CP PROCESS 
CP DEFINING A PROBLEM, ROUGH DRAFT #1, REVISION/ DRAFT #2, REVISION/ DRAFT #3, CP FINAL, & CP REFLECTION

The first thing we were told to do was choose a problem in health care we are interested in writing about. We were required to do research and asked to use some scholarly sources. This assignment was to simply define our problem. Who it's hurting, how they are being hurt, where the problem exists, since when it has been a problem, our personal connection, and so on. When I began my first chose of topic was racial and socioeconomic disparities in access and treatment. I definitely added and took out topics through the process.

This was my very first draft for the CP assignment and as you can see I began with extremely weak claims they rather looked like just plain facts or a straightforward opinion, nothing arguable.. 

In this draft I asked my classmate to go over my paper and she was really helpful and pointed out several errors and suggestions she had

She helped me with my claim and advised me as to how it should sound and what I should focus on.

One of the most helpful things is to have someone proof-read my paper, because there are parts in my writing that may not be clear or repetitive/run-on.

It was made known to me that my focus is not entirely right.  In this draft of my CP paper, I was bringing up 5 healthcare issues and not connecting them to one another. When I would read over my paper I did not notice that it was not flowing with each other so these comments were of great help.

These general comments helped improve my paper

 and know what parts I should go back and revise.

CP FINAL

Vivian Girgis 

Writing 39C 

Professor Wells 

May 9, 2022 

The Modern Issue: Inadequate health outcomes of ethnic minorities

      Modern medicine has evolved to be far more reliable and efficient in treatment than most other types of medical practices, resulting in its worldwide application in hospitals. The expansion however has raised the issue of inadequate health treatment of minorities and the cultural practices they may carry. POC groups in the US tend to be disproportionately affected by cultural factors. These include family and community, religion, perspectives on death, gender roles, health beliefs, and beliefs about medication to list a few; usually a direct result of people immigrating to different countries and their cultural beliefs becoming incompatible with western medical practices. Mistrust of medical institutions will be seen among many such patients, caused by poor past experiences, biased predispositions about western medicine, legitimate fear of facing racial/gendered prejudice, and even the inability to understand complicated medical jargon. This mistrust can harm a patient's health, leading their case to become more severe even. Upon studying implicit bias in medicine, it can be witnessed that many ethnic-racial communities get discriminated against, and are offered a much lower quality of healthcare in addition to dealing with degrading bedside manner among medical professionals.

       In healthcare, there have been issues with understanding different cultural factors, people mistrusting medical institutions, implicit bias, and racial discrimination, from doctors have limited people from obtaining proper medical care. Additionally, patients of color have historically always been neglected and the transparency between medical institutions and people of color hasn’t always been truthful. “In comparison to whites, blacks and other minority groups in the United States face greater disease, worse results, and early mortality. Although a deliberate attempt by government agencies resulted in some progress, the most current report indicates continued variations by race and ethnicity for all categories,” (How Structural Racism Affects Healthcare). Therefore, causing distrust and skepticism from people of color to have medical professionals diagnose them or recommend treatment. Furthermore, these different factors come into play in our society, very often this is due to the fact that people in the U.S. are from multiple different cultures and the care providers may not be familiar with the patient's religion or health beliefs. This may lead to arguments and can negatively affect a patient's case. Although theoretical considerations imply that healthcare-related skepticism may lead to poor health outcomes by interfering with appropriate healthcare delivery, little is known about the effects or consequences of distrust in the country's healthcare system. A study conducted on 961 adults verifies that this is true, their results state that “distrust of the healthcare system is relatively high in the United States, with between 20% and 80% of respondents reporting distrust for each item on the Health Care System Distrust scale and a median scale score of 31 (potential range from 10 to 50). Distrust of the healthcare system is strongly associated with self-reported fair/poor health (odds ratio [OR] 1.40%, 95% confidence interval [CI] 1.12 to 1.75 for each standard deviation increase in distrust), even after adjusting for sociodemographic characteristics, access to health care and trust in primary physicians. In contrast, low trust in one's primary physician is much lower (only 10% to 20% of respondents reported distrust for each item) and is not associated with health status)”(Armstrong).

