How a past of institutional deception and mistruths has resulted in a shared distrust of healthcare in Black communities.
On the 8th of April, Dr. Rochelle Walensky, the director of the CDC, declared racism a “serious public health threat”.
Referencing the unequal number of COVID-19 deaths in the Black community as opposed to others, the director of the CDC attributed the adverse health outcomes to structural racism. Needless to say, we know that the pandemic did not produce these disproportionate rates of disease and early death; it simply flashed a spotlight on the issue.
For years, American racial discrimination has erected a myriad of barriers that govern where minorities aggregate, live, and work.
Housing discrimination has kept Black families out of more preferable neighborhoods and districts, which has directly impacted the group’s health outcomes. The National Housing Act of 1934 and the simultaneous establishment of the Federal Housing Administration implemented “redlining” — the discriminatory practice of avoiding investment in communities with unfavorable or high-risk demographics, typically those with greater minority populations. This practice deemed Black neighborhoods “dangerous” by outlining them in red on city diagrams; redlining has kept housing segregation in place all these years, restricting the African American’s opportunity to accrue and pass down generational wealth.
Though redlining is illegal today, several of these same neighborhoods continue to grapple with impoverishment. Many historically redlined communities remain disadvantaged and lack the features of wealthier regions, such as healthier food options and walkable parks or trails. The concentration of poverty in the redlined districts discourage grocery markets from moving into these spaces, producing food deserts that leave many families with extremely limited access to nutritious food options.
Quality health care that is also culturally sensitive remains obscure in predominantly Black areas — medical provider awareness of racial biases in the healthcare system is absent. For example, these disenfranchised neighborhoods have higher infant mortality rates and about 40 percent of babies born in these areas are born prematurely. Without knowledge of these disparities, healthcare professionals can lack compassion and empathy for an individual patient’s experiences, potentially missing vital signs and symptoms of an impending health condition.
The Deceit of the Tuskegee Study
In 1932, the U.S. Public Health Service and the Centers for Disease Control and Prevention began the “Tuskegee Study of Untreated Syphilis in the Negro Male.” Poverty-stricken Black participants from rural Alabama were enticed to sign up for the study with the promise of free meals, health examinations, and burial benefits. In 1947, physicians pronounced penicillin to the suitable treatment for syphilis; knowing this, researchers decided to withhold the medication from 399 men with the condition and instead continued to monitor the progression of the untreated illness.
Trust in health professionals is the foundation of good quality healthcare; the loss of that trust is the direct consequence of systemic racism. “Many African Americans are reluctant to fully engage with the healthcare system because of both personal and collective experiences,” said Tolu Oyelowo, D.C., Ph.D., professor and chair at Northwestern Health Sciences University. “The emergency room is often the first or the only place they go for help because they tend to avoid the system until an acute problem arises.” As a result, the African American population has an increased risk of chronic ailment.
“I would like to say that mistreatment of Black patients ended with the Tuskegee study,” Oyelowo said. “Unfortunately, research tells us that is not the case. Implicit racial bias has a significant impact on provider empathy, and in turn, how BIPOC patients are treated.” Oyelowo also mentioned a 2016 study that found that half of the medical students polled believed Black people did not feel pain to the same degree as their White counterparts. The repercussions of this type of assumption are extremely dangerous.
The Never-Healing Laceration of Internalized Racism
From history books to a plethora of media coverage, instances of outright racism and the injury it produces are plentiful. Alas, a more obscure type of racism is also prevalent — internalized racial discrimination can be very damaging to individuals and communities.
“We are all subject to the same images. If we aren’t careful, we will associate them with negative emotions about ourselves,” Oyelowo explained. “We are constantly seeing media stereotypes that feed the narrative of the angry Black woman or the Black man with his fist in the air. Where are the images of Black men being kind and loving fathers or Black women relaxing and laughing with friends?” The stress of trying to not portray a negative stereotype can be very daunting; add this to the underlying stress of battling against microaggressions routinely, and health outcomes can become compromised.
Video on healthcare provider discussion on matter: Structural Racism in Medicine and Healthcare
In the 1939 “Doll Test”, Black children exclusively chose White dolls over Black dolls when asked which doll was expected to be “pretty and nice”. What is even more disturbing is that two-thirds of the Black children chose the Black doll when asked which doll was “bad”. The study ultimately revealed that the negative imagery of Black people, along with the effects of segregation, had greatly impacted the self-perception and self-confidence of many Black youth, some as young as 7 years of age.
The Healing Process
Research shows that empathetic, relationship-based care positively affects health discrepancies. In the past five years, the Roots Community Birthing Center — a culturally-centered care center determined to improve value and equity in childbirth based in Minneapolis –has helped lower infant mortality and the number of premature births in its Black communities. In its short time of operation, 300 babies have been delivered, none of which were preterm.
Though there is a more recent increase in racial and ethnic diversity among health professionals, more has to be done training-wise to address health disparities and to increase access to consolidative care for marginalized communities. By partnering with these communities and instilling diversity and trauma-advised coursework into university curricula, future health care providers can take the first steps toward a more impartial healthcare system.