California Black Women in Industry: Healthcare
By Kellie Todd Griffin & Raksha Kopparam
Summary
For centuries, Black women have been ignored or manipulated by the healthcare industry. Maternal healthcare advocates in California have detailed several incidences of young black mothers, especially those with multiple children, feeling judged by healthcare providers for their lifestyle health situations or having been assumed to seek drugs for their pain. This treatment can take the focus off their need and place more emphasis on what care providers feel are their ‘choices’. For Black women, the underrepresentation within the healthcare industry is more than statistics; it is a deeply personal and urgent issue that profoundly affects all aspects of life.
Representation matters because it directly impacts the accessibility and quality of healthcare services available to them. Black women often encounter systemic barriers and biases when seeking medical care, ranging from misdiagnosis to inadequate treatment. In a 2022 survey of Black Americans’ views on health disparities, 63% of respondents said that less access to quality healthcare in their communities and neighborhoods is a major reason why Black adults have worse health outcomes than adults of other races. Having healthcare professionals who understand their cultural backgrounds, experiences, and health needs from first-hand experience can mitigate these challenges and ensure that Black women receive the comprehensive, respectful care they deserve.
Additionally, the lack of representation perpetuates a cycle of distrust between Black women and the healthcare system. Historical injustices such as the Tuskegee Syphilis Study, the nonconsensual use of biological material from Black women like Henrietta Lacks, and contemporary instances of medical racism underscore the deep-rooted mistrust that many Black women harbor towards healthcare institutions. When Black women do not see themselves reflected in the healthcare workforce, it reinforces feelings of alienation and skepticism about the intentions and motivations of healthcare providers. Studies collecting the stories of Black women’s experiences accessing healthcare show that many Black women experiencing pain feel that their healthcare providers don’t take their pain seriously, singularly associate their pain to weight or stress, or insultingly assume that Black women patients are using pain as an excuse to access painkillers. Increasing representation can help bridge this trust gap, fostering more positive and collaborative relationships between Black women and their healthcare providers.
Moreover, the issue of representation is complex. It is intertwined with broader struggles for social justice and equity. Misogynoir, a form of racial discrimination that refers to the specific “hatred of, aversion to, or prejudice against black women” can be linked to systemic barriers to equity in healthcare access, treatment, and outcomes. The underrepresentation of Black women in positions of leadership and influence within the healthcare industry contributes to disparities, exacerbates existing inequalities, and limits opportunities for advancement and advocacy. The country saw a temporary increase in inclusion efforts after the summer of 2020 when nationwide protests for George Floyd led to a wave of DEI (Diversity, Equity & Inclusion) programs across all industries However today, less than four years later, many of those inclusionary programs
specifically for BIPOC (Black, Indigenous, or People of Color) no longer exist. Recognizing the importance of long-term and sustainable representation is thus essential for addressing the systemic injustices that disproportionately impact Black women's health and well-being. More importantly, When Black women are intentionally included in the healthcare workforce, especially in systems-level decision-making, health outcomes improve.
Culturally responsive care must include black women’s experiences and access to black medical care representation. Representation in the healthcare industry matters to Black women because it validates their expertise, voices, and lived experiences. Black women are active agents in their own health and often operate as advocates for their family members and larger communities. By centering Black women’s perspectives and expertise, healthcare institutions are better equipped to address- the unique health challenges faced by Black women. Encouraging Black women to shape healthcare policies, research agendas, and clinical practices is not just a matter of equity but a fundamental step towards realizing the full potential of healthcare as a tool for justice and empowerment.
Increasing Black women’s representation in healthcare is essential for improving healthcare outcomes for everyone. Health disparities among marginalized communities not only impact the individuals directly affected but also contribute to broader public health challenges. Disparities in maternal mortality rates, chronic disease prevalence, and mental health outcomes disproportionately affect Black women but also reflect systemic failures within healthcare systems that compromise the health and well-being of society as a whole.
Understanding the role and representation of Black women in the healthcare industry will help guide policymakers and support the sustainable improvement of Black women’s health and employment outcomes. The purpose and intention of this report are to contribute research, data, and meaningful discourse to the discussion of representation equity with the hope that it will lead to more evidence-based interventions to improve Black women’s access to and experience of healthcare systems.
Research
Black female healthcare workers play a crucial role in the healthcare system, contributing their skills, expertise, and lived experiences to promote the well-being of diverse patient populations. According to our analysis of the 2022 American Community Survey, approximately 70% of healthcare workers in California were women. Looking deeper into California’s employment statistics, we know 10% of Black women in the state work in the healthcare industry, comprising 5% of women working in healthcare occupations. Within the array of healthcare occupations, Black women’s representation varies, with them heavily populating physically laborious positions within the industry. Black women make up nearly 14% of Home Health Aides workers. Yet, they remain underrepresented in healthcare executive leadership. Less than 10 Black women hold executive positions in hospital groups in California. Despite their significant contributions, Black women often face systemic disparities in the workplace that can hinder career advancement and overall job satisfaction.
Disparities in healthcare leadership can also have detrimental impacts on Black women seeking healthcare. Studies have shown that excess mortality rates for Black women in America in 2020 were 192 for every 10,000 people, up from 87 in 2015. Evidence has shown that culturally sensitive care can reduce preventable mortalities significantly, which is indicative of the
importance of improving the representation of Black women in healthcare. Research on the social determinants of health has found that poverty cannot fully explain the disparities in health outcomes between African Americans and the rest of the nation’s population; racism in healthcare and race-related stress cause severe health crises for Black women is one of the most significant reasons why Black women in California have a life expectancy of six years less than the state average.
