-on because they feel guilty, but they shouldn’t. I encourage them to learn about history, so it isn’t repeated,” says Ward-Gaines. “It’s more honorable to take the time to learn about history, because if we don’t, we simply erase Black history along with it. Some of our nation’s health care progress is still stagnant due to providers not recognizing the ripple effects of history’s impact on our current patients.”

Current biases and disparities in the field

Health care professionals complete rigorous training to care for patients, but it’s important to acknowledge that they also carry implicit biases from their lived experiences, especially towards historically underserved populations, says Ward-Gaines. This is why her work to establish strong DEI principles within the Department of Emergency of Medicine is critical. It’s important for faculty and providers to understand how history ties into the current patient scenarios to be able to respond with the best care.

In her role as department DEI lead, she works closely with departmental leadership to find ways to put principles of DEI into place, which is crucial for the recruiting, retention, and advancement aspect for our faculty. "It all translates into better health care,” says Ward-Gaines.

Ward-Gaines also mentions that disparities of the past still weigh heavily in the present. Today, underserved communities in Denver are still faced with redlining, which is a historic race-based exclusionary tactic that limits residents’ access to health care, housing, and critical services.

“Our Denver community still feels the impact of redlining in neighborhoods today; it’s created a disparity in health care,” says Ward-Gaines. “Poor environmental and business factors, transportation to get patients to health centers, fewer grocery stores and fewer health centers in those neighborhoods create a barrier. Those neighborhoods have the highest rates of morbidity and mortality in the city.”

Denver has taken some measures, like the metroDPA Social Equity Program to help previously redlined homeowners, but Ward-Gaines says she hopes that hospitals will focus on opening satellite clinics in some of these areas and that bus routes will be expanded. “There are areas where our faculty has an opportunity to focus on these improvements for these communities and aim for equal treatment and care.”

The next generation of doctors to represent our patients

Through an updated residency application review process and inclusion of DEI health equity principles in the curriculum, Ward-Gaines believes there are many opportunities for improvement for the next generation of emergency medicine residents.

“In the 1990s, I was one of seven out of 104 medical students and one of two out of 20 interns of color in my cohorts,” she says. “Today, the majority of our Denver providers still don’t look like our patient population. We have a strong Latinx patient population in Denver, and we’ve recently increased our number of Latinx residents, but we still haven’t crossed the threshold for representing the diversity of our patients.”

Ward-Gaines, third from the left, marches with friends in the early 1990's for Martin Luther King Jr. Day to become a national holiday

In 2020, the Denver Health Emergency Medicine Residency program implemented an updated holistic review process for emergency medicine residents, which considers the entire applicant rather than just their United States Medical Licensing Exam (USMLE) score. Ward-Gaines is part of the admission committee for accepting new residents.

“In the past, we focused only on test scores. Our residency leadership embraced the evidence that standardized tests were not entirely indicative of what type of health care provider that applicant may be,” she says. “We like to know what types of experiences from their past will make them successful. We want innovative leaders in the future of health care. Can they relate to patients? Do they have grit and tenacity that would allow them to persevere in difficult situations?”

Evaluating applicants from this expanded perspective has opened the doors for more diverse cohorts, a change that Ward-Gaines believes will benefit their training peers, all patients and the community.

Along with the updated application review process, Ward-Gaines initiated a new DEI-focused curriculum in 2020 through which emergency medicine residents can participate in health equity simulation immersion.

“Residents can practice the simulation in a safe space where it’s OK to address biases and make mistakes,” she says.

Ward-Gaines is hopeful for the future of health care, and that biases and disparities will be reduced in and outside of the hospital. “When we can embrace the backgrounds and beauty that diversity brings,” she says, “it means better health care for everyone.”