Here’s a Terrifying Example of How Systemic Racism Works

Even without bigoted intent, merely making decisions based on white norms can be deadly

Tim Wise
4 min readAug 1, 2022


Image: Troyan, Shutterstock, standard license, purchased by author

The picture above is of a pulse oximeter.

You may know that. If you have asthma, COPD, or other lung function issues or have spent any time in a hospital, there’s a good chance you’ve used one at some point.

And during the COVID pandemic, suffice to say that this little device was a life-saver for many: alerting them to dangerously low oxygen levels, necessitating a trip to the hospital for supplemental oxygen when they might otherwise not have realized they were that bad off.

Last week, the Washington Post ran a fascinating piece about the development of the oximeter. Therein, they traced its history from a clunky, expensive device for Air Force fighter pilots to what we have now — units so small that millions of people have one in their bedside drawer or medicine cabinet.

The problem, however, is that pulse oximeters aren’t as accurate for people with darker skin.

Specifically, persons of color are more likely to exhibit “occult hypoxemia.” In these cases, an oximeter will indicate that a user has normal oxygenation even though their actual level is dangerously low.

In one study conducted in Veteran’s Administration Hospitals, Black patients exhibited occult hypoxemia 25 percent more often than whites.

According to a second study, Black patients with low oxygenation levels were about 30 percent less likely than whites to be deemed eligible for supplemental oxygen. Latinos were nearly one-fourth less likely to be deemed in need of intervention.

And Black patients in two other studies were nearly three times as likely as whites to experience low oxygenation undetected by pulse oximetry.

Flawed readings can then directly contribute to less concrete medical intervention on behalf of patients.

Indeed, one study found that inaccurate oxygen readings for Black, Latino and Asian patients caused these patients to receive less supplemental oxygen than whites, despite needing it.



Tim Wise

Anti-racism educator and author of 9 books, including White Like Me and, most recently, Dispatches from the Race War (City Lights, December 2020)