From Tuskegee to Today: The Fraught History of Black Americans with the Medical Field, and the Contemporary Issues Faced Under the Coronavirus
By Isha Abbasi
Associate Editor, Vol. 26
Ding. The familiar, and now haunting, sound of a CNN news notification pierced my expecting ears. I was used to getting one a day now. Sometimes a mundane story about who won The Voice, most times a horrific statistic about the rapid spread and death toll of the COVID-19 virus. However, on November 18th, 2020, I was greeted with what I would hyperbolically refer to as the only good news I had heard in a year: “Pfizer announces coronavirus vaccine is 95% effective with no safety concerns.” I was ecstatic and ready to roll the end credits to what had felt like a 9-month long bad horror movie. My optimism quickly dissipated once I opened Twitter to the reality that many may not desire to be vaccinated at all.
I felt hopeless at the notion that “herd immunity” may very well be a pipe dream. My resentment was quickly quelled by an even more sobering realization; many had every right to their qualms. Among Americans asked whether they would be open to being vaccinated, Black Americans came in as the most hesitant. Only 42% of Black Americans said they would be open to doing so, compared with 63% of Hispanics and 61% of White adults.[1] This statistic is especially jarring when considering the disparate impact the Coronavirus has had on Black Americans.[2]
This essay explores the historical context for this hesitancy and focuses on the ongoing crisis of medical racism that has led to Black communities’ vulnerability today.
Tuskegee. The word that crosses most people’s minds when discussing the atrocities that have been carried out against Black people in the name of medicinal research. The 40-year study involved hundreds of poor Black sharecroppers from Alabama who worked for White farmers under a debt peonage system.[3] These men were intentionally withheld treatment for syphilis and were allowed to die without treatment and then studied in the name of medical research.[4]
Tuskegee is far from the only historical example of medical racism and systematic disregard for Black lives in medicine. Tracing back to slavery, Black women were experimented on medically against their will.[5] In the 19th and 20th centuries, Black people’s bodies were used in medical schools as a tool for education for white students.[6] African American women were “targeted for involuntary, coercive, and compulsory sterilization under eugenics laws.”[7] Black women had experimental procedures performed on them without anesthesia by the “Father of Modern Gynecology,” James Marion Sims.[8]
The story of Henrietta Lacks also serves as an essential example of the exploitation of Black people for medical research. Samples of Henrietta Lacks’ cells were taken while she was hospitalized for cancer and used in “research, reproduced, and disseminated without her knowledge or consent.”[9] The history of Black Americans and medicine has been fraught with the dehumanization and abuse of Black bodies in the name of medical research. A history that stripped Black people of meaningful consent to their bodies has understandably led many to be protective over their bodily autonomy.
This history is imperative to keep in mind, but the past atrocities should not dominate the conversation. Instead, historical mistreatment should serve as an important context for the atrocities carried out against Black people today and further explain why many don’t trust the medical field. Karen Lincoln, a social work professor at the University of Southern California, touches upon the dangers of framing medical racism in this “historical” manner: “People in the community are more interested in talking about contemporary racism and barriers to health care, she says, while it seems to be mainly academics and officials who are preoccupied with the history of Tuskegee.”[10]
Focusing on Tuskegee allows us to only consider the atrocities of the past without giving meaningful consideration to the structural barriers and stereotypes that make access to healthcare difficult today. For example, today, Black Americans are systematically undertreated for pain relative to white Americans.[11] Historical segregation of the medical field has exacerbated this problem. In 2019-2020, only 2.9% of medical school enrollees were Black males only 2.9% of medical school enrollees were Black men; 3.3% were Black women.[12] This scarcity of Black medical professionals leaves important perspectives out of the medical discourse. A study shows “half of a sample of white medical students and residents endorsed false beliefs of the biological differences and pain tolerances of black patients vs. white ones.”[13] “There is evidence that medical students believe that the black body is biologically different, and in many cases, stronger than the white body.”[14] This leads to disproportionate outcomes for treatment and it also results in under-medication for Black patients, who are thought to be “stronger” with “higher pain tolerances,” a stereotype rooted in the dehumanizing practices of slavery. Medical schools currently have curriculum gaps that fail to consider Black patients at all. For example, medical curriculums focus on how symptoms present on white skin as opposed to black.[15]
Black women sit at the nexus of the medical field’s history of racism and misogyny. Historically, women have been mistreated and oppressed by the medical profession and often labeled as experiencing “hysteria” when reporting their medical problems.[16] When you pair this with the specific misogynoir directed at Black women, it results in shocking outcomes for Black women in healthcare. Present-day stereotypes of African American women as “hypersexual,” “aggressive,” and “angry” have their origin in historical representations of this demographic during slavery.[17] These stereotypes can seep into medical treatment for reproductive issues, among others. Today, Black women are two to three times as likely as white women to die due to pregnancy-related causes.[18] Black women in higher economic brackets are still more likely than white women to die from pregnancy and childbirth-related problems.[19] Even tennis champion Serena Williams has spoken out about her near-death experience when birthing her first child.[20] The disparities for Black pregnant women are consistent even when accounting for obesity, poverty, and educational attainment.[21] Black women consistently report that they are dismissed in medical settings and not trusted when conveying concerns about their health.[22]
These facts make it less than surprising that Black individuals may be resistant to a novel vaccine. Even though a mistrust of the medical community makes sense, Kimlin Tam Ashing, Ph.D., director of the Center of Community Alliance for Research and Education at the cancer center City of Hope in Los Angeles County, takes issue with the use of the word “mistrust.” “It puts it on the community when in fact the community has been let down by the medical system and by providers who continue to discriminate.”[23] Ashing makes a compelling point about who the onus to fix the lack of trust should and should not be on.
