Some of my white friends hate when I use the phrase, “systemic and structural racism.” They respond by saying, “My family worked hard and earned each penny we have.”
Well, when I refer to systemic and structural racism, I mean a system built by white men with no intentions of meeting the needs of Black people. I mean that as a white person, you were born into a system designed to see you prosper at the expense of Black people’s continued oppression.
The systematic and structural racism creates health disparities and environmental, social, and economic disadvantages that have resulted in Black people carrying a heavier burden of both HIV/AIDS and COVID-19 cases and deaths.
That these disparities exist is not a failing of Black people, but rather a failure of the United States government and its adjoining health agencies to assess and meet the health care needs of Black people. Black Americans constitute just 12% of the U.S. population, yet they account for a startling 43% of new HIV diagnoses and 44% of deaths among people diagnosed with HIV. At the same time, nationwide, Black people have died from the COVID-19 virus at nearly twice the rate of white people.
The Dangers of Racism in Health Care Settings
Medical racism remains high on the list of factors that contribute greatly to these and other health care inequalities for Black Americans, as evidenced by historical as well as very recent examples. A 2016 study published in the journal Proceedings of the National Academy of Sciences revealed that half of white medical students and residents held at least one false belief about biological differences between Black people and white people. Among the group, some believed that white people had larger brains than Black people, that Black people’s skin is thicker than white people’s, that Black couples are much more fertile than white couples, and that Black people have stronger immune systems than their white counterparts. Taking into account false beliefs like these, it’s not difficult to see how they might influence how some white physicians misdiagnose and mistreat Black people in their care.
In the early 19th century, James Marion Sims, crowned “the father of gynecology,” claimed that Black people do not feel pain. Thus, Sims caused unimaginable pain to enslaved Black women, performing gynecological surgeries on them without anesthesia.
It may come as no surprise then that findings from a study published less than a year ago revealed that Black newborn babies are more likely to survive when their physicians are Black—and that these effects are more pronounced at hospitals that deliver more Black newborns.
Taken a layer further, it’s also not surprising that events throughout U.S. history, coupled with individual experiences, have contributed greatly to Black people’s mistrust in the health care system—down to their own physicians. A survey conducted by the University of Pittsburgh found that Black participants reported a relatively higher level of distrust for their own physicians than did their white counterparts. In turn, they were less likely to utilize preventative health care and services, such as the flu vaccine or prostate-specific antigen (PSA) tests, which, according to studies, in part is a window into the poor health outcomes and ongoing health disparities long experienced in Black communities.
How to Turn the Tide? Start With Self-Reliance Strategies
Throughout history and up to the present, Black people have done what is necessary, then what is possible, and suddenly—the impossible. Black people did not wait for someone else to say Black Lives Matter. Civil rights activists did not ask for permission. In the same way, as public health activists, we have to focus on what we can do and where we have to make progress.
We are not imagining that HIV and AIDS and COVID-19 disproportionately affect us. It is real. Then what? We must choose progress. In an article for Treatment Action Group on the links between racial injustice and HIV disparities, writer and activist Kenyon Farrow provides an insight into the external work needed to tackle Black people’s mistrust in the health care system, such as leadership development and community-education programs. In addition, we must adopt self-reliance strategies that focus on growing and utilizing the strengths and resources within our communities.
Self-reliance strategies for the Black community mean that we take control of our destiny by choosing a survivor mindset and getting rid of a “victim mindset.” In fact, focusing on our strengths—on what we can do, what we have—is arguably one of the most effective self-reliance strategies toward meeting our health care needs.
As veteran, motivational speaker, and author of Guru in the Glass, Curtis Tyrone Jones explains, “Life is a delicate balance between the idea that we need others for almost everything and the striking reality that nobody owes you anything!” Truly, my self-reliance beliefs and progressive ideas are coming from a good place.
Community Is the Way Forward
In order to heal and move forward, we need Black leaders to offer services and lift up our community; for example, by holding virtual listening sessions on Black Americans’ experiences with health care systems.
Meanwhile, as much as we need others to meet our health care needs, we must take responsibility for our own health care needs. Even if all the reasons why we can mistrust the medical system are valid and backed with concrete evidence, we must aim for progress over dwelling in emotions. We must work with our allies in the health care system to make progress. We must seek accurate health care information and break the spread of fake health information.
When we navigate our health care system, let us look for opportunities to educate health care providers. For instance, as you read this piece, take a step in the interest of your own health and schedule an HIV test, or if you’re living with HIV, commit to prioritizing your treatment.
We must also call on Black community leaders and influencers (Black churches and physicians, as well as sports and entertainment stars) to use their visibility to engage with the younger Black community and promote accurate health care information. Case in point: It increased my family’s confidence in the COVID-19 vaccine when Theodore Jones, M.D., a trusted and beloved Black physician in the Detroit area, shared his own experience with getting the COVID-19 vaccine on social media back in January. In the post, Jones urged followers, “If you are still unsure about taking the vaccine, please have a conversation with a doctor or other health care professional about the questions or concerns you still have.”
In Lexington, Kentucky, even before the first COVID-19 vaccine was approved, Black church leaders were educating their communities on COVID-19 vaccination. And 30 miles away, in Frankfort, Kentucky, faith leaders publicly took the COVID-19 vaccine to increase COVID-19 vaccine confidence and encourage their congregations to get vaccinated.
Black leaders must do what is necessary, then what is important—and, suddenly, they will be doing the impossible in tackling the effects of medical racism in Black communities.
Another way that Black people can empower each other: Getting more involved in the political process and supporting the Biden administration putting forward policies to advance Black lives. Within a few days in office, President Biden began undoing some of the Trump administration’s racist policies and putting in place policies aimed at protecting Black lives, such as expanding Medicaid and Obamacare. Engaging in politics means staying organized for local and national elections and preparing for the 2022 Congress elections.
As a Black community, we are not victims. We are surviving a health care system built on racism, in which a substantial number of white health care providers still hold false beliefs about us. In this continuing COVID-19 crisis, once again, history is weighing on Black leaders’ shoulders. They are the right people in the right place at the right time to contribute to dismantling medical racism. In order to turn things around, we must choose progress over emotions by doing what is necessary, then what is possible, and all of a sudden, doing the impossible to meet our health care needs.