       In the healthcare environment, doctors can have difficulty acknowledging a patient's background and religious-cultural beliefs about medicine and treatments. This can cause difficulty in ensuring the right treatment for different cultures since there is not just one religion in each nation, and physicians, like everyone else, are not aware of every faith and their distinct views on medical treatment. If patients with different beliefs walk into a general clinic where the nurse and/or doctor(s) aren’t aware of these cultural practices, this may cause a problem for the doctor or for the patient directly. An example of this, in Pacific Islander families, the oldest family member has authority. When a patient from this cultural background comes their eldest family member will speak for them. With this comes the possibility of risking the care provided to the patient. Having the patient’s elder speak on their behalf can cause conflict between the elder’s preference of care vs the doctor’s suggested treatment. Doctors might think they are trying to harm or not seeking the best treatment, while in reality, they are making decisions based on their religion or cultural background. According to the EuroMed organization, “the extended family has significant influence, and the oldest male in the family is often the decision-maker and spokesperson. The interests and honor of the family are more important than those of individual family members. Older family members are respected, and their authority is often unquestioned.” This shows that in this culture no matter if the patient is at the age to speak for themselves, the oldest male makes the decision in their place, and it is disrespectful if it is questioned. Furthermore, in healthcare, these patients of different ethnic backgrounds and cultures can lead doctors unable to adequately provide care.

     The medical misunderstanding may be hazardous because individuals may choose to avoid obtaining care or may fail to follow the treatment plan recommended by the healthcare professional. People who lack faith in the healthcare system are less likely to use it, which can lead to a lack of preventative services and procedures that might otherwise keep them healthy. Impoverished results and far worse patient satisfaction are more probable as an outcome. In the “Immortal Life of Henrietta Lacks,” Rebecca Skloot who writes a book about Henrietta Lacks, figures out after speaking to the family member stating “Everybody always saying Henrietta Lacks donated those cells. She didn’t donate anything. They took them and didn’t ask...What really upset Henrietta is the fact that Dr. Gey never told the family anything—we didn’t know anything about those cells and he didn’t care.” The family was not aware of anything until over 20 years later and the doctor lied to them over the years. After finding this out, it shows how mistrust starts in the healthcare and can cause people to not go to the hospital when they are sick because they do not believe doctors will give them true treatments and so their cases get more severe and can strongly damage their health resulting in death because of one specific situation that took place. 

      In health care, there has always been implicit bias from medical professionals towards American ethnic groups. Experts note that these issues stem from classism and racism that are tied into American history with the mistreatment of minorities. Most notably, African Americans. For example., “Black people’s nerve endings are less sensitive than white people’s.” “Black people’s skin is thicker than white people’s.” “Black people’s blood coagulates more quickly than white people’s,” (Sabin). The notion of pain tolerance is higher than “other groups” causes medical officials to have a notion that African American individuals can withstand pain compared to other groups. This then leads to the under-prioritization of medicine to cover black individuals as compared to other groups such as white Americans. Health professionals tend to display implicit bias because of snap judgments they make, they have it noted in their brains that people of colored skin are ‘this and that’ so when they are dealing with patients that are not white they automatically give a thought to that they deserve lower-quality care or aren’t in need of urgent care. An example of this would in the article  “Black Americans’ views about health disparities, experiences with health care” which states “Less access to quality medical care is the top reason Black Americans see contributing to generally worse health outcomes for Black people in the U.S. Large shares also see other factors as playing a role, including environmental quality problems in Black communities, and hospitals and medical centers giving lower priority to the well-being of Black people” (Cary Funk). Overall emphasizes the limited amount of medical care African Americans and as well other American Ethnic groups experience. Implicit bias in healthcare has a major impact on the way doctors can interact with their patients and the type of service they provide. While more ethnic groups are more susceptible than others, implicit bias affects every group in the way of patient-provider interaction.

      Throughout American history, medical health institutions have neglected people of color from receiving their social services. Medical health is one of the major institutions barring people of color to receive inadequate treatment or service since the first recording from the 1900s. The reason why this is an issue is that statistically, people of color are underserved compared to their White American counterparts. However, research statistics can influence healthcare professionals in how they treat people of color. In an article titled “In Focus: Reducing Racial Disparities in Health Care by Confronting Racism” by Martha HostetterLinks to an external site., Sarah KleinLinks to an external site. states that Compared with whites, members of racial and ethnic minorities are less likely to receive preventive health services and often receive lower-quality care. They also have worse health outcomes for certain conditions. To combat these disparities, advocates say health care professionals must explicitly acknowledge that race and racism factor into health care. (Hostetter, Klein, 2018). Furthermore, the evidence provided implies a clear correlation between ethnicity and lack of quality health care. 

