William Shakespeare wrote “For trust not him that hath once broken faith,” (“King Henry VI, 1591); and many Black grandparents have wisely warned, “Fool me once, shame on you, fool me twice, shame on me.” History and old adages alike emphasize healthy mistrust after being deceived, scammed or flim-flammed, and for many members of the Black community — that thinking applies to the health care system.
While there has been representation of Black medical leaders over centuries, from tribal healers, physicians, scientists, surgeons, pharmacists and herbalists, history unveils a complicated and, at times, detrimental relationship between African Americans and health care. The nuanced nature of both health and African American, plays a role in how many Black people approach health care as both practitioners and patients. As African Americans continue to be disproportionately affected by several diseases including COVID-19, heart disease and HIV/AIDS, health providers are working to mend, build and maintain healthy, long-lasting trust with the Black community, after centuries of unhealthy treatment and systemic racism and abuse.
“One has to acknowledge the overall systemic racism as a part of a problem where … African American people are suspicious of European Americans because of just the history of racism, but also people’s encounters with the medical system,” said Dr. Donald R. Hopkins, a trained pediatrician who has spent more than four decades specializing in public health, particularly in Africa.
“Some of those [negative] encounters with the medical system are directly a result of medical people’s personal biases, and some of it is arrogance related … to the profession itself, including by some African American physicians, who sometimes will give the impression of being superior to people who come to them for medical help,” Hopkins added.
As the Association for the Study of African American Life and History (ASALH) examines “Black Resistance,” as its 2023 theme, the relationship between African Americans and health care is important to consider. For many Black Americans, health care has been a form of oppression and source of trauma. However, with Black medical schools and practices, as well as African American health professionals uplifting the health care field, in many ways, emphasizing “Black health,” is “Black Resistance.”
Why the Mistrust
Enslaved Africans battled disease and unhygienic conditions when first captured and inhumanely transported to the Americas more than 400 years ago. At least two million people died during the Middle Passage, many from malnutrition, or diseases such as measles, scurvy and smallpox.
During slavery, research shows that enslaved Black people were only seen by doctors as a last resort; and then their masters would be told their results and diagnoses, sometimes without making patients privy to the ailments or offering effective care.
Then there’s the 40-year Tuskegee Experiment, where the U.S. Public Health Service (PHS) used Black bodies as lab rats. In 1932, 600 participants were told they were being treated for “bad blood. In what was supposed to be a six-month study, 399 men had latent syphilis and were not told of their diagnosis, and 201 others were not infected. The participants were told they would receive free medical care for participating in the study and thought they thought they were being treated for their symptoms, but, in reality, the patients were given placebos and ineffective treatments.
By 1943, penicillin had already proven a successful treatment for syphilis. However, with continued false treatment, 128 participants died and many families and generations were seriously affected as a result of the experiment, which concluded after the study was exposed in an Associated Press story in 1972.
“The notorious Tuskegee Experiment,” Dr. Hopkins said, “was just another egregious example of the vantage taking of African Americans, and how when it comes to light, it leads into often justified paranoia.”
James Wilson, 35, said he’s always been “standoffish,” when it comes to Western medicine because of what he’s learned from history and witnessed in life.
“Black people have been used as experiments since day one,” Wilson said after discussing the Tuskegee experiment. ” I just never, really trusted anything about the health system, since we’ve always been that person to be a test trial.”
Wilson also explained he’s known of instances where someone appears fine before going to a doctor, but seems sicker once being treated, which has added to his skepticism of traditional health care in the U.S.
Finally, once people are treated, they don’t always have the best experience.
“In this country, we deal with sick care, not health care,” said. Dr. Akmal Muwwakkil. “When we go to the doctor or hospital, we don’t get the care that we need. We don’t just need to take something for what’s going on, but we also need compassion. We also need to know that ‘I’m not just a number … that I’m worthy of you spending time with me because of what’s going on with me.'”
Growing Trust
As African Americans continue to be disproportionately affected by disease, people like Wilson, are working to grow their trust with medical professionals by prioritizing wellness and regularly checking in on their overall health.
“The way life is going so fast now you need that checkup, you need physical therapy, you need mental therapy, you need a dentist. It’s some things you still need, you have to see,” Wilson said.
When it’s time to treat patients, Dr. Hopkins, 81, contends that all medical professionals must approach the situation “human to human.”
“The most basic thing, no matter what color your skin, is to treat people with respect and humanity,” he said.
As an international physician working part-time now with The Carter Center based in Atlanta, Hopkins emphasizes the importance of treating everyone with respect.
“These materially poor people, in these rural villages … they sense immediately condescension and disrespect,” Hopkins said of the people he has worked with on the continent of Africa. “If you go in conveying that kind of [condescending] attitude, they pick up on it, and they will shut you down. They’re not going to listen to any suggestions you make to try to help them.”
In addition to treating people with more respect, Wilson and Doctors Hopkins and Muwwakkil also uplift the importance of Black medical professionals.
However, Hopkins, who was the only African American in his class of 52 medical students at the University of Chicago, said even Black doctors have to come correct and respect “basic human dignity — human decency.”
“You can’t skip over that just because you’re Black and they’re Black, because people want to be respected by anybody.”