Image 1. Two ambulances follow a police officer riding a motorcycle. Image courtesy of Flickr.
From diagnosis to treatment, racial and ethnic disparities in medicine remain glaring. The disproportionately high rates of infant mortalities by race are a testament to this reality. To address such racial and ethnic disparities, experts have called for a broader and more impactful focus on diversity, equity, and inclusion (DEI) within the institution of medicine.
Conversations about the interactions between social institutions and healthcare, specifically regarding the structural racism that continues to impact the field, have led to a significant amount of research on the associations between race and social practice as it impacts population health and well-being. A Yale research team has recently published a particularly striking discovery: minority patients experiencing mental health crises brought to the hospital via police transport are more likely to experience use of physical restraints during their treatment at the emergency department, indicating that disparities may start before they have even arrived at the hospital.
“One thing that this paper really showed is that interactions with police and the justice system really have an impact on what happens in healthcare, in the emergency department,” said Ambrose Wong, an emergency physician and lead researcher of the study. “And even when we control for other factors that might confound that, we found that whether the person is arriving with police transport or not has a big impact on these decisions to restrain [the patient].”
The paper details the team’s finding that the ratio of patients restrained in the presence versus absence of police is approximately five-and-a-half to one, after adjustment for confounding variables such as age and sex. For minorities, this statistic is only made worse. The researchers found that, compared to white patients and other minorities, the ratio of African American patients restrained following police intervention was 1.38—a thirty-eight percent greater likelihood. Approximately eleven percent of this increased risk of experiencing excessive use of restraint during transit to and at the hospital can be directly tied to the involvement of law enforcement. The researchers discovered this by conducting a cross-sectional analysis of emergency department health record data from northeastern and southeastern states.
“Restraints are things that come with side effects and complications. For one, when you are talking about tying someone down, it is taking somebody’s autonomy away,” Wong said.
To provide possible explanations for their results, the Yale researchers placed their findings within a larger social context. The researchers proposed that racial and ethnic disparities in physical restraint mediated by the police are fostered by a synthesis of social and institutional factors that criminalize, discriminate against, and cause distress among minority communities experiencing mental illness. Such factors are apparent in the carceral treatment and dehumanization of minority patients during and following police intervention, the strained relationship between minority communities and law enforcement, and social determinants of health, which prevent minorities from accessing vital healthcare resources like outpatient psychiatric treatment.
These institutional factors are cornerstones that contribute to racial and ethnic disparities in physical restraint use observed in the emergency department. Therefore, by turning our attention to and targeting these structural factors, we can make strides toward reducing the disproportionate use of restraint on minorities in need of medical care.
“We need to find long-lasting solutions to try to make the problem [of excessive restraint] easier to treat and decrease the frequency of these events happening,” Wong said. “How do we prevent individuals from even getting agitated to begin with? Could they have potentially been treated in the outpatient setting? Maybe they need to go to an alternative location dedicated to mental health treatment in a more compassionate and patient-centered setting.”
In conjunction with these efforts to target “upstream” structural factors, it is vital that the associations between structural components of our society and health disparities continue to be studied. Through such research and the open dialogue it nurtures, our society can better understand and mitigate the racial and ethnic disparities in medicine, and improve minorities’ hospital experiences and quality of care.
“The general thought [about DEI] in healthcare is that if we’re trying to deliver as much good as possible to as many people in our community as we can, we have to think fundamentally about health inequities,” Wong said. “Otherwise, you can’t take care of the folks that have the worst health outcomes.”
[Citations]
Jang, C. J., & Lee, H. C. (2022). A Review of Racial Disparities in Infant Mortality in the US. Children (Basel, Switzerland), 9(2), 257. https://doi.org/10.3390/children9020257
Chang-Sing, E., Smith, C. M., Gagliardi, J. P., Cramer, L. D., Robinson, L., Shah, D., Brinker, M., Jivalagian, P., Hu, Y., Turner, N. A., & Wong, A. H. (2024). Racial and Ethnic Disparities in Patient Restraint in Emergency Departments by Police Transport Status. JAMA Network Open, 7(2), e240098. https://doi.org/10.1001/jamanetworkopen.2024.0098