    In conclusion, the purpose of this research paper was to identify how medical institutions with different factors such as cultural factors, mistrust of medical institutions, and racial discrimination in medical health have impacted communities and have led to lower quality of medical health care for ethnic communities. Upon studying the most current research and analysis, it can be inferred these issues have disproportionately affected minority populations and have led to lower health outcomes.  

Works Cited

“Do Patients Understand? - PMC.” PubMed Central (PMC), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037129/. Accessed 18 Apr. 2022.

• Suzanne Graham Rn and Ph.D. and also John Brookey MD. These authors are arguing that limited access to health services is a hidden epidemic and it can affect health outcomes, health costs, health status, and also health care use. They make a good point stating that the whole system is standing on the assumption that patients can access and understand what they are being informed by medical professionals. These authors use google scholar, pub med, and government sites as their references, overall their evidence is articles, studies, and journals about the understanding of health communication. 

“In Focus: Reducing Racial Disparities in Health Care by Confronting Racism | Commonwealth Fund.” Home | Commonwealth Fund, https://www.commonwealthfund.org/publications/2018/sep/focus-reducing-racial-disparities-health-care-confronting-racism. Accessed 18 Apr. 2022.

•  Martha Hostler and Sarah Klein. These authors inform us that it has been over 15 years (as of this year, 19) since the publication of the Institute of Medicine’s Unequal Treatment report. They explain that U.S. racial and ethnic minorities are not likely to receive preventive medical treatment as whites and are more likely to receive lower-quality care.

“Patients’ Perceptions of Cultural Factors Affecting the Quality of Their Medical Encounters - PMC.” PubMed Central (PMC), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5060265/. Accessed 27 Apr. 2022.

•  Authors include Anna M. Nápoles‐Springer, Ph.D.,  Jasmine Santoyo, MPH, Kathryn Houston, MA, Eliseo J. Pérez‐Stable, MD, and Anita L. Stewart, Ph.D. From just the viewpoint of racial and ethnic patients, the focus of this research has been to identify critical dimensions of cultural competency. They came to conclude that cultural flexibility is required to obtain and adapt to cultural aspects in medical encounters when giving quality care to ethnically different patients. Cultural issues that affect the quality of medical interactions must be addressed in interventions to eliminate inequities in care and wellbeing in the United States.

Rees, Mathieu. “Racism in Healthcare: Statistics and Examples.” Medical and Health Information, Medical News Today, 17 Sept. 2020, https://www.medicalnewstoday.com/articles/racism-in-healthcare.

• Medically reviewed by Alana Biggers, M.D., MPH, written by Mathieu Rees on September 16, 2020. Discussing how covid 19 opens our eyes to racial discrimination in healthcare. The COVID-19 epidemic has brought this to light. According to a study published in May 2020, black people in the United States are 3.57 times more likely than white people to die from COVID-19. Similarly, the Latinx population faced roughly twice the chance of death as the white population. An important point Rees brings up is that many countries' healthcare systems, including the United States, are riddled with racial prejudice. Patients and healthcare staff alike suffer as a result of this, with higher risks of sickness and, in certain situations, inferior levels of care for persons of color (POC).

Reich, Michael. “Who Benefits from Racism? The Distribution among Whites of Gains and Losses from Racial Inequality.” The Journal of Human Resources, vol. 13, no. 4, [University of Wisconsin Press, Board of Regents of the University of Wisconsin System], pp. 524–44, doi:10.2307/145261. Accessed 19 Apr. 2022.

•  Michael Reich undergraduate and Ph.D. in economics. The majority of neoclassical studies claim that racial discrimination harms employers while benefiting white workers; nevertheless, these distributional hypotheses have not been empirically validated. This article argues that racial disparity benefits capitalists and disadvantages white workers by diminishing workers' unity and bargaining power, regardless of how it is created but whether or not industrialists separately or jointly practice discrimination. We may believe that no one benefits from these concerns, but when we examine racial injustice more closely, we see that "blacks lose, so whites gain."

Sanchez, Gabriel R., et al. “Discrimination in the Healthcare System Is Leading to Vaccination Hesitancy.” Brookings, Brookings, 20 Oct. 2021, https://www.brookings.edu/blog/how-we-rise/2021/10/20/discrimination-in-the-healthcare-system-is-leading-to-vaccination-hesitancy/.

