Health Wanted Show Notes: Public Health and the Black Community
February is Black History Month, which means it’s a great time to explore the intersection of public health and the Black and African American experience.
Black History Month should be an opportunity to celebrate the people and organizations that have been instrumental in propelling the field of public health forward, and there have been many.
It would be dishonest not to also acknowledge horrific ways in which public health and medicine have treated Black bodies throughout history and how that treatment has shaped their care, even today.
So, this is a warning that the next section will be a retelling of the mistreatment, abuse, and violence that real people suffered as a result of oppression and racism.
Since the first enslaved Africans arrived in the colonies in 1619, the legacy and impact of slavery has persisted for over 400 years.
During the time when the trans-Atlantic slave trade was legal, physicians themselves benefited not only from owning slaves, but also from having access to bodies for medical experimentation that were not required to give consent.
Thomas Hamilton, a Georgia physician, documented his experiments on enslaved people.
For the enslaved man “Fed,” Hamilton forced him to sit naked in a heated pit while trying various medications to see if any made him withstand the temperatures better. This was an experiment no doubt designed to find ways for slave owners to keep the enslaved working longer in the Southern heat.
Hamilton was also obsessed with proving that there are physiological differences between Black people and white people.
Over a period of nine months, he repeatedly applied blisters to the hands, legs, and feet of the enslaved man John Brown in an effort to determine if Black skin really was thicker than white skin.
The myth of physiological differences is what allowed J. Marion Sims, another physician in the antebellum south, to be dubbed “the father of modern gynecology.”
In 1808, it became illegal to import slaves to the U.S. from other countries, but slavery itself was not outlawed.
As a result, slave owners had a vested interest not only in domestic slave births providing healthy babies to grow into healthy slaves, but also quick recoveries of enslaved women after giving birth so they could return to hard labor.
Sims is credited with creating both the vaginal speculum (a medical tool used during gynecological visits) and the first procedure to treat vesicovaginal fistula, an abnormal opening between the vagina and bladder that causes urine to continuously leak out of the vagina.
Sims made these contributions to modern medicine by experimenting on the bodies of 14 enslaved women who were kept on his property over a period of four years.
His experimentation lasted from 1845 to 1849 but without the use of anesthesia, which had its first public demonstration in 1846.
Given that Sims had been documented to use anesthesia on white women who received the procedure, it’s likely his incorrect belief (and that of many other physicians at the time) that Black people didn’t feel pain in the same way as white people allowed him to justify such invasive and painful procedures.
These falsehoods about the differences between Black and white people persist today, continuously contributing to poor health outcomes.
One survey of white medical students and residents found that nearly half of those surveyed held false beliefs about the physiology of Black people.
One quarter of medical residents thought that Black people’s skin was thicker than white people’s. 12% agreed that their nerve endings were less sensitive.
As a result, studies have shown that Black and African American patients are less likely to receive appropriate pain management.
Black Americans are also at risk of suffering from the results of internalized bias that physicians might not even be aware they hold.
Studies have shown that physicians (particularly white ones) hold a preference for white patients, viewing Black patients as being less intelligent and less likely to follow instructions for medical care.
They are less likely to receive appropriate care for HIV, have disparities when it comes to things like kidney disease and diabetes, and Black women are three times more likely to die from pregnancy-related complications compared to white women.
The stress of discrimination itself has been consistently found to increase the risk of poor health outcomes in Black people, even more so than financial, traumatic, and interpersonal stress.
Even our medical tools are designed with a bias against darker skin.
Just this year, the FDA finally released updated guidance for how the makers of pulse oximeters should test their devices after knowing for years that they do not work as well on darker skin tones.
Recently, the calculation to estimate kidney function removed an adjustment for race.
The adjustment was based on the faulty assumption that Black bodies have more muscle mass, and it’s estimated that millions of Black Americans were likely denied treatment or even inclusion on the kidney transplant list as a result of its use.
The poor treatment of Black Americans throughout history has, understandably, resulted in a distrust of modern medicine, which further contributes to health disparities.
The story of Henrietta Lacks could be seen as a cautionary tale about engaging in the U.S. medical system.
In 1951, Lacks sought care at Johns Hopkins Hospital in Baltimore for an aggressive form of cervical cancer.
Samples of her tumor were given to cancer researchers there without her consent or knowledge, and the rapidly dividing cells have been used throughout the years in studies of everything from toxins, to cancer, to viruses, to hormones.
The biomedical companies that have made huge profits off the use of Lacks’s cells did not pay anything back to her or her family members for their use for decades. Doctors and researchers continuously failed to get consent from her surviving family members before doing things like publishing her full name, giving her medical records to the media, or even putting her entire genome online for anyone to access.
The Tuskegee Syphilis Study is another well-known example of the different standards that medical research holds for people of color.
