If you have been paying attention to the news, you will be aware that the United States’
healthcare system is letting down many Black Americans.
This is not new.
Today we’re going to discuss historic reasons for distrust of the medical establishment
in the Black community.
Next we’ll tackle why these huge healthcare disparities exist.
And finally we’ll address why these disparities continue to impact the Black community to
this day.
So, this is a lot to cover in ten minutes.
As always, I encourage you to refer to the Works Cited for further reading after you’re
done watching.
So what happens when you get sick?
You call up the doctor and make an appointment, right?
Well, you need enough trust in the medical establishment to feel comfortable going to
the doctor in the first place.
Sadly, there are famous precedents that have caused some members of the Black community
to distrust the American medical establishment.
That leads us to the Tuskegee syphilis experiments and the research done at Johns Hopkins on
Henrietta Lacks’ cancer cells.
The “Tuskegee Study of Untreated Syphilis in the Negro” started in 1932, when there
was no treatment for syphilis.
Doctors from the U.S. Public Health Service enrolled 600 Black men from Alabama in their
study.
Most of these men were sharecroppers, lured by the promise of free health care.
399 had latent syphilis.
201 formed the “control” group.
Even after penicillin began to be used to treat syphilis in 1947, these health workers
only provided their subjects with aspirin, supplements and placebos.
They did not want to cure anyone.
Their goal was to track the full progression of the disease.
Over time, the men with syphilis became blind, went insane, spread the disease to partners,
and passed it onto their kids.
In the 1960s, a Public Health Service investigator named Peter Buxtun filed a protest questioning
the ethics of the study.
Despite this, the Public Health Service decided to carry on.
Buxtun leaked the story to the press and, in 1972, due to public pressure, the agency
finally ended it.
A year later, Congress gave a $10 million out-of-court settlement to survivors and heirs
of those who had died.
It also established new guidelines that protected human subjects in government-funded research
projects.
The public disclosure of the Tuskegee study led to an increase in mistrust of the Public
Health Service and, more broadly, the American medical community.
In 2016, Marcella Alsan, of the Stanford Medical School, and Marianne Wanamaker, of the University
of Tennessee, tried to quantify how the experiment actually influenced health outcomes in the
Black community.
The researchers argue that the disclosure of the study led to fewer outpatient and inpatient
physician interactions for older Black men.
Their estimates suggest that, “life expectancy at age 45 for black men fell by up to 1.5
years in response to the disclosure.”
As the Atlantic magazine reporter, Vann R. Newkirk II, maintains, “the Tuskegee Study
was not a singular event that was reported and processed immediately, but a generational
scarring that defined a decade of black history.”
Another “generational scarring” took place with the disclosure of how Henrietta Lacks,
a Black woman with cervical cancer, was treated at Johns Hopkins University.
Lacks died in 1951, at the age of 31, leaving behind a husband and five children.
Her tumor cells (named HeLa cells) were used by researchers without the knowledge or consent
of Lacks or her family.
Although the medicines developed from this research made millions for private companies,
Lacks’ family received no financial benefit.
These cases, which show examples of systemic abuse within the Black community by the medical
establishment aren’t as unusual for that time period as we may at first assume.
During the century following the Civil War, “Jim Crow” laws made racial segregation
legal.
These laws denied African Americans the right to vote, made it difficult for them to obtain
certain kinds of employment, and created obstacles to benefits from certain educational opportunities.
(For more on the history of the Jim Crow laws, check out our episode, “The Racist Origins
of U.S. Law,” right here on our channel.)
During the Jim Crow era, White doctors could refuse to treat Black people and, in some
states, White nurses were legally forbidden to take care of Black men.
At the end of the 19th century, Black Americans who wanted to become doctors usually attended
a handful of Black medical colleges, including Howard University College of Medicine (founded
in 1868) and Meharry Medical College (founded in 1876).
Although other options would become available at the start of the 20th century, it wasn’t
until the mid-20th century that higher education was forced to desegregate.
In 1946, the Hill-Burton Act financed the construction of more hospitals throughout
the country.
This sounds great, except the Hill-Burton Act still followed the principle of “separate
but equal” when it came to medical services.
In Alabama, for example, Hill-Burton funds supported the construction of segregated hospitals
in 65 out of 67 counties.
In 1964, President Johnson signed the Civil Rights Act, which outlawed discrimination
based on race, color, religion, sex, and national origin.
(Later this act would expand to include discrimination based on sexual orientation.)
However, it wasn’t until 1966, when the Medicare program was established, that distribution
of federal funds for low income patients was tied to whether an institution actually complied
with non-discrimination and non-segregation clauses in the Civil Rights Act.
The public policies and institutional practices that kept educational and medical segregation
in place for so long laid the groundwork for the structural racism that carries on to this
day.
American housing policy provides an excellent example of how structural racism can influence
health outcomes.
Before the passage of the 1968 Fair Housing Act, it was legal in the U.S. to discriminate
in the sale, rental, and financing of housing.
This meant that people could legally be forbidden from living in certain communities.
