Big Data for Health Equity (BD4HE) is a collaborative exploring the social and cultural factors that contribute to racial health disparities. The director of BD4HE, Thu T. Nguyen, is an associate professor of epidemiology and biostatistics at the University of Maryland School of Public Health. Nguyen has contributed to numerous publications spanning from her time as a graduate student to her career as a Public Health professor. Despite some gaps between publications, Nguyen’s interest in health disparities never faltered, with many of her early and recent investigations addressing health equity in some respect. I was introduced to Dr. Nguyen through her paper titled Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Women. Interested in expanding my knowledge of obstetrics and labor experiences, I reached out and requested an interview, to which she kindly agreed. Published in the Journal of Racial and Ethnic Health Disparities in 2022, Nguyen’s paper revolved around the lived experiences and perceptions of Black, Latina, Asian, and Pacific Islander individuals throughout their pregnancy and labor. 

Abby: I noticed your study found distinct experiences of racism across the different racial groups you looked at. For example, you noted that Latin pregnant individuals were concerned about immigration status, while Middle Eastern pregnant individuals faced increased stigmatization following the Muslim ban and anti-Semitic rhetoric. I was curious if you were surprised by how these broader socio-political factors impacted the experiences of each racial or ethnic group?

Nguyen shares that her team hypothesized that modern sociopolitical circumstances, such as President Trump’s numerous anti-Muslim remarks in 2019, would impact the lived experiences of birthing individuals. She notes that Muslim and Middle Eastern participants specifically felt rejected by Trump’s discriminatory remarks, which translated into their obstetric experiences. This example, however, is just one of many. Nguyen’s team rationalized their broad eligibility for this study to explore how modern politics, like Trump’s political rhetoric, impacted select groups. Oftentimes, research exploring obstetric racism focuses on the experiences of Black individuals who have given birth. This research is vital given the maternal mortality rate and argues that such research needs to continue, and new research must emerge exploring the lived experiences of other demographics. Nguyen’s study is unique in that it included individuals of varying races, which allowed her team to notice similarities among each participant. Colorism, described as “skin color stratification, is a process that privileges light-skinned people of color over dark in areas such as income, education, housing, and the marriage market”, was frequently mentioned among varying ethnicities and races present. To dismantle the unique ways in which colorism manifests and exists within varying racial groups, it is essential that research is not limited to a single demographic. 

Abby: That's fascinating because other studies I have read emphasized that when accompanied by a paler person, the patient often notes a higher quality of care. I know numerous patients warned against racial concordance, or providing physicians of the same race, as a band-aid solution to the deep-rooted racial discrimination in healthcare. What are some larger changes to the healthcare system that can be made aside from increasing provider diversity to mitigate this discrimination? 

Representation among care providers is a solution of significant value in mitigating colorism, which Nguyen finds striking given the modern resistance of Diversity and Inclusion (DI) efforts. This, however, is just one of many solutions. Nguyen maintains that multiple methods must be used to effectively reduce discrimination and improve patient care, such as staff training with an emphasis on elements of respect and cultural humility. More often than not, existing training is superficial and fails to address the issues faced by the actual patient population. Nguyen proposes participant panels inquiring about care experiences concerning interactions with staff and the quality of care received. The answers received could identify the pressing issues within a hospital and contribute to training dialogues structured to address said problems. Nguyen hopes that these dialogues would encourage collective efforts to address such, rather than the responsibility falling solely on staff members who have an understanding of a patient’s culture to begin with. 

This does not account for the many complex presentations of racial bias, however. Margaret Hunter, an assistant professor in the Department of Sociology and Anthropology at Mills College, defines colorism as “a process that privileges light-skinned people of color over dark in areas such as income, education, housing, and the marriage market” (Hunter 2007). Nguyen suggests that colorism is distinct, in that it is deeply ingrained in society and is often recreated implicitly by care providers. These providers are unwilling to admit they are biased in the care they provide, often maintaining their care is inarguably equal. Ultimately, colorism is inescapable as we all exist in a society with a clear racial hierarchy. Resultantly, Nguyen explains colorism is a form of discrimination that is more difficult to dismantle, let alone in a healthcare setting. To counteract colorism, Nguyen believes bias reduction strategies must be implemented on a cultural and structural level. 

Abby: Relating to DI efforts, I believe a Black participant of your study noted how a Black physician was able to identify health issues more effectively and at a faster rate because they shared the same race as the patient. Although not a complete solution, could you expand on the importance of racial concordance and how that connection benefits patient interactions in terms of identifying health concerns? 

The aforementioned Black participant had gone to numerous providers and experienced a plethora of misdiagnoses, with care providers failing to identify the health risk experienced. Such instances are far from common, Nguyen explains. Prefacing this as a broader generalization, Nguyen provides the example of Asian patients and a cultural hesitation to receive mental health care. A provider does not have to share the same ethnic or racial background to realize that there is often more resistance in specific groups when receiving specific forms of care. This further emphasizes the need for provider sensitivity, and encourages physicians to approach topics like mental health care with ease in order to mitigate the initial hesitation of a patient. An increased awareness of cultural norms may aid greatly in having such complex conversations about patient care. While these patterns were represented in her team’s findings, Nguyen raises concerns regarding how generalizable the noted patterns were. The findings made were still noteworthy, however, as Black patients avoided provider-engaged labor care much like their Asian counterparts avoided mental health care. Black participants were opting for cesarean sections to minimize their time spent in the hospital out of fear of experiencing additional discrimination, even if the decision was not health optimal. This is one consequence of medical mistrust, and further proves that providers must navigate patient interactions with ease to mitigate fear or cultural biases that can negatively impact a patient’s health decisions and subsequent outcomes. 

Abby: It is my understanding that the interactions had with care providers inform not only the health decisions a patient makes moving forward, but the decisions they make regarding child care.  Do you think healthcare systems and their cultural connections, or lack thereof, play a role in welcoming families of color? And if so, can you elaborate on this role?

When asked about future plans regarding children, participants often shared their first experiences with racism. This translates into a disconnect, where participants desire to start a family while simultaneously fearing their children’s experiences will mirror their personal experiences with racism. Parents often want to maintain the innocence of their child, yet protect them, so they feel they have to discuss racial discrimination even before their child experiences it. Healthcare facilities contribute to welcoming families of color, but it equally falls on a family’s attraction to specific educational and community environments. All facilities, ultimately, play a role in welcoming families and providing a certain level of cultural humility.