When discussing the COVID-19 pandemic, it is essential to examine the disproportionate outcomes for Black people. Eleven percent of African Americans say they were close with someone who has died from COVID-19, compared with 5% of Americans overall and 4% of white Americans.[24] Black, Hispanic, and Native Americans are dying from COVID nearly three times the rate of white Americans.[25] Structural racism, generational trauma, and scant access to testing and healthcare are the main reasons put forth for this disparity.[26] As crucial as vaccination may be, it is essential to grapple with the medical trauma that the Black community has dealt with from Tuskegee through today and deal with the structural barriers to proper healthcare and testing.
Rebuilding trust with Black communities during this time is imperative to resolve the issue. Increasing vaccine accessibility in Black communities and investing in educational campaigns to dispel misinformation are some ways to lead to better outcomes. Desegregating the medical field will help build more trust between Black patients and their medical providers. Black doctors in medical school classrooms are pivotal to dispelling misinformation rooted in salient stereotypes in the medical community. Valuing Black people’s medical well-being means having more Black people in the rooms where these conversations happen.
History shows us the racist roots of a system that devalues, misunderstands, and harms Black people. That said, academics and politicians must resist the temptation to fixate on historical causes of medical mistrust when modern-day reasons still exist and permeate the medical community. The field systemically fails to provide adequate medical care to historically marginalized Black populations and is a breeding ground for distrust. Understanding the history while still focusing on tackling the issues present in the field today will help build a more equitable future for Black Americans.
[1] Carly Funk, Alec Tyson, Intent to Get a COVID-19 Vaccine Rises to 60% as Confidence in Research and Development Process Increases,Pew Res. Center (Dec. 3, 2020),https://www.pewresearch.org/science/2020/12/03/intent-to-get-a-covid-19-vaccine-rises-to-60-as-confidence-in-research-and-development-process-increases/.
[2] Hannah Recht & Lauren Weber, Black Americans Are Getting Vaccinated at Lower Rates Than White Americans, Kaiser Fam. Found. (Jan. 17 2021), https://khn.org/news/article/black-americans-are-getting-vaccinated-at-lower-rates-than-white-americans/.
[3] Ayah Nuridden, Graham Mooney, & Alexandre R White, Reckoning with Histories of Medical Racism and Violence in the USA, 396 Lancet 949, 950 (2020).
[4] Id.
[5] Id. at 949.
[6] Id.
[7] Id.
[8] Id.
[9] Id. at 950.
[10] April Debosky, No, the Tuskegee Study Is Not the Top Reason Some Black Americans Question the COVID-19 Vaccine, KQED (Feb. 25, 2021), https://www.kqed.org/news/11861810/no-the-tuskegee-study-is-not-the-top-reason-some-black-americans-question-the-covid-19-vaccine.
[11] Martha Hostetter & Sarah Klein, Understanding and Ameliorating Medical Mistrust Among Black Americans, The Commonwealth Fund. (Jan. 14, 2021), https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans.
[12] Dana Brownlee, Why Are Black Male Doctors Still So Scarce in America?,Forbes, (Aug. 11, 2021), https://www.forbes.com/sites/danabrownlee/2020/08/11/why-are-black-male-doctors-still-so-scarce-in-america/?sh=74b1509f27c2.
[13] Hostetter & Klein, supra note 11.
[14] Kelly M. Hoffman, Sophie Trawalter, Jordan R. Axt, & M. Norman Oliver, Racial Bias in Pain Assessment,
113 Proc. of the Nat’l Acad. of Sci. 4296, 4296(2016).
[15] Cathy Cassata, This Med Student Wrote the Book on Diagnosing Disease on Darker Skin, Healthline (Sept. 4, 2020), https://www.healthline.com/health-news/this-med-student-wrote-the-book-on-diagnosing-disease-on-darker-skin.
[16] Lisa M. Lines, The Myth of Female Hysteria and Health Disparities among Women, RTI Int’l (May 09, 2018), https://www.rti.org/insights/myth-female-hysteria-and-health-disparities-among-women.
[17] Prather, Cynthia et al. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity, 2 Health Equity 249, 255 (2018).
[18] P.R. Lockhart, What Serena Williams’s Scary Childbirth Story Says About Medical Treatment of Black Women, Vox, (Jan. 11 2018), https://www.vox.com/identities/2018/1/11/16879984/serena-williams-childbirth-scare-black-women.
[19] Id.
[20] Id.
[21] Id.
[22] Id.
[23] Martha Hostetter, Sarah Klein, Understanding and Ameliorating Medical Mistrust Among Black Americans, The Common Wealth Fund (Jan 14, 2021), https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans.
[24]Kat Stafford & Hannah Fingerhut, Poll: Black Americans Most Likely to Know a COVID-19 victim, Associated Press (June 15, 2020), https://apnews.com/article/52ed0842bd17102560e5d896be79d38c.
[25] Recht & Weber, supra note 2.
[26] Id.
