Listening to Black Californians: How the Health Care System Undermines Their Pursuit of Good Health

California, home to the most culturally diverse population in the country and the fifth-largest Black population of any state, has a major opportunity to be a leader in health equity. But, again and again, research has shown that racism and structural barriers in the health care system prevent Black Californians from achieving the health they actively seek.

To identify solutions for dismantling persistent health inequities, CHCF engaged EVITARUS, a Black-owned public opinion research firm in Los Angeles, to conduct a study that listens deeply to Black Californians talking about their experiences with racism and health care.

“This survey dispels the narrative that Black people don’t care about their health, when actually, they are very intentional.”

— Connie Stewart, Listening to Black Californians Advisory Group Member and Executive Director of Initiatives, Cal Poly Humboldt

Key Findings: What Black Californians Experience

Listening to Black Californians is one of the largest studies focused on the health care experiences of Black Californians to date. It represents in-depth interviews with 100 Black Californians and 18 focus groups, as well as a statewide survey of 3,325 adult Black Californians. Key findings include:

Pursuit of Quality Care

Black Californians are highly intentional in their pursuit of physical and mental health. Most Black Californians report focusing on their mental health (79%); getting appropriate screenings or preventive care (77%); and tracking health indicators, such as blood pressure and cholesterol (71%).

Most Black Californians are insured, have a regular provider, and have had at least one visit with a health care provider in the last year. Nine in ten Black Californians (90%) say they currently have health insurance coverage, and 83% have access to a regular provider. Over 9 in 10 Black Californians (92%) have seen a doctor or health care provider in the last year.

Failures of the Health Care System

“I feel like Black voices aren’t as loud. They are not taken as seriously. . . . I wasn’t listened to, and it ended up being a very serious, actually life-threatening problem. . . . I told [my doctor] I was short of breath, and he told me, ‘You are out of shape. . . . You just need to lose weight and exercise more.’ It ended up being that I was severely anemic and had to have two blood transfusions.”

— Black woman, focus group participant, private insurance – urban

Nearly one in three Black Californians has been treated unfairly by a health care provider because of their race or ethnicity. This experience occurs particularly for Black Californians with mental health conditions (47%); for those who identify as LGBTQIA+, which includes lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more (43%); for those with disabilities (40%); and for women (40%). A significant number of Black Californians overall (38%) and of Black women in particular (47%) say there has been a time when a health care provider did not treat their pain adequately.

More than one in four Black Californians avoid care due to concerns that they will be treated unfairly or with disrespect. Black Californians who identify as LGBTQIA+ (41%) and those who are enrolled in Medi-Cal (35%) report having avoided care.

Many Black Californians adopt measures to mitigate potential negative experiences in preparation for a health care visit. Two-thirds (66%) of Black Californians report researching a health condition or concern before meeting with a health care provider, and over one-third (35%) say they have tailored their speech and/or behavior to make a provider feel at ease.

What Should Be Done

Black Californians agree on the importance of strengthening the patient-provider relationship. Virtually all Black Californians consider it extremely important or very important to have a provider who listens to them (98%), who spends the time needed to answer questions (97%), and who discusses specific health goals (93%).

Black Californians have clear opinions on how to make the health care system work better for them. More than three in four respondents say it is extremely important or very important to increase Black representation among health care leaders and providers, expand community-based education and advocacy, and train providers and hold the health care system accountable. Approximately 7 in 10 Black Californians think it is extremely important or very important to develop more holistic approaches to health care.

“I think by having more Black people represented in the health care profession and in those positions of power and able to make the changes that we need for us . . . will allow us to have our voices heard and our concerns addressed better in the health care system.”

— Black man, focus group participant, Central Valley stakeholders

The diverse voices of participants speak loudly through Listening to Black Californians.  They tell us that eliminating the detrimental effects of racism and discrimination on their health is within our grasp if we are willing to listen to Black Californians, build trust and partner with them, and hold the health care system accountable for equitable care.

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