Medical racism refers to the ways racial bias, both individual and systemic, leads to unequal healthcare treatment and worse health outcomes for people of color. It operates at every level of the healthcare system: in how doctors assess symptoms, how algorithms sort patients, how clinical tools measure vital signs, and how institutions allocate resources. The result is a well-documented pattern in which Black, Hispanic, and Indigenous patients receive lower-quality care and die at higher rates from preventable conditions than white patients.
Individual Bias vs. Systemic Racism
Medical racism takes two broad forms. Interpersonal racism is the discriminatory treatment that happens between people, like a doctor dismissing a Black patient’s pain or making assumptions about a patient’s lifestyle based on their race. Institutional racism is the set of policies, practices, and defaults embedded in the healthcare system itself. When institutional racism operates across multiple connected systems (insurance, education, hospital funding, housing), researchers describe it as structural or systemic racism.
In practice, these forms are nearly impossible to separate. A hospital policy that relies on a biased algorithm is institutional racism, but it’s carried out by individual clinicians who may also hold their own biases. The two reinforce each other, making the effects compound rather than stay isolated.
False Biological Beliefs Still Persist
One of the most striking findings in recent research is that medical professionals still endorse false beliefs about biological differences between Black and white bodies. A study published in the Proceedings of the National Academy of Sciences surveyed white medical students and residents and found that roughly half endorsed at least one false belief about racial biological differences. Among first-year medical students, 40% believed Black people have thicker skin than white people. About 29% believed Black people’s blood coagulates more quickly. Around 21% believed Black people age more slowly or have stronger immune systems.
These numbers dropped somewhat among more advanced students and residents, but they remained surprisingly high for people in clinical training. The false belief about thicker skin, for instance, was still endorsed by 25% of residents. These beliefs have real consequences: participants who held them were more likely to rate Black patients’ pain as lower and to recommend less adequate treatment for that pain.
Pain Treatment Disparities
The gap in pain management is one of the most studied examples of medical racism in action. A meta-analysis covering 20 years of research across multiple settings found that Black patients were 22% less likely than white patients to receive any pain medication. That gap holds across emergency rooms, post-surgical care, and chronic pain management. It reflects a combination of false beliefs about pain tolerance, implicit bias in clinical decision-making, and institutional patterns that flag minority patients as higher risk for substance misuse.
Maternal Mortality
The maternal mortality gap is among the starkest health disparities in the United States. In 2024, Black women died from pregnancy-related causes at a rate of 44.8 per 100,000 live births. For white women, that rate was 14.2. For Hispanic women, it was 12.1. That means Black women are roughly three times more likely to die from pregnancy or childbirth complications than white women.
This gap persists across income and education levels, which rules out poverty as the sole explanation. Black women with college degrees still face higher maternal mortality rates than white women without them. Contributing factors include delayed recognition of complications, less attentive postpartum monitoring, and a well-documented pattern of Black women’s symptoms being minimized by providers.
Heart Disease Treatment Delays
Cardiovascular care shows similar patterns. When patients arrive at hospitals with heart attacks, the time from walking through the door to having a blocked artery opened (called door-to-balloon time) is a critical measure. Longer delays mean more heart tissue dies. Research consistently shows that African American and Hispanic patients experience longer door-to-balloon times compared to white patients. They also receive lower rates of procedures to restore blood flow, even after accounting for differences in insurance and hospital quality.
These disparities hold among elderly patients and across multiple studies spanning years of data, suggesting they reflect systemic patterns rather than isolated incidents. African American and Hispanic patients in communities with large minority populations had lower rates of life-saving procedures and worse outcomes compared to white patients in other communities.
Bias Built Into Medical Tools
Some of the most insidious forms of medical racism are embedded in the technology and formulas clinicians rely on every day. Two examples stand out.
Pulse Oximeters
Pulse oximeters, the small clips placed on your fingertip to measure blood oxygen levels, are less accurate on darker skin. An FDA review of multiple studies found that these devices overestimate oxygen saturation in Black patients by an average of about 1.5 percentage points. That may sound small, but in critical care settings, it can mean the difference between a patient receiving supplemental oxygen or not. One laboratory study found that oximeters overestimated readings in Black patients by roughly 3 percentage points compared to white patients. During the COVID-19 pandemic, this inaccuracy had potentially life-threatening consequences, as patients with dangerously low oxygen levels appeared stable on monitors.
Kidney Function Calculations
For years, the standard formula for estimating kidney function included a race-based adjustment that automatically scored Black patients as having better kidney function than they actually did. This meant Black patients had to be sicker before qualifying for referrals, transplant waitlists, or medication adjustments. A study published in The Lancet Oncology found that removing the race adjustment from kidney calculations nearly doubled the proportion of Black cancer patients (from 7% to 13%) who fell below a critical threshold where drug doses need to be changed. Up to 18% of patients received different treatment recommendations depending on whether the race correction was used. Many institutions have now moved to race-neutral kidney function equations, though implementation remains uneven.
Algorithmic Bias in Care Management
A landmark 2019 study in Science examined a widely used algorithm that health systems relied on to identify patients who needed extra care and resources. The algorithm predicted healthcare costs as a proxy for health needs. But because Black patients historically had less access to care and therefore generated lower costs, the algorithm systematically scored them as healthier than they actually were. At any given risk score, Black patients were considerably sicker than white patients with the same score.
The researchers estimated that fixing this bias would increase the percentage of Black patients flagged for additional help from 17.7% to 46.5%, nearly tripling it. The algorithm affected millions of patients nationwide, and its bias arose not from any explicitly racial input but from using a seemingly neutral variable (cost) that carried the fingerprint of decades of unequal access.
Historical Roots and Ongoing Trust
Medical racism did not emerge from modern algorithmic errors or unconscious bias alone. It has deep historical roots that continue to shape how communities of color interact with the healthcare system. The most well-known example is the U.S. Public Health Service Syphilis Study at Tuskegee, conducted from 1932 to 1972. For 40 years, researchers withheld treatment from Black men with syphilis in Alabama, even after penicillin became the standard cure, in order to observe the disease’s progression.
The study’s legacy extends far beyond its direct victims. It contributed to a deep and rational distrust of medical institutions among Black Americans, a distrust that research has linked to lower rates of preventive care, clinical trial participation, and vaccination uptake. The CDC itself has acknowledged that the effects of Tuskegee are still felt today and has framed the challenge not as building trust in communities, but as building trustworthiness in institutions.
Institutional Responses
Medical institutions have begun to formally acknowledge and address racism within healthcare. The American Medical Association’s 2024-2025 strategic plan includes implementing health equity goals tracked through an anti-racist accountability framework, transforming medical education to focus on social determinants of health, and applying an equity lens to advocacy priorities including maternal health, Medicaid expansion, and the removal of harmful race-based clinical algorithms.
At the clinical level, changes are happening unevenly. Some hospitals have revised their kidney function calculations, updated pulse oximeter protocols, and introduced implicit bias training. Others have not. The shift from identifying medical racism to dismantling it remains a slow, institution-by-institution process, complicated by the fact that bias is woven into data, tools, and habits that were never designed with equity in mind.