Black Health Matters

In Louisville, as in any city in America, racism is a public health issue.

Jun 24, 2024 at 3:40 pm
The need for Black professionals in healthcare is great
The need for Black professionals in healthcare is great Adobe

Data gathered by the Centers for Disease Control and Prevention shows that Black Americans have higher infant mortality rates, higher hypertension rates, and lower life expectancy. And these outcomes are not genetic. Racism is a public health issue in America.

How It Started Versus How It's Going

Systemic racism, racism that extends beyond interpersonal engagement between white people and Black, Indigenous, and other people of color (BIPOC) — involves structures, policies, practices, and social norms — that value and devalue people and determine their outcomes, based on their observable genetic characteristics. It goes beyond skin color or hair texture and can include any phenotype deemed inferior within a systemically racist system. In Louisville, like every other city in America, systemic racism is based on a white supremacist worldview. These unfair advantages and unjust disadvantages affect our entire society. Racism negatively affects the mental and physical health of millions of BIPOC people, severely limiting them from living healthy lives. And that ill health affects the health of our entire culture.

Mountainous research shows that centuries of systemic racism in the U.S. has had a cascade effect on BIPOC communities. Social determinants of health — the non-medical factors that affect our general well-being, like where we are born, where we learn, where we work, and where we play — are informed by systemic racism. Health inequities among the BIPOC population result in net negative health outcomes. Data continues to show that BIPOC people in America experience higher rates of illness and death as a result of conditions like asthma, diabetes, obesity, and heart disease than white Americans. The life expectancy of Black Americans is still four years less than the life expectancy of white Americans.

The Black Lives Matter movement focuses on the way Black lives are systematically and intentionally targeted for demise. For many BIPOC people, that same racism begins in the delivery room and extends into the convalescent home.

click to enlarge The need for Black professionals in healthcare is great - Adobe
The need for Black professionals in healthcare is great

As recently as 2016, Psychology Ph.D candidate Kelly Hoffman led a study at the University of Virginia that interviewed 222 white medical students and residents and found that fifty percent of them believed in biological differences between Black and white people. These differences range from the belief that Black people age more slowly than other races; that Black people's nerve endings are less sensitive, that their blood coagulates more quickly, and that their skin is thicker than White people. All of these beliefs are false, a startling example of pseudoscience that still permeates the American mindset. What is most distressing in Hoffman's research is that the respondents were not self-identified neo-Nazis, alt-right activists, or incel conspiracy theorists. These were the earnest beliefs of non-Black students who were aspiring to practice medicine and residents who were already working in medical facilities.

Even when pseudoscientific beliefs are not present, Black health has historically been overlooked in clinical research, both in observational studies and in clinical trials. For example, asthma is the most common chronic disease of children globally, irrespective of race. Vanderbilt University Human Genetics Program alum Marquitta White once published a study that showed that most of the genetic information scientists have on asthma patients does not even apply to Black people. Because the majority of genetic studies are done among populations of European descent, even the longest studies do not include many Black patients. As a result, Black patients are not receiving the best care, because doctors might not know the disease etiology in their population.

The Liberation Health Model

The lack of Black representation in clinical research was part of the impetus for the Liberation Health Model. Dr. Dawn Belkin Martinez, Associate Dean for Equity and Inclusion and a Clinical Professor at Boston University School of Social Work co-created the Liberation Health Model. The Liberation Health model is a theory of human behavior that proposes that health problems cannot be understood in isolation from the historical, social, economic, and cultural conditions that created them. Health care — particularly, in the context of Belkin Martinez's work, mental health care — for historically marginalized social groups cannot be meaningfully facilitated without that understanding.

The implication is not that only a BIPOC practitioner can effectively treat a BIPOC patient, but rather that understanding the historical inequities experienced by the BIPOC patient is essential for the practitioner. The Liberation Health Model challenges healthcare workers to develop a detailed understanding of the cultural experience of their patients, and to take a social justice approach to compassionate care.

click to enlarge Aisha Rucker - Aisha Rucker
Aisha Rucker
Aisha Rucker

Positives Outcomes on the Horizon

Like any social group, the Black Americans are not a monolithic community. Throughout the West End and across Louisville, there are intersections of social identities and nuances of lived experience that make each life different. But many of the barriers to care among the Black population are the same.

Aisha Rucker, (soon-to-be) Manager of Social Work and Care Continuum at Norton Healthcare speaks from her experiences as a medical social worker. "I believe many of the barriers in the Black community stem from systemic issues such as redlining, food apartheid, poverty, health disparities, and housing inequities," she says. "I feel that there is a lot of work that needs to be done to create trust in the Black community when it comes to healthcare.

Rucker enumerates some of the major medical traumas experienced by Black Americans. In the Marion Sims experiments, in which a surgeon from Alabama named Dr. J. Marion Sims conducted a series of experimental operations on enslaved Black women between 1845 and 1849. Manipulating the laws around chattel slavery, he performed unethical experiments on unconsenting women.

In the Tuskegee syphilis study, 399 Black men with syphilis were denied the penicillin that would have healed them. The men were promised free medical care but were never informed of their syphilis diagnosis and were only provided disguised placebos and endured deceptive diagnostic procedures. What was originally promised to be a six-month biomedical research study was extended across 40 years and 128 of the participants died of syphilis or complications related to the disease.

In 1951, Henrietta Lacks had samples taken of her own cancerous cells during the course of her diagnosis and treatment. Those samples were given to researchers without Lacks's knowledge or consent. None of the biotechnology companies that have since profited from the use of her cells ever made any payment to her family. That lack of consent and compensation continued into 2023 when Henrietta Lacks's family finally received a settlement from Thermo Fisher Scientific.

Despite this history, Rucker says, "I do feel there are organizations and medical offices — for example, Norton West Louisville Hospital and all-Black medical practices like HMPS Internal Medicine of West Louisville that are trying to close the health disparity gaps and build trust in the community."

Rucker feels that the Black, Brown, and LGBTQ communities in Louisville need "practitioners that really listen, serve with empathy and compassion, free of judgment, and meet these patients where they are." Her hope is that Norton West Louisville Hospital and practices like HMPS Internal Medicine of West Louisville will help these historically marginalized communities feel more comfortable — and more empowered — in engaging their own healthcare."

To cultivate wellness for all Louisvillians — regardless of race, ethnicity, sex, gender, or socioeconomic status — it is imperative that we come together to confront the systems that created and perpetuated the injustices that cause race-based health inequities. With ongoing this need in mind, Rucker shares a quote from bell hooks: "What we do is more important than what we say or what we say we believe."