By Keisha Ray, PhD
I have been interviewed by many journalists who are writing articles about the COVID-19 vaccines and Black people. Most of the interviews are very similar; journalists want to know how do medicine’s and public health’s past abuses of Black, Latinx, and Indigenous people affect their willingness to trust medicine and get vaccinated against COVID-19. After making it clear that it is not people of color (POC) that need to work on their trust of medicine but that it is medicine who needs to work on its ability to be trusted, I tell journalists that medicine must do three things: 1) Acknowledge the problem, namely that medicine is not trustworthy in the eyes of many POC; 2) Apologize for past and current abuses of POCs bodies and minds and apologize for medicine’s role in structural racial inequality; and 3) Correct the way it treats POC, including remedying provider bias and racially biased diagnostic and therapeutic tools.
Acknowledge
When I interview with journalists they frequently refer to the Tuskegee Syphilis Experiments on Black men as a reason why Black people don’t trust medicine. Although Tuskegee has had a lingering effect in medicine given that it didn’t end that long ago and President Clinton didn’t issue a formal apology to the victims until 1997, what I take to be the larger problem is that almost every Black person has a story or being mistreated by a medical professional. Stories tend to either be about themselves, or someone that they know like a friend of family member. These stories transcend geographical location, class, education, or profession. I have my own stories of racial profiling, racial insensitivity, and bias and I know the stories of my Black family members and friends who have shared with me their similar experiences. People of color may not currently be experiencing abuses at the level of Tuskegee, but their experiences with medical racism can have severe and sometimes deadly consequences for themselves and their family. Therefore, acknowledging that medicine continues to have racism problem is imperative for medicine to repair its relationship with people of color. The issue of medical racism cannot be seen as an issue of decades past; medical racism is a contemporary problem that has contemporary effects. We are seeing this now in some people of color’s rightful distrust of medicine.
Apologize
In 2020, the Ann & Robert H. Lurie Children’s Hospital of Chicago became the first American hospital to apologize for performing medically unnecessary surgeries on intersex children. In doing so, this Chicago hospital took the first step in righting the wrongs committed against intersex children. This Chicago hospital set an example of what it means to participate in wrongs, apologize for the wrongs, and create a new, more just path for properly caring for patients made vulnerable by their circumstances and the value medicine places on their bodies.
People of color are still waiting on their unified, sincere apology for medicine’s and public health’s abuse of power that led to the mistreatment of POC, and ultimately their generally poorer health outcomes. Apologies, when they are not empty, can be powerful and transformative. Apologies display an acknowledgment of wrongdoing. This is why an acknowledgement of the problem is useless without an apology to accompany it. Apologies show that institutions recognize their past and current role in structural problems like poor health outcomes and poor health care experiences by POC.
Additionally, given that health care is a social determinant of health, medicine must apologize for its disparate withholding of health and wellbeing from POC. Health can give and poor health can take so much from individuals. So when the gatekeeps of medicine are racist, medicine contributes to structural racial inequities such as income, housing, and education inequities. Apologies will not solve poor health outcomes for POC. Apologies will not right the wrongs committed against POC. Apologies, however, are a step in the long and complex process of bettering health outcomes and access to medicine for POC.
Correct
What makes Ann & Robert H. Lurie Children’s Hospital of Chicago’s apology noteworthy is that it wasn’t a Twitter apology. It wasn’t an apology half-heartedly written using the Notes app on a cell phone and given to the public without mention of how it will correct the problem. Its apology came with a plan for what it will do differently in the future, including policy changes and changes to the whom is the subject of intersex surgeries. Acknowledging a problem and apologizing for involvement and perpetuating the problem mean nothing if institutions don’t commit and perform real change. What are individual medical institutions going to do to rectify medical racism and the treatment of POC? What nationwide policies are the American Medical Association going to recommend and require to enact real change? We have to implement racially just policies, reparative policies, training and education requirements for providers, medical education reformation, and holding individuals accountable for their racism and the effects of their racism.
Correcting the problem is the most important part to repairing medicine’s relationship with people of color. Although it is imperative to acknowledge the problem and apologize, correcting the problem makes the former two meaningful. POC want to see real change in how they are treated by medicine and its stewards.
I have by no means given an exhaustive list of the specific practices medicine must take to repair its relationship with POC, nor have I given exact details to who in medicine would be responsible for these changes. Instead, here is a bare-bones, basic method for how we might get started and build on some, yet insufficient, successes we have already gained in helping medicine be viewed as a trustworthy institution.