• Gabriel R. Sanchez Ph.D., Matt Barreto Ph.D., Ray Block Ph.D., Henry Fernandez, CEO of the African American Research Collaborative,  and Raymond Foxworth Ph.D. and Vice President of First Nations Development Institute. These authors are informing us that during the coronavirus we could see evidence of implicit bias; this would be that black and Latinos lack access to covid testing. This group sent out a survey concerning if certain races are getting lower-quality care. According to the poll, people of color face healthcare discrimination on a regular basis.

“Understanding and Addressing Racial Disparities in Health Care - PMC.” PubMed Central (PMC), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194634/. Accessed 18 Apr. 2022.

“Understanding and Ameliorating Medical Mistrust Among Black Americans | Commonwealth Fund.” Home | Commonwealth Fund, https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans. Accessed 27 Apr. 2022.

•  David R. Williams, Ph.D., M.P.H. and Toni D. Rucker, Ph.D.Racial differences in medical care must be considered in the context of socioeconomic inequality. Guidelines and implicit bias caused by negative stereotypes often enable widespread discrimination, which is not the result of a few bad apples. Improved data systems, enhanced regulatory monitoring, and new initiatives to correctly prepare healthcare practitioners and engage more doctors from disadvantaged minority families are all required to effectively address gaps in the quality of care. A national priority should be set for successfully implementing effective ways to decrease racial disparities in health conditions and healthcare.

“Understanding and Ameliorating Medical Mistrust Among Black Americans | Commonwealth Fund.” Home | Commonwealth Fund, https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans. Accessed 27 Apr. 2022.

• Martha Hostetter and Sarah Klein are the authors. The writer discusses how black people distrust healthcare, they give an example by saying, “As Michael Che, one of the stars of Saturday Night Live, quipped last month, “I’ve got mixed feelings about the vaccine. On the one hand, I’m Black, so naturally, I don’t trust it. But on the other hand, I’m on a white TV show, so I might actually get the real one.” 

Vaughn, Lisa M., et al. “Cultural Health Attributions, Beliefs, and Practices: Effects on Healthcare and Medical Education.” Bentham Open, Scientific Research, 22 Aug. 2009, https://benthamopen.com/ABSTRACT/TOMEDEDUJ-2-64.

• Lisa M. Vaughn, Farrah Jacquez, and Raymond C. Bakar are the authors of this journal. Health attributions have an impact on health attitudes and behaviors. Culture has an influence on health attributions. Cultural health attributions, in turn, influence perceptions regarding diseases, treatments, and health behaviors. Similarly, culture has an impact on health and therapeutic techniques. Culture-bound syndromes exist in some societies, and health professionals should be educated on them. Other socio-cultural elements that influence medical attributions and medical commitment include immigration, cultural values, and social support. Medical educators must acquire new approaches of cultural evaluation and therapy in order to be successful with culturally varied patients. Medical educators also require teaching and learning methods and philosophies that take into account patients' medical inferences, beliefs, and practices.

Yearby, Ruqaiyyah, et al. ``Structural Racism In Historical And Modern US Health Care Policy.” Health Affairs, Project HOPE, 1 Feb. 2022, https://www.healthaffairs.org/author/Yearby%2C+Ruqaiijah.

• Ruqaiijah Yearby, Brietta Clark, and José F. Figueroa contributed to the writing of this journal. The COVID-19 epidemic has to light and intensified the stark realities of health disparities that racial and ethnic minorities face in the United States. COVID-19 has disproportionately infected and killed members of these communities, although they still lack fair access to services and immunizations. The lack of fair availability of high health care is mostly caused by structural discrimination in US healthcare policy, which favors Whites and disadvantaged racial and ethnic minorities. This article gives historical context as well as a detailed overview of contemporary structural racism in healthcare policy, concentrating on its impact on healthcare coverage, finance, and quality.

..THE END OF THE CP..

Above are just a few of my revisions and edits. I personally believe I improved on my claims and organizations on this paper. I put much effort and time into this research CP and defintly learned new things along the way. I learned about the healthcare issues in much detail, and why they are happening and exactly who they are impacting. Over the first half of this course I realized how much new skills I learned, and the amount of advice and suggestions I received helped me notice the little mistakes and keep an eye out for them when I'm writing the following paragraph. My general outline was not all that bad in my very first rough draft but there is clear improvement in the way I worded and organized my final CP paper before submitting.