We know that on virtually every measure of health, African-Americans fare far worse than their White counterparts – from diabetes to heart disease to infant mortality. These disparities can be explained by myriad and co-influencing factors, including a lack of access to affordable healthcare, nutritional education and safe spaces to exercise.
A less apparent, but equally troubling, reason for unequal outcomes in Black health is a strong sense of skepticism – even mistrust — in physicians, in medicine and in the healthcare system in general. The impact of the Tuskegee syphilis study, a four-decades-long clinical trial in which African-American men, unaware of their condition, endured the disease for the purpose of medical observation, still looms large on the Black consciousness, perpetuating a culture of wariness that has lingered for generations.
Mistrust in medicine is particularly pronounced among African-American men, many of whom will enter the healthcare system only after their conditions are severe or life-threatening. A 2011 study by the University of North Carolina at Chapel Hill found that Black men who self-identified as “highly mistrustful” of healthcare were more than twice as likely to delay check-ups and cholesterol screenings, and three times more likely to delay a routine blood pressure screening, than those who were more trusting.
Distrust, skepticism, fear — these beliefs are intensely embedded in the history of Black healthcare, but they are ones we must overcome if we are to truly improve the health of our families and communities. Today, too often, a lack of trust can become a huge liability, even a death sentence, for Black patients.
I became a healthcare professional, because I saw my family members, friends and neighbors plagued by diseases that could have been prevented, if they had taken a proactive approach to their care. While it’s important to acknowledge that African-Americans’ relationship with the healthcare system is complex, our community cannot afford to remain disengaged in these matters.
That’s why all of us must take a hard look at the barriers that prevent African-Americans from achieving health equity and commit to an effort to reclaim Black health and wellness.
On the part of individual members of the Black community, that means not only taking advantage of the coverage opportunities provided by the Affordable Care Act, but also taking a hands-on approach to health – one that seeks out care in a timely and accountable fashion and works to nurture a positive culture of health in our families, churches, neighborhoods and cities.
On the part of healthcare providers, this work will require a new standard of care that recognizes the unique needs of minority populations and designs a care strategy around what works for each individual patient. Working with physicians at our facilities, we are learning that when we actively engage the patient in his or her care, we’re better able to build meaningful, long-term relationships that lead to better health outcomes. This personalized care approach is proving vital in earning trust and improving the health of the African American community.
Representation also matters when it comes to building confidence in healthcare among minority communities. Black Americans make up 13 percent of the population, yet they account for barely 4 percent of practicing physicians nationwide. What’s more, studies show relationships between patients and physicians of the same race or ethnic background also are characterized by higher levels of trust, respect and patient satisfaction. It’s clear that more needs to be done to encourage African-Americans to pursue medical professions – and ensure the proper supports are in place to nurture diversity in the field.
As we remember and reflect on Black history – the bad and the good, the darkness and the light – there is no better time than now to commit to actions that will make our community healthier and stronger. And it begins by working together to break down barriers, real and perceived, to the care we need and deserve.
Patricia A. Maryland, Dr.PH, is the President of Healthcare Operations and Chief Operating Officer of Ascension Health.
PHOTO CAPTION: Patricia Maryland says that studies show relationships between patients and physicians of the same race or ethnic background also are characterized by higher levels of trust, respect and patient satisfaction.