Dr. Uche Blackstock is a physician and founder and CEO of Advancing Health Equity. She appears regularly on her MSNBC and her NBC News, and is a former associate professor in the Department of Emergency Medicine and a former faculty member in Recruitment, Retention, and Inclusion in the Division of Diversity Affairs at the New York University School of Medicine. . Dr. Blackstock received both his undergraduate and medical degrees from Harvard University.
Below, Uche shares five key insights from his new book. Legacy: Black doctor reflects on racism in healthcare. Listen to the audio version read by Uche himself on the Next Big Idea app.
1. Just over 2 percent of physicians in the United States are Black women.
I consider myself, my twin sister, and my mother to be unicorns. Just over 2 percent of physicians in the United States are black women, but black Americans make up 13 percent of the population. Having three black female doctors in one family is incredibly rare. Being part of the legacy of the first black mother and daughter to graduate from Harvard Medical School is even more unusual. I'm incredibly proud of our accomplishments, but I'm even more proud considering her mother came from a very humble background. Raised by a single mother on welfare, she never met a black doctor during her childhood.
At the same time, I find it frustrating that at this point in history we are still celebrating “firsts.” This illustrates how Black Americans' path to becoming a physician is hindered by multiple interpersonal and organizational barriers. These barriers include limited access to quality education, mentorship programs, and the resources needed to enroll and enroll in college or medical school. Then there's the whole other issue of what happens when you're in a predominantly white organization.
Unfortunately, these environments are often not favorable to us. That's one of the main reasons I left a seemingly successful career in academic medicine to start my own consulting firm. I am now doing health equity work in my own way and not fearing retribution for speaking truth to power.
2. Delayed or missed diagnoses are more common among people of color.
During my first year of medical school, I had to visit the emergency room as a patient.
The experience was incredibly scary and vulnerable, but it was also a powerful teaching moment for me. This helped me understand what some patients experience when they are not heard by health professionals or have their concerns ignored.
Patients of color are more likely to be misdiagnosed and more likely to be harmed by a diagnostic error than white patients. This is true regardless of educational background or socio-economic status.
“While I was in the ER, I was told multiple times that it didn't seem to hurt that much.”
Appendicitis was missed during multiple emergency room visits to my own medical school for severe abdominal pain. While in the ER, I was told multiple times that it didn't seem to hurt that much. I was also asked many questions about my sexual history. Eventually, my appendix ruptured and I had to have open surgery, which resulted in post-operative complications. I had to miss almost a month of school on sick leave. It could have cost me my life.
From that experience, I learned how important it is for all healthcare professionals to actively listen to patients and take their concerns seriously.
3. There are historical reasons why Black patients face multiple barriers to receiving care.
The treatment of Black patients when seeking treatment has very deep historical and systemic roots. These roots go back to slavery, a social institution based on the false notion that black people are biologically inferior to other races. Enslaved Black people were experimented on and traumatized during slavery without their consent in order to help medical institutions make important discoveries that benefit society as a whole.
These were often displayed in medical school lecture halls, and textbooks also included the myth that black people were biologically different. These concepts and myths have persisted for centuries and still permeate medical education curricula.
Medical professionals can perpetuate health care inequities by not listening to Black patients or minimizing their complaints. This results in inadequate treatment of pain and symptoms. Medical professionals also do Black patients a disservice by not properly investigating the cause of their symptoms and making the correct diagnosis. When pain is untreated, people experience physical, emotional, and psychological suffering.
We've seen these stories play out even in mainstream media with famous or well-known Black people like Serena Williams and Beyoncé Knowles. Often, these unpleasant and disrespectful experiences with medical professionals lead Black patients to mistrust medical institutions and decide not to seek treatment when they need it, putting their health and well-being at risk. I'll expose it.
4. The coronavirus pandemic has exposed deep inequalities in our health care system.
The COVID-19 pandemic has caused devastating loss and trauma for many communities, but a silver lining has been that it has unearthed deep inequalities within the health care system and other social systems.
Scholars have been having these discussions in their own silos for decades, but now they are being debated in the mainstream media. COVID-19 has shown how social determinants of health—education, employment, housing, access to food, transportation, and access to health care—directly impact the health of communities. Additionally, we were able to see in real time how systemic racism is a driver of social determinants of health.
“COVID-19 has shown us how social determinants of health directly impact the health of our communities.”
For example, in March 2020, I spoke to Black communities and other people of color because we live in communities that have been chronically disinvested due to historically racist practices and policies. We knew our communities would be disproportionately affected. Black people are more likely to be in service jobs and essential workers due to occupational segregation, putting them at higher risk of exposure to the coronavirus.
We are less likely to have access to employer-provided health insurance, paid sick and family leave, and culturally responsive care. We are more likely to live in overcrowded multi-generational housing.
All of these factors put our community at higher risk of contracting, being hospitalized, and dying from COVID-19. Our leaders are finally having policy conversations about health equity and how to embed equity in social, economic, and health policies to prevent further harm to marginalized communities.
5. Despite advances in medical innovation, research, and technology, racial health disparities are worsening.
We are reaching a wide audience, including policymakers and organizational leaders, to understand why, despite significant advances in medical innovation, research, and technology, we continue to see worsening racial health disparities. You need to connect the dots to get the answer.
Many people don't know or understand why the Black maternal mortality crisis is worsening. Black women giving birth are three to four times more likely to die from pregnancy-related complications than white women. Black babies are more than twice as likely to die in the first year of life than white babies. There is greater inequality today than there was 15 years ago, when slavery was abolished. but why?
The answer is simple: interpersonal and systemic racism.
Until our social institutions, leaders, and communities consider the harm that racism continues to cause and respond appropriately through equitable practices and policies, this country will continue to see this decline in health outcomes among racial demographic groups. We will continue to see such surprising differences.
There is a horrific history of medical racism that still affects us today. Learning about this history could be one way he improves health care for everyone. The history of medical experimentation on enslaved Black people, or how the Flexner Report of 1910 led to the closure of historically Black medical schools in the early 20th century, or redlining and other discriminatory housing policies. Understanding how this is negatively impacting the health of Black people today is critical to finding solutions.
To hear the audio version read by author Uché Blackstock, download the Next Big Idea app now.
