Dynamics of Race and Disability in Healthcare Disparities
Exploring how the intersection of race and disability shapes inequities in healthcare and impacts the quality of life for marginalized communities.
By Kyanda Bailey
Content Warnings
- Discrimination & Racism: This blog addresses systemic racism, medical racism, and racial discrimination in healthcare.
- Ableism: The blog discusses ableism and the discrimination people with disabilities face in healthcare settings.
- Historical Trauma: The blog references the history of eugenics, forced sterilization, and the mistreatment of Black people and people with disabilities.
- Medical Abuse: The blog mentions examples of medical abuse, such as the Tuskegee Syphilis Study.
- Mental Health: The blog briefly touches on the mental health challenges faced by people of color with disabilities.
- Violence and Oppression: The blog includes references to the violence and oppression faced by marginalized groups, particularly Black, Indigenous, and People of Color (BIPOC) with disabilities.
Consider the challenges faced by individuals navigating the healthcare system — challenges exacerbated not just due to a single aspect of their identity, but by the intersection of their race and their disability. This is the reality for millions of Americans.
The U.S. healthcare system is riddled with challenges and inequities, particularly for disabled people of color. The roots of medical racism and healthcare discrimination trace back to the foundations of organized healthcare in the United States. From the exclusion of enslaved Black people from medical institutions to the development of modern healthcare systems in the mid-1900’s — marked by the shift from private practice to hospital-based care — these inequities have been systematically ingrained. These historical injustices continue to have consequential effects¹. This blog explores the complex barriers faced by these marginalized groups, examining how the intersection of race and disability leads to health inequities for these individuals.
Understanding the Intersection of Race and Disability
To fully understand the barriers that people of color with disabilities face, we must examine how race and disability intersect, thereby impacting healthcare outcomes. The perception of race may vary depending on where you are in the world. It is essential to acknowledge how social, economic, and political factors interact with race. People with disabilities represent a spectrum of conditions and have diverse, individualized needs. Disability is linked to various factors, such as age, race, ethnicity, chronic conditions, environment, socioeconomic status, and immigration status. Research from the National Disability Institute reveals that disabled Americans make up between 13%-20% of the population, making this the largest minority group in the country. The experiences of people of color with disabilities are shaped by overlapping systems of oppression such as racism, ableism, and classism. We know that Black and Indigenous adults have disproportionately higher rates of disability compared to White adults. The disparities (e.g., excess morbidity, misdiagnosis) are not new; the intersection of race and disability has long been shaped by harmful and discriminatory policies and practices.
Historical Context of Health Disparities
Public health research has shown that racism is a significant determinant of health outcomes and health disparities. Social determinants of health refer to the non-medical factors that affect health outcomes — such as socioeconomic status, ableism, education, housing, and more. Within this framework, medical racism — encompassing both discriminatory policy and practice — has been integral in shaping current inequities in the healthcare system. The intertwined histories of ableism and racism have profoundly shaped the unfair experiences of disabled people of color in the medical system.
The Eugenics Movement, spanning the 19th and 20th centuries, propagated a deeply harmful and scientifically incorrect notion that promoted “racial improvement” and “planned breeding.” People with disabilities were viewed as genetically inferior and subjected to forced sterilization. Black individuals were also targeted for forced sterilization, reflecting the multi-faceted marginalization they endured. From the onset of the transatlantic slave trade to as late as the 20th century, White scientists and academics upheld dehumanizing beliefs that Black people were animal-like and racially inferior. These beliefs were used to justify extremely poor health care and exploitation.
In “Race, Medicine and Health Care in the United States”, the authors present an account that highlights how, historically, Black people were often seen as inherently unhealthy or genetically inferior. This led to medical professionals creating a separate lexicon for ‘Negro Diseases,’ which reinforced the inferior treatment Black Americans received. Perhaps the most infamous example is the Tuskegee Syphilis Study, where Black men were deliberately uninformed and untreated for the purpose of observing the progression of syphilis.
The legacy of institutionalized abuse and medical neglect continues to impact the relationship between disabled people of color and the healthcare system. These historical abuses and marginalization created, and continues to produce, a foundation for disparities in healthcare, systemic bias, and exclusion within medical institutions today.
Health Disparities Faced by People of Color with Disabilities
Discrimination based on both race and disability can significantly worsen health outcomes. For instance, studies have shown that healthcare outcomes for BIPOC individuals with intellectual and developmental disabilities (I/DD) are worse than for White individuals with I/DD. Implicit bias among healthcare providers is also a major contributing factor to these disparities. According to a study on racial and ethnic disparities in diagnosis and treatment, the combined burdens of excess morbidity and decreased life expectancy for people of color have persisted for centuries and show resistance to substantial change, even today.
Research has found that healthcare providers may unconsciously treat disabled patients of color differently, leading to underdiagnoses, misdiagnoses, and failure to provide proper care. Despite presenting with the same symptoms, Black patients with disabilities are less likely to be prescribed pain medication compared to their White counterparts. This is rooted in the long-held, dehumanizing belief that Black people have higher pain thresholds and are more “animal-like,” which leads to misinterpretations of symptoms. Symptoms may be attributed to race or disability rather than diagnosing and treating the actual condition present. Furthermore, the majority of medical procedures, equipment, tests, and diagnostic standards were developed based on the assumption of White, able-bodied male patients. As a result, these standards often fail to accurately access and treat individuals who fall outside this demographic. For example, the Body Mass Index (BMI) disproportionately impacts people of color.
