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With the recent news on COVID-19 vaccine trials and distribution has come an onslaught of differing opinions on the safety and efficacy of each one. Feelings about vaccines don’t just correlate with education, but also with political ideology, religion, and racial and ethnic background. For instance, you might be surprised to hear that African Americans communities are particularly hesitant. Rates at which these communities are being hospitalized due to COVID-19 is triple that of White Americans communities; yet, African Americans remain hesitant or non-compliant. This is due to the structural violence of the healthcare system against them.
Although many Americans have lost trust in the American healthcare system because of its capitalistic nature, the African American community has its own reasons to not trust it: there are a myriad of examples of when the Black community has been abused and neglected by medical practices. One of the most horrific incidents was the Tuskegee project, which involved 40 years of blatant abuse of Black men.
The Tuskegee project was a study designed to observe the natural progression of syphilis in a population of 600 sharecroppers from Macon County, Alabama. Penicillin became known as a viable treatment option 15 years into the study, but in the interest of observing the full progression of syphilis, researchers actively prevented local physicians from treating the study population without the knowledge or consent of study participants. The study began in 1932 and ran for 40 years. During that time, researchers noted a variety of symptoms including blindness, and even death, as a result of a treatable disease that they allowed to go untreated. The Tuskegee experiment had and continues to have a devastating impact on trust in healthcare for many African Americans.
The Tuskegee experiment was not the only time African Americans were singled out and abused by the American healthcare system. Throughout the 20th century, for example, African Americans were forcibly sterilized in an attempt to reduce their population. For instance, the North Carolina Eugenics Boards sterilized almost 7,600 men and women between 1929 and 1974. Poor African American women, in particular, were targeted for forced or coerced sterilizations.
While the victims of both of these incidents received compensation, this did nothing to ease the emotional suffering of the victims. Instead, compensation efforts only emphasized the monetization of physical and mental trauma experienced by African Americans at the hands of the healthcare system, as evidenced by the emotional testimonies given by survivors during the Justice for Sterilization Victims Foundation task force compensation hearing in 2011.
As mistrust in the healthcare system grew among the African American community, the community experienced a rise in self-advocacy through organizations such as the Black Panther Party (BPP). The BPP heavily criticized the treatment of black individuals in hospitals as they believed health care should be provided free of charge due to the structural systems that enforced poverty in Black communities. Their mission was to see health as a human right, and have people of the Black community feel respected and comfortable within healthcare institutions.
To fulfill their mission, the BPP created community-based clinics aimed at giving black individuals access to healthcare in a friendly and trusting environment. Ultimately the BPP established 13 free healthcare clinics across the US in places like Boston, Mound Bayou, MS and Chicago. When individuals needed further treatments or consultations beyond what these clinics could offer, volunteers would accompany patients to larger hospitals to act as advocates and as a comforting presence. Although the BPP has since dissolved, their legacy in public health remains. Now, many understand that the US healthcare system is in need of structural change to combat institutional racism, and the concept of free healthcare has become a heated topic in contemporary politics. The BPP’s work in healthcare highlights one potential template for improvement of medical treatment of African American communities.
It is important to consider reshaping healthcare in ways that can ultimately ease mistrust and account for diversity, both in research and in practice. The National Institutes of Health are trying to address this concern with its All of Us Research program, which fosters dialogue between diverse communities and scientists. The program aims to measure everything from air quality in a region to food insecurity, with the aim of monitoring the dynamic nature of someone’s lifestyle and local environment and how that affects their health. Such information will be used to approach medical intervention based on the current needs of a community. The overarching goal is to create a new type of healthcare system that is based on continuous communication between healthcare workers and the surrounding community. This program shows promise as it could start to slowly mend the deep wounds that the healthcare system has inflicted upon the African American community.
As we begin the largest mass vaccination program in American history, it is important for the medical community to take hesitancy towards vaccination seriously. Such hesitancy has been fueled by years of system injustice and outright abuse that cannot be ignored. The medical community must take the time to alleviate concerns surrounding vaccines and to reduce mistrust in the healthcare system as a whole.