Reckoning with Race & Racism in Healthcare & Medicine: Workshop

The legacy of racism in American medicine is deeply ingrained, with examples such as the Tuskegee Study, a study that lasted for 40 years, in which black men with syphilis were not treated despite the availability of cure. This study is a glaring example of the mistreatment and neglect faced by the black community in terms of healthcare. However, it is important to note that the Tuskegee Study is not an isolated incident, but rather a symptom of a larger pattern of racism and mistreatment towards the black community in healthcare. Throughout history, black bodies were used for medical studies during slavery, and even during the interwar period and beyond, black men, along with men of other races, were used in medical experiments for financial gain. These experiences have led to a mistrust of medical providers among the black community, which continues to contribute to health disparities to this day.

• Reading 1: “Historical Black Superbodies and the Medical Gaze” in Cooper Owens, D.B. (2018). Medical bondage: race, gender and the origins of American gynecology. University of Georgia Press. (pp. 108-121). Describes the ways doctors experimented on slaves before the Civil War.
  
  
• Reading 2: Heller, J. (1972, July 26). “Syphilis Victims in U.S. Study Went Untreated for 40 Years.” The New York Times. The AP article that first reported The Tuskegee Study
  
  
• Reading 3: “What Happened to the Men and their families” in Reverby, S.M. (2009). Examining Tuskegee: the infamous syphilis study and its legacy. University of North Carolina Press. (pp. 111-134). A description of the lives of the people experimented on in The Tuskegee Study after the study ended.
  
  
• Supplemental Reading 1: “The Money Was Good; The Money Was Easy” in Hornblum, A.M. (1998). Acres of Skin: human experiments at Holmesburg prison. Taylor & Francis. (pp. 3-28). A discussion of experimentation on prisoners from the 1930s to the 1970s in a prison in Pennsylvania.

Jim Crow policies and segregation had a significant impact on the health of the urban poor, particularly among black communities. These policies led to the spread of illness and created barriers to education and employment for minority groups in the medical field. As a result, there were not enough doctors to serve the needs of sick and poor populations, who often did not have access to white doctors or received inadequate care from them.

• Reading 4: “Urban Underdevelopment, Politics, and the Landscape of Health” in Roberts, S.K. (2009). Infectious Fear: Politics, disease, and the health effects of segregation. University of North Carolina Press. (pp. 67-86). A discussion of respiratory illnesses resulting from Jim Crowe Era Segregation among poor urban African Americans in Baltimore from the 1910-1930.
  
  
• Reading 5: “Better Part of Valor” in Smith, D.B. (2016). The power to heal: civil rights, Medicare, and the struggle to transform America’s health care system. Vanderbilt University Press. (pp. 63-99). Describes the desegregation of hospitals during the Civil Rights Era.

The practice of segregation in the past not only led to a lack of access to healthcare for minority communities and an increased risk of infectious diseases, but it also had long-lasting effects on environmental justice. This can be seen in the way certain areas were zoned and developed in cities, leading to a disproportionate impact of pollution on minority populations, particularly those living in poverty. The history of segregation has played a significant role in creating these disparities in environmental justice that we see today.

• Reading 6: Excerpts from the EPA Journal (Vol. 18, No. 1 March/April 1992). An early analysis of environmental segregation.
  
  
• Reading 7: “Environmental Contamination, Health Studies, and Mitigation Politics” in Hoover, E. The river is in us: fighting toxics in a Mohawk community. University of Minnesota Press. (pp. 60-121). Description of the environmental catastrophe that occurred to the Mohawk Nation at Akwesasne.
  
  
• Supplemental Reading 2: “Public Housing, Black Ghettos” & “Racial Zoning” in Rothstein, R. (2018). The color of law: a forgotten history of how our government segregated America. Liveright Publishing Corporation. (pp. 17-57).  A detailed discussion of the history of zoning in the United States.

The history of social injustice in American medicine has led to mistrust and suspicion in medical encounters, both from patients and healthcare providers. This mistrust is compounded by the high cost of healthcare, which further perpetuates these legacies of bias and discrimination. Neither patients nor providers intend to be overtly biased, but the potential for past injustices to shape illness and care is always present. Both providers and patients may also bring implicit biases to their encounters, which can lead to misunderstandings and mistrust. The impact of these histories of structural violence has been to create suspicion and mistrust in a crucial and necessary interaction.

• Reading 8: “Color Coded Pills” in Roberts, D. E. (2012). Fatal invention: how science, politics, and big business re-create race in the twenty-first century. New Press. (pp. 168-201).  Roberts describes the ways race science and racism endures and explores the way this also creates ongoing meaning for African Americans who need to engage with medicine and healthcare.
  
  
• Reading 9: “Implicit Bias During the Clinical Encounter” in Matthew, D. B. (2015). Just medicine: a cure for racial inequality in American health care. New York University Press. (pp. 106-127). A discussion of the nature of our implicit bias – what we bring with us in our encounters.
  
  
• Supplemental 3: “Implicit Bias Beyond the Clinical Encounter” in Matthew, D. B. (2015). Just medicine: a cure for racial inequality in American health care. New York University Press. (pp. 128-153). A discussion of the nature of our implicit bias – what we bring with us in our encounters.
  
  
• Supplemental Reading 4: “Traditional Ways of Wellness” in Lovern, L., & Locust, C. (2013). Native American communities on health and disability: a borderland dialogues. Palgrave Macmillan. (pp. 205-221).

1. Understand the diversity of patients, including their class, gender, socio-economic status, ethnicity, culture, and spiritual orientations, and how this diversity shapes medical encounters.
2. Recognize the historical context of racism in medicine and adopt a “do no harm” approach to patient care.
3. Analyze the historical development of medical and scientific ideas on race, including the claims that biological race creates innate vulnerabilities and differences, and evaluate these claims through historical study of structural determinants and political decisions that have led to health disparities.
4. Compare the dynamic history of medical ideas and practices, their implications for patients and healthcare providers, and the need for lifelong learning and reflexive understanding of implicit biases.
5. Examine the nature, ends, and limits of historical medicine and their impact on modern treatment and the development of health disparities.
6. Identify 2-3 successes and failures in the history of medical professionalism that led to social or environmental injustice.