by Keisha Ray, Ph.D.

It’s well known that in America there are great disparities in health, access to health care, and health care outcomes between black people and white people, with black people, on average, faring much worse than white people. For example, if you are black in America you are more likely to die from breast cancer, heart disease, strokes, and giving birth than if you are white in America. According to the National Institute of Medicine, health disparities between races exist even when factors such as stage of disease presentation and the severity of disease are the same.

This has led some researchers to believe that there are social causes for some health disparities that are not due to people’s lifestyle choices or their noncompliance with medical advice. For example, there are sleep disparities between races, with black Americans more likely to get less sleep and lesser quality of sleep than white Americans. Explanations for sleep disparities include disparities in discrimination (The more discrimination you encounter, the more stressed you become, and the more stressed you become the less likely you are to sleep.). Additionally, researchers at the University of California, San Diego have speculated that there is a correlation between living in lower quality neighborhoods (including high noise levels, lack of safety, and higher rates of crime, which are more likely to be populated by black Americans than white Americans) and a lack of sleep.

Social factors are also thought to be responsible for disparities in adequate pain management between black Americans and white Americans. Black people are less likely to receive adequate pain management and are less likely to be prescribed pain medication, including after experiencing injuries typically thought of as very painful, such as bone fractures. In a study conducted at University of Virginia, in which researchers studied white medical students’ views of black patients, they found that many students held false beliefs about the biology of black people, which could explain disparities in pain management. For example, researchers found that some white medical students believed that black people have thicker skin than white people, black people’s blood coagulated quicker than white people, black people have stronger immune systems than white people, and that black people’s nerve endings were less sensitive than white people’s nerve endings. Other than these views being troublesome simply because of their false nature and not being grounded in science, many of the medical students who held these beliefs also had false beliefs about black people’s ability to feel pain, believing that they feel less pain than white people. The worry is that these unscientific views could be used to develop treatment recommendations by future physicians and are currently used by some practicing physicians to treat their black patients.

There is a case to be made that basing pain management procedures on the belief that black people experience less pain than white people is inhumane. Diminishing or ignoring people’s pain, in general is cruel because simply pain is typically not thought of as desirable; few people want to be in pain, particularly when it’s pain they cannot control. Additionally, pain can greatly diminish autonomy and severely limit opportunities to live the lives that we choose to live. If black people are more likely to have their pain untreated then individual black people are also more likely to not be able to live the kinds of lives that they desire to live because of pain. One of the great benefits of adequate health care is the autonomy it can confer. But when health care’s stewards can manage pain, but don’t because of racist beliefs they are acting as barriers to autonomy rather than facilitators of autonomy.

There is also a case to be made that believing that black people feel less pain than white people treats black people as if they are superhuman. Just as comic book superhumans, such as Superman or Spiderman are superhuman because they have power and skills that ordinary humans do not have, thinking of black people as being able to feel less pain than white people treats them as if they have a power that ordinary humans do not have, a power that separates them from normalcy.

Taking a lesson from comic book superhumans, being thought of as superhuman is not always as desirable as it may seem and is sometimes very hard. In comic books, because of their abilities, superhumans are viewed as being odd, as if they are from another planet (even when they are not) and then treated by the populous as if they are not human, or not normal. They are then ostracized, ridiculed, and condemned for not being one of us (human). In general, they are thought of as being different and because they are different they can be treated in ways that we would not normally treat humans; they can be poked and prodded, experimented on without consent, or even killed (which is usually the goal of a supervillain). This is the general problem with thinking that black people feel less pain than white people—it treats them as an “other” and when a group of people are treated as an “other” it spurs lies and falsehoods about their humanity. These lies and falsehoods in turn justify not treating them as human, giving us permission to treat them as we desire, without regard to their health or safety or their wants. This is how historical injustices like genocides and apartheids, racism in and outside of medicine (e.g. Tuskegee Syphilis study), and disparities in health and health care are justified.

Thinking of black people as having a higher tolerance for pain than white people is another method of making some types of lives not available to some black people, namely a life free of pain. It’s also another way that health care contributes to the already troublesome disparities in health. But it’s difficult to say whether treating black people’s pain differently than white people’s pain because of racial bias is an instance of inhumane treatment or superhuman treatment. And one is no better than the other. Both require us to look at people as if they do not deserve to be treated like other people. They require us to look at pain as if it is something that only some people are worthy of not experiencing, which is another falsehood perpetrated by racism in health care.