The compounded effects of race and disability create significant barriers to accessing quality care, resulting in poorer treatment outcomes. Studies show that disabled people are at higher risk for chronic conditions like diabetes, heart disease, and hypertension, often due to delayed or inadequate treatment. Socioeconomic barriers further exacerbate these disparities. One study found that Black and Hispanic adults with disabilities are significantly more likely to delay or forgo medical care due to barriers such as cost. Mental health disparities add another layer, as disabled people of color commonly live with mental health conditions and experience the compounded effects of mental health stigma and racial discrimination. This dual stigma can discourage individuals from seeking care or lead to misdiagnosis, further exacerbating their conditions and perpetuating a cycle of poor health outcomes.
These healthcare disparities cannot be fully understood through statistics alone — disabled people of color must be given space to share their lived experiences. Personally, I, along with other disabled people of color I know, have witnessed firsthand the devastating consequences that healthcare discrimination can have on both physical and mental health. I have observed how disabled and chronically ill BIPOC patients’ experiences differ from those of White disabled and chronically ill patients.
There needs to be a greater emphasis on transforming the medical school curriculum. Medical education should foster cultural competency through practical experiences and an understanding of historical context. The curriculum should include mandatory courses addressing how factors like poverty, limited employment opportunities, and lack of disability accommodations contribute to poor health outcomes. I support the approach outlined in the research study “Diversity and Discrimination in Health Care,” which advocates for healthcare professionals to prioritize the individual contexts of patients over labels like race and social status. This approach emphasizes the importance of seeing patients as unique individuals, considering their specific health needs, perspectives, and experiences. It encourages curiosity and empathy rather than reliance on assumptions or stereotypes, urging professionals to consider how a patient’s lived experiences shape their views and behaviors.
Where Do We Go From Here?
Intersectional advocacy is essential for addressing both racial and disability-based discrimination in healthcare. Disability and racial justice movements must collaborate to improve health outcomes for disabled people of color. The Disability Justice Movement aims to end the oppression of people with disabilities, including disrupting the medical industrial complex that perpetuates discrimination and exclusion. Advocating for policy solutions — such as expanding Medicaid and creating disability-inclusive healthcare policies — is another crucial step. We must center the voices of disabled BIPOC and support them in advocating for their health and rights.
The intersection of race and disability in healthcare highlights inequities in our medical system. The health status of disabled BIPOC has historically been inferior to that of White Americans, as evidenced by disparities in healthcare access and social determinants of health. The combined effects of race and disability have a lasting impact on quality of life (QOL). The World Health Organization defines QOL as a broad concept that includes physical health, psychological state, level of independence, social relationships, personal beliefs, and one’s environment. Addressing inequities in QOL requires acknowledging racism and ableism. Healthcare providers, advocates, policymakers, and communities must work together to /create a new healthcare system that no longer devalues the lives of disabled people of color. No one’s identity should be a barrier to healthcare.
The Center for Racial and Disability Justice is working on the Ableism in Discrimination and Care initiative, which aims to uncover and address the intersections of race and disability in healthcare and caregiving. Another valuable resource is the National Center for Disability, Equity, and Intersectionality, which is dedicated to disrupting systemic inequities like healthcare disparities affecting disabled people and other marginalized communities.
Definitions/Explanations of Key Terms
- BIPOC: Stands for Black, Indigenous, and People of Color. This term encompasses non-White individuals and communities, highlighting the unique and often compounded experiences of Black and Indigenous people while recognizing the diversity within people of color.
- Ableism: Discrimination, prejudice, and social stigma against people with disabilities. It reflects a belief system that devalues individuals who do not conform to traditional norms of physical and mental abilities.
- Medical Racism: A form of systemic racism in healthcare, where racial minorities face substandard care, bias, or discrimination from healthcare providers due to their race. Its roots lie in historical practices like the exploitation of Black bodies for medical experimentation.
- Eugenics Movement: A discredited and unethical set of beliefs and practices aimed at “improving” the genetic quality of the human population. It often involved forcibly sterilizing those deemed “genetically inferior,” including people with disabilities, racial minorities, and the poor.
- Intersectionality: A framework for understanding how multiple social identities — such as race, gender, class, and disability — intersect to create unique experiences of discrimination or privilege. Coined by Kimberlé Crenshaw in the 1980s, it highlights how various forms of oppression overlap and compound their effects on marginalized individuals.
- Disability Justice: A movement and framework dedicated to dismantling ableism and removing barriers faced by people with disabilities. It embraces an intersectional approach, recognizing the experiences of disabled individuals from marginalized communities (e.g., racial minorities, LGBTQ+ individuals).
- Implicit Bias: Unconscious attitudes or stereotypes that influence understanding, actions, and decisions. In healthcare, implicit bias can lead providers to make assumptions about patients based on race, disability, or other factors, resulting in disparities in care.
- Healthcare Disparities: Differences in access to or quality of healthcare services experienced by different populations. These disparities are often shaped by social determinants such as race, socioeconomic status, disability, and geographic location.
- Socioeconomic Status: A person’s economic and social position relative to others, based on factors such as income, education, and occupation. Socioeconomic status significantly influences access to healthcare, with lower-income individuals often experiencing greater health disparities.
[1] To learn more about the historical context of healthcare inequities, refer to Strangers at the Bedside by David Rothman, which explores the evolution of medical ethics and patient care.
Kyanda Bailey was a Fall 2024 intern with the Center for Racial and Disability Justice through the American Association of People with Disabilities (AAPD) internship program. During her internship, she contributed significantly to advocacy and research efforts aimed at addressing disparities — particularly healthcare disparities — at the intersection of race and disability.
The Northwestern Pritzker Law Center for Racial and Disability Justice (CRDJ) is a first-of-its-kind center dedicated to promoting justice for people of color, people with disabilities, and individuals at the intersection of race and disability.
Learn more about CRDJ by visiting the Center for Racial and Disability Justice webpage.