Since health is influenced by the quality of one’s living environment, this put many
Americans of color at a disadvantage.
Even after the Fair Housing Act was passed, a kind of de facto segregation still existed
in many parts of America.
Some people stayed in their segregated communities.
Others relocated to urban centers.
From 1950 to 1980, for example, the total Black population in America’s urban centers
increased from 6.1 million to 15.3 million.
At the same time, many White Americans left urban areas to live in suburbs.
In her recent article Michelle Gourdine explains that living in urban neighborhoods can, quote,
“directly affect the health of African Americans.”
As she writes, in some neighborhoods, children might be exposed to lead paint, have limited
to no access to recreation centers or parks, and be taught in overcrowded classrooms.
These environmental factors can influence physical and mental health.
So far, I have discussed some of the reasons that there are disparities in health outcomes.
But how are these disparities tracked today?
One way is via pregnancy and childbirth statistics.
In September 2019, researchers from the Centers for Disease Control found that, “Black,
American Indian, and Alaska Native women are two to three times more likely to die from
pregnancy-related causes than White women.”
More specific to the African American community, the pregnancy-related mortality ratio for
Black women who had earned at least a college degree was, “5.2 times that of their White
counterparts.”
Here is another terrible statistic: According to the US Dept. of Health and Human Services,
African American infants are 2.3 times as likely to die as those born to non-Hispanic
White mothers.
This trend is consistent, despite the mothers’ educational level and socioeconomic status,
according to Cristina Novoa and Jamila Taylor.
Here, they argue that this disparity is not simply due to African American women’s higher
maternal health risk factors.
It is also caused by how institutional racism and sexism, “compromise women’s health
across time.”
But what about now, in the modern era?
Why are the statistics still so dire?
For the answer to this, we need to consider the concept of “implicit bias.”
In her 2019 book, Stanford psychology professor, Jennifer Eberhardt writes: “Implicit bias
is a kind of distorting lens that’s a product of both the architecture of our brain and
the disparities in our society.
We all have ideas about race, even the most open-minded among us.
Those ideas have the power to bias our perception, our attention, our memory, and our actions
— all despite our conscious awareness or deliberate intentions.”
To understand how implicit bias plays out in healthcare, consider the prescription of
pain medication, which is essential for healing after surgery.
Black Americans are prescribed less pain medication than their White counterparts.
A 2013 article in the American Medical Association's Journal of Ethics suggests that this results
from a large gap between “the evaluation and treatment of pain in White people and
its evaluation and treatment in African American and Hispanic people.”
Implicit bias also affects how providers diagnose and treat psychological pain.
In a recent story on NPR’s “Morning Edition,” reporter Yuki Noguchi showed that many Black
patients only receive mental health treatment in spaces that she refers to as “places
of last resort,” including jails, schools, and emergency rooms.
Noguchi reports that, “studies show that African Americans tend to be given psychiatric
diagnoses that are incorrect or especially severe or less treatable — such as schizophrenia
instead of depression or bipolar disorder --and that can lead to inappropriate treatment.”
Noguchi quotes Doctor Altha Stewart (the first Black president of the American Psychiatric
Association) as pointing out that there is a scarcity of Black mental health professionals
working in the U.S.
She cites another medical professional, Doctor Ruth Shim, as explaining that errors in diagnosis
are “often” being made by “non-Black doctors who misread emotional cues like anger.”
Having access to mental health providers is even more urgent as our society responds to
image after image of physical and emotional violence perpetrated against people of color.
In the Works Cited, we have included a link to a website called “Black Mental Health
Matters” that links to therapists, hotlines and other organizations specifically aiming
to help Black Americans.
Access to a support network is especially important during the COVID-19 crisis.
Black Americans are becoming infected at a much higher rate than White Americans.
One report issued by the CDC in April found that a third of patients hospitalized with
COVID-19 were Black, despite the fact that this group comprised only 18% of the community
being evaluated.
When presenting this statistic, the president of the American Medical Association, Patrice
A. Harris, explained that three factors put the Black community at a greater risk.
These factors (and I am paraphrasing a bit) include: 1, Higher rates of certain preexisting
conditions in the group, including diabetes, hypertension and obesity; 2, The fact that
people of color form a disproportionate proportion of the essential work-force outside the health
professions; and 3, The existence of implicit bias and racial discrimination in our society
that continue to produce structural inequities and social determinants that can lead to negative
health outcomes.
This trend continues.
In June of 2020, NPR reported on a study issued by the Centers for Medicare and Medicaid Services,
which reveals that “Black Americans enrolled in Medicare were hospitalized with the disease
at rates nearly four times higher than their white counterparts.”
The physical and emotional strain that this higher infection rate puts on Black communities
is overwhelming.
As a global pandemic and assaults on people of color dominate the headlines, it is painfully
clear that these failures are not a thing of the past.
We need to understand the history of health disparities in America; to chronicle our experiences
with them in the present; to address our implicit biases; and to speak up against injustice
if we are to successfully advocate for change.