Structural inequities within the American healthcare system continue to jeopardize lives and erode the quality of life for marginalized populations. These failures manifest as lower standards of medical care, higher mortality, and significantly shortened life expectancy. Data indicate that one in five adults in the “United States” has encountered discrimination in a medical setting, largely driven by racial or ethnic bias. This injustice is most visible in the longevity gap: as of 2019, life expectancy for non-Hispanic white individuals stood at 78.8 years, while non-Hispanic Black Americans averaged 74.8 years, and American Indian/Alaska Native (AI/AN) populations* averaged just 71.8 years, a stark seven-year deficiency that highlights the human cost of systemic neglect.

Even after the formal end of segregation, disparities persisted through more subtle but equally harmful mechanisms—implicit bias, unequal access to hospitals, and systemic underinvestment in Black communities. Studies have shown that Black patients are less likely to receive adequate pain management, more likely to have their symptoms dismissed, and often face delays in critical care.

12 years of study data indicate that Black patients are 10% less likely to be admitted to the hospital, and they are 1.26 times more likely to die in the Emergency Department (ED) compared to white patients. 

A recent PhillyCEAL study conducted in “Philadelphia, Pennsylvania,” provides a localized look at how these systemic issues manifest. Between February and April 2024, 327 Black Philadelphia residents participated in a cross-sectional study by completing online surveys regarding their experiences in medical settings. The research revealed that nearly two-thirds (64.5%) of the participants reported experiencing racial discrimination in healthcare. Statistical analysis showed a direct association between this discrimination and increased levels of loneliness, depression, and anxiety. Notably, loneliness was found to be a key mechanism in these mental health outcomes. When researchers controlled for loneliness, the link between healthcare discrimination and depression became non-significant, suggesting that depressive symptoms are largely driven by the social isolation and rejection felt during discriminatory medical encounters. However, the association with anxiety remained significant even after accounting for loneliness, indicating that anxiety may also stem from other structural and emotional consequences of such experiences. Furthermore, the study indicates that individuals with existing medical conditions reported significantly higher levels of loneliness following discriminatory experiences compared to those without.

A 2023 review in the Western Journal of Emergency Medicine highlights how structural racism and implicit bias continue to obstruct access, degrade quality, and worsen health outcomes for communities of color across the healthcare system. Recent data from Denver, Colorado, collected between 2021 and 2022 by Johns Hopkins University, reveals troubling experiences: nearly 30% of American Indian and Alaska Native respondents reported feeling uncomfortable during a healthcare visit because of their race. Of these, 51% say they are now less likely to seek medical care in the future because of experiences categorized as racial microaggressions or outright racism. 

The systemic neglect highlighted in Black communities mirrors a parallel, often invisible crisis within Tribal nations. For Native American women, the barriers to care are not only psychological but are deeply embedded in a landscape of geographic isolation, chronic underfunding, and environmental hazards.

Rachael Lorenzo, a queer Indigenous parent from the Laguna Pueblo and Mescalero Apache tribes and the Co-Founder of Indigenous Women Rising, emphasizes that these outcomes are a direct result of structural failures. Lorenzo, who also served as a political appointee at the New Mexico State Land Office (2019–2023), notes that the disparity is starkly evident in reproductive health. 

These figures are corroborated by clinical research published in Gynecologic Oncology analysing a decade of healthcare visits (2010–2020) across Indian Health Service (IHS) and Tribal clinics in the Pacific Northwest. It found that cervical cancer screening rates for Native American women range between 57.1% and 65.0%, significantly lower than the “U.S.” national average of 73.5%. The disparity was most pronounced in the 50–64 age group, where screening rates fell to 51.2%.

 The Infrastructure of Inequity

The Indian Health Service (IHS), which many Native people rely on, is described by Lorenzo as “the most underfunded health program in the federal government.” This financial neglect manifests in a lack of basic specialty care. In many IHS service units, such as the one in “Albuquerque, New Mexico,” there is “very limited access to different kinds of birth control” and often no obstetrician or OB-GYN on staff.

This infrastructure gap creates dangerous delays. “If someone is having a miscarriage or needing emergency pregnancy-related care, they’re going to have to travel a lot farther to get care,” Lorenzo says. This is compounded by geographic and economic barriers. Lorenzo recounts their own struggle to complete the HPV vaccine series: “It was really hard for me to continue to go back because I had to leave college to go back and forth to the reservation, and that wasn’t always possible. There’s that geographic barrier.”

The data reflects this struggle on a systemic level, noting that while HPV vaccination rates have reached 58.6% among AI/AN individuals, they remain well below the national public health goal of 84.3%, leaving a significant portion of the population vulnerable to preventable malignancies.

Socioeconomic and Environmental Assaults

The “biological harm” often attributed to Indigenous bodies is frequently a byproduct of their environment. Lorenzo argues against the concept of “biological susceptibility,” instead pointing to socioeconomic factors. On many reservations, basic nutrition is a luxury. “Buying fresh fruits and vegetables on the reservations is really expensive… trucks have to drive further to deliver that food,” Lorenzo notes. “It’s almost impossible to buy bananas; it’s like $8 for a few. Meat is also really expensive.”

These external pressures may have direct biological consequences, too. A 2024 pilot study published in Cancer Prevention Research examined women in northern “Arizona” and found a higher prevalence of high-risk HPV and vaginal dysbiosis—a depletion of protective Lactobacillus bacteria among Native American participants compared to non-Native women. The researchers identified that these biological risks are compounded by sociodemographic stressors and limited access to care, suggesting that the environment and social standing directly influence the body’s ability to defend against infection.

Environmental racism further compromises health. During their tenure at the State Land Office, Lorenzo witnessed the direct impact of industry on Tribal lands. They describe oil and gas companies “dumping produced water wherever they wanted… contaminating aquifers” and flaring that makes breathing a painful experience. “Breathing just stings your throat,” they recount, noting that the chemicals used in fracking remain “proprietary information,” leaving communities in the dark about what they are consuming.

Policy and the “Climate of Disregard”

The failure of the system often feels deliberate to those on the ground. Lorenzo points to a lack of political alignment between Tribal nations and the federal government as a barrier to emergency aid. They cite the 2020 response to the COVID-19 pandemic as a low point: “We saw the Trump administration send body bags instead of PPE to the Navajo Nation… like, body bags for dead people instead of masks and suits and gloves”.

The internal policy of Tribal nations also plays a role, as many are led by men who may not prioritize sexual or reproductive health. “The sad part is that a lot of tribes are led by men, and there isn’t a lot of focus on sexual health, reproductive health, or HPV,” Lorenzo observes. This lack of cultural alignment and the persistent “historical distrust of doctors” create an environment where even simple diagnostic tools like pap smears can be viewed with apprehension.

For many Indigenous women, navigating this system is an act of survival against a backdrop of “racist notions” that continue to separate them from their autonomy and their health. Whether it is the lack of a screening kit at an IHS clinic or the high cost of a healthy meal, the results are the same: a systemic failure that translates directly into lost lives and broken bodies. 

*“American Indian/Alaska Native (AI/AN)” is a demographic classification used in cited studies and may not reflect how Indigenous communities self-identify.