Share of women in healthcare occupations in California, by race 2022
One pressing concern of underrepresentation is the large disparities in compensation, growth opportunities, and access to educational and professional development opportunities, Black healthcare workers experience. In 2022, Black women made up only 4.8% of female physicians in California, while Asian American and White women made up 41% and 40% respectively. California falls behind the national rates, where Black women make up 7.3% of the female physician workforce. Aligning with what we’ve reported in our wage research, Black women experience pay gap disparities, even when accounting for education and experience among medical professionals. Looking at the breakdown of income, Black female physicians make on average $177,000 annually, while Asian and White female physicians make on average $215,00 and $197,000 respectively.
In addition, Black healthcare workers often encounter microaggressions and racial discrimination in the workplace. A meta-analysis of research on Black women in healthcare found that many Black women working healthcare jobs report that “they have to work twice as hard to get half as far” and “are not given the agency to step back because there is no safety net beneath them if they make missteps and fall”.
In California, where the cost of living is 48.6% higher than the national average, wage disparities are pronounced and have a particular effect on quality of life. The wage gap between Black women and women of other races is exacerbated within the healthcare sector, where Black female healthcare professionals often find themselves concentrated in lower-paying roles. In
2022, Black women in California working in healthcare occupations earned an average of $49,000 annually, while Asian and White women earned $72,000 and $60,000 respectively. An analysis of the share of Black women in healthcare occupations found that the occupation with the greatest share of Black women in California is Home Health Aides (14.2 %), and on average, Black women make approximately $38,000 annually in this position, nearly $10,000 less than industry top rates for California. The income disparities faced by Black female healthcare workers in California are compounded by multiple factors, such as occupational segregation, limited opportunities for advancement, and historical inequities. Black women are more likely to be employed in support roles, where wages are generally lower than in higher-skilled positions.
Occupations with the highest share of Black women employees, 2022
Personal care aides
Emergency medical technicians
Nursing assistants
Cardiovascular technologists and technicians
Dietetic technicians and ophthalmic medical technicians
Licensed practical and licensed vocational nurses
Recreational therapists Audiologists
Psychiatric technicians
Home health aides
Average salaries earned by Black women working in occupations with the highest share of Black women workers, 2022
Personal care aides
Emergency medical technicians
Nursing assistants
Cardiovascular technologists and technicians
Dietetic technicians and ophthalmic medical technicians
Licensed practical and licensed vocational nurses
Audiologists
Recreational therapists
Psychiatric technicians
Home health aides
The disparities Black women face in representation and income can be traced to centuries of discriminatory practices and unequal access to mentorship and sponsorship within the healthcare system. In 2020, Black women accounted for only 8% of medical school graduates in the United States. Research has found that structural barriers such as “segregated housing, economic instability, and underfunded school systems”, and the closure of historically Black medical schools and women’s medical colleges have resulted in many Black women being excluded from medical school tracks. However, Black communities rely on healthcare provided by Black physicians who understand their health concerns. A 2022 report looking at the healthcare experiences of Black Californians found that between 66 and 69% of Black women between ages 18-44 said that it is extremely important for them to have a Black physician because they are more likely to trust their physician and believe that they receive more effective care from Black physicians. Improving the representation of Black female physicians is proven to improve the health outcomes of Black patients.
Policy Recommendations
1. Mentorship Programs for Black Women Pursuing Healthcare Education
Addressing disparities requires a multifaceted approach, including providing mentorship and career development programs; and fostering a culture that values and supports the contributions of all healthcare professionals By promoting equity in the workplace, healthcare organizations will enhance the overall quality of care and better address the diverse needs of the patient populations they serve.
2. Expand Loan Repayment Programs for Black Women Who’ve Receive Higher Education
State and federal policymakers should pursue legislation that addresses the lack of Black women’s representation in high-paying healthcare professions. Studies have shown that pathway
programs for students at public colleges and universities can help “attract, support, and graduate” students from systemically excluded backgrounds. Additionally, the expansion of the Health Resources and Services Administration’s Faculty Loan Repayment Program would help minority students pursuing degrees in healthcare fields cover student loan debt. These types of policy solutions will open more opportunities for Black women to seek out high-quality healthcare jobs without the detrimental and long-term financial burden.
3. Codify the CROWN Act to Protect Black Women in the Workplace
Furthermore, despite their essential contributions, Black women often encounter barriers to career progression, including discrimination within the workplace. California Senate Bill 188, also known as the CROWN Act, amends the Fair Employment and Housing Act by redefining race as “inclusive of traits historically associated with race, including, but not limited to, hair texture and protective hairstyles”. It protects Black women who wear “protective hairstyles, including braids, locks, and twists” from facing discrimination in the hiring process or the workplace. Policies that protect the culture and expression of Black women in the workplace will only further encourage workplaces to see the value that Black women bring to the healthcare industry.
4.
Pass
Reparations for Black Californians
The California Reparations Task Force issued a Reparations Report earlier this year that quantified the various harms faced by all Black residents in California, including health harms. They found that Black Californians are owed “$13,619 per person for each year lived in California, or $966,921 total for someone living about 71 years the average life expectancy of Black residents in California in 2021” for the injustices and discriminations and injustices Black Californians have faced while seeking healthcare. This financial reparation would not only right the wrongs that government has done to Black Californians, but it would also provide Black households with the supplemental money to support their future healthcare needs and allow them to seek out higher quality food, resources, mental and physical health care.
Conclusion
Addressing these income disparities requires a multifaceted approach that includes enforcing policies that promote pay equity, coordinated efforts to diversify leadership roles within healthcare organizations, and targeted interventions to address the systemic barriers faced by Black female healthcare professionals in California and beyond. By fostering an inclusive and equitable work environment, the healthcare sector can better recognize and reward the valuable contributions of Black women to the healthcare industry and overall workforce.