The study took place in Alabama from 1932 to 1972, with the goal of documenting the natural history of syphilis in Black men.
There were no treatments for syphilis at the time the study started, and the researchers told the men they’d be in the study to treat “bad blood” (a local term that covered a number of nonspecific ailments) and they would be provided medical care at a level that was typically not available to Black men of their socioeconomic status.
Even though penicillin was discovered and put in place as the standard treatment for syphilis in 1947, it was actively withheld from study participants.This means there was a period of 25 years where men were unnecessarily living with a curable infection that they could be passed on to their partners and children.
After the study was uncovered in 1972, many outlets misrepresented the study as having intentionally infected men with syphilis. Though this was incorrect, the lasting memory has, understandably, impacted many people’s willingness to seek medical care, or participate in research studies, within predominantly white institutions.
Hesitancy to engage with the current medical systems is widening the health gap.
The cancer report for 2024 noted that Black people are 50% more likely to die of cervical cancer than white people, even though there is an effective vaccine for the strains of cancer-causing HPV.
And I want to be very clear: the point is not to blame the Black and African American community for potentially avoiding engagement in health care, even when they have access.
The point is to highlight that there are very real reasons that this community holds anxiety and skepticism about the U.S. health care system, which has been historically cruel to them, and to say that it is the responsibility of providers and public health professionals to do the work to restore that trust.
Of course, this is only a brief review of the factors that contribute to the health disparities that Black and African American people face in this country. If you really want an in depth read my personal recommendation is Medical Apartheid by Harriet A. Washington, or Racism: Science and Tools for the Public Health Professional, by Dr. Chandra Ford. Both are linked in the show notes of this episode.
It’s important that we also highlight just a few of the absolute heroes of health you might not already be aware of.
While Edward Jenner is credited with the invention of the first smallpox vaccine, the precursor of “variolation” had actually been practiced for centuries before by civilizations in Asia and Africa.
As a reminder, variolation is the practice where matter from a smallpox wound of an infected person is rubbed into an open wound on the arm of an uninfected person, which can help build immunity to the virus with a lower (though not zero) chance of death.
In 1716, a Bostonian slave owner by the name of Cotton Mather remarked in a letter that his newly acquired Ghanaian slave Onesimus had told Mather of a process by which he was infected, but not really infected, with smallpox.
Thanks to this information, when a smallpox outbreak hit Boston in 1721, Mather and the local physician used this knowledge of variolation to inoculate several members of their family and the public.
In their group, only six people died, making their death rate 1 in 40, a significant improvement over the general public’s death rate of 1 in 6.
Though little is known of what became of Onesimus, he should be remembered as one of the first public health educators.
In Pittsburgh in the early 1960s, emergency medical care typically consisted of being put in the back of a cop car and driven to the hospital. Understandably, residents of the predominantly Black Hill District were not inclined to call the police for medical help.
So, in 1967, the Freedom House Ambulance service began to serve the neighborhood, recruiting what would be the first paramedics in the nation from among the unemployed members of the community.
The all-Black paramedics underwent extensive training, making them the first emergency responders to have more than basic first aid.
Though the original Freedom House ambulance service was disbanded in the 1970s, the university of Pittsburgh revitalized the program in 2020 to give practice EMS training to people from impoverished communities.
Alice Ball was a 23-year-old chemist at the University of Hawaii who, in 1915, was able to convert oil from the chaulmoogra tree into a water soluble, injectable form to help treat leprosy before antibiotics became available.
As with many groundbreaking works by women and people of color, her incredible contribution to science was stolen by the white men who worked above her.
Ball died suddenly in 1916 before she could publish her findings, and the university’s president, Arthur Dean, and chemistry professor Richard Wrenshall claimed the discovery as their own. Dean even went as far as to name it after himself, calling it the “Dean method,” with no mention of Ball in any of the published papers.
It wasn’t until the 1970s that Ball was properly credited for the treatment.
Charles R. Drew is known as the “father of the blood bank” for his pioneering research into blood storage.
Prior to his research in the early 1930s, blood had to be collected from donors for immediate transfer to patients in need. By the late 1930s, blood could be stored for up to two weeks.
Through his research, Dr. Drew was able to standardize collection, testing, and storage of blood, leading the way for modern blood banks.
He’s also credited with inventing the first mobile blood collection clinics, a practice which is still in use today.
He was also part of the team that developed a way to separate plasma from whole blood so it could be shipped and transfused into soldiers during World War II, saving countless lives on the battlefield.
And finally, a modern hero: Kizzmekia Corbett, a viral immunologist who was a senior research fellow at the NIH when the COVID pandemic began.
She was able to use her years of research on coronaviruses to take the genetic sequence of SARS-CoV-2 and identify what areas a vaccine could be modeled on to inhibit disease.
Her incredible skill and knowledge was instrumental in moving the vaccine development process along quickly.
