Black Women's Health Care Project: Health and resilience among the black middle class

Background: Evidence of racial/ethnic disparities is remarkably consistent across a range of health conditions. Differences persist after controlling for socioeconomic status. This study explores how middle-class black women perceive health care providers and whether they use positive self-presentation strategies to avoid differential treatment based on race and gender. Method: The study uses in-depth interviews to explore the experiences of 20 black middle-class women between 35 and 65. Results: Respondents overwhelmingly endorsed the importance of positive self-presentation to mitigate differential treatment. They noted that they must demonstrate specific knowledge of their health, which was burdensome and distracting. In keeping with the literature on race concordance, respondents did not necessarily prefer a black provider. Rather, a trusting relationship with a competent provider was more important. They reported that they did not interpret their experiences in health care settings to be overtly discriminatory. However, all respondents agreed that discrimination against blacks continues to be pervasive, in health care settings and in general.

Conclusion: The study provides important information about an understudied group. Although black middle-class women have resources, they are not immune to bias. They have their own strategies for mitigating bias by emphasizing certain resources, i.e., specific knowledge of health care issues, demonstrating intelligence, etc. Although the women did not report overt instances of discrimination, they felt black women were subtly discriminated against in ways that often go unnoticed. Finally, because black middle-class women have many social identities, interventions based solely on increasing race-concordance are unlikely to completely reduce health disparities.