Welcome back to Equity Matters! In this monthly column, I hope to explore a range of topics related to health equity, public health, global health, and social justice.
This article lists and describes a few key books, articles, and other resources that anyone can use to understand the past and present role of racism in US healthcare. This is by no means an exhaustive list, but instead can serve as a starting point for people looking to know more.
The Origins and Impacts of Scientific Racism
If you want to understand the current disparities and injustices that exist in our healthcare system, you have to be willing to explore our nation’s difficult history. Since colonial times, pseudo-science and medical malpractice were needed to justify the system of chattel slavery that supported the US economy. The book Medical Apartheid by Harriet Washington provides a longitudinal overview of “The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.” The journal article “Social Darwinism, Scientific Racism and the Metaphysics of Race” also provides a deep dive into the ways that medicine and science were used to justify some of our country’s worst travesties.
Finally, the University of Pennsylvania hosted a landmark conference entitled “Ordering the Human: Global Science & Racial Reason” where an international team of experts discuss the global role and impact of racialized medicine. Thankfully, they have posted videos of the informative conversations from this event. For a shorter primer, check out keynote speaker Dr. Dorothy Roberts’ TED Talk entitled “The Problem With Race-Based Medicine”
An Infamous Example: The Tuskegee Study
No discussion of racism in healthcare would be complete without mentioning the “Tuskegee Study of Untreated Syphilis in the Negro Male.” For 40 years from 1932-1972, our US Public Health Service enrolled hundreds of Black men into a study. Half of the participants had syphilis, but they were told that they had “bad blood” and were not given adequate treatment. Syphilis is a debilitating disease as it progresses but can be effectively addressed with antibiotics. This study by the US Public Health Service has gone down in history as one of the greatest injustices in health care research. Since the study, strict ethical requirements for research have been adopted nationwide. The CDC maintains a timeline and overview of the study, its exposure, and the aftermath here. This infamous study has also inspired a movie and several books.
Racial health disparities do not exist in a vacuum. In fact, those disparities often intersect with discrimination related to other factors such as neighborhood, gender, and/or sexuality. The following resources introduce the importance of intersectionality and holistic thought when addressing these issues.
This fascinating article by Dr. David R Williams and Dr. Chiquita Collins takes a deep dive into the ways residential segregation maintains disparities in education and economic opportunity. They explain the origins of our highly segregated communities and explain, in detail, how this determines health outcomes for so many Americans. Dr. Williams also delivered one of my favorite TED Talks in 2016 at the TEDMED conference that goes over similar ideas.
Earlier this year, Serena Williams shared her harrowing experience during and after the birth of her first child. Despite her fame, physical health, and social status, it seems that Serena still fell victim to the fact that Black women face worse outcomes in pregnancy and childbirth. Nonprofit journalists at ProPublica and NPR published a series on this topic. They weave in the story of a young woman who lost her life during childbirth to illustrate the shocking disparities that currently exist. I would also highly recommend the most recent episode of Yale University’s “Flip The Script” podcast entitled “Poor, Black and Pregnant” where the host interviews Dr. Khiara Bridges, a lawyer and anthropologist who is a reproductive rights expert. I’d say anyone interested in health disparities more broadly should subscribe to the “Flip The Script” podcast which explores these topics on a regular basis and in an accessible format.
The literature has long established that LGBT Americans also face poorer health outcomes than those who identify as heterosexual. What has not been explored thoroughly, however, is how those disparities and the racial disparities we have discussed coalesce in the lives of LGBT people of color. The Center of American Progress published an aarticle entitled “How LGBT Health Disparities Intersect With Other Health Disparity Groups” that serves as a great introduction to that topic.
As I mentioned before, these resources are meant to serve as a starting point for anyone interested in health disparities, whether you are a student or a current professional. I selected pieces that I found particularly interesting and informative. If anyone reading this has any additional resources that they think should be on this list, please share them in the comments!