How can the public health care system build trust among African Americans?

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A banner says “RACISM IS A PUBLIC HEALTH CRISIS,” Baltimore, Maryland, July 9, 2020. Photo by Elvert Barnes Photography (CC BY-SA 2.0)

If it wasn’t obvious before, COVID-19 has made it crystal clear: Deep racial disparities result in varying medical outcomes. In Southern California, people of color are more likely to die from the virus than white people, and they’re less likely to be vaccinated too. Surveys have also found that 70% of Black Americans believe people are treated unfairly based on race or ethnicity when they need medical care. 

Chandra Ford is a professor in the Department of Community Health Sciences at UCLA, and director of the Center for the Study of Racism, Social Justice and Health at UCLA’s Fielding School of Public Health. She says thousands of studies have linked racial injustice and poor health, and it’s time to do more to address the disparities.

KCRW: You've said racism is a public health issue. What do you mean by that?

Chandra Ford: “So technically, racism has always played a role in shaping health. 

We can see it in the neighborhoods that we drive through, the disparities that we see that happen in health along racial and ethnic lines. What's different now is we're actually using the term racism to characterize the effects of racism. 

Until now, we've largely not used that word to describe problems that are linked to racism. So racism has been a problem because it disproportionately leads to higher rates of disease — and also not just disease but also death in communities of color.”

What about anti-Blackness? What role does that play in public health?

“The idea of anti-Blackness is not new. In thinking about the ways that anti-Blackness operates, it's important to set concerns about mistrust and the vaccine with respect to COVID-19 in the context of historical anti-Blackness. In that context, it makes sense for African Americans to express concerns about the possibility of being treated unfairly in the health care system.

I think that gets conflated with vaccine mistrust in general. So the vaccine hesitancy or even science denialism. I think it needs to be looked at as very different things. On the one hand, we have historical and ongoing anti-Black forms of racism that need African Americans to perceive and to be concerned about the ways they might be treated in society in general and within the health care system.”

We often hear about the devastating Tuskegee study, which involved doctors letting Black men die from syphilis. But you've indicated that the field of medicine and health has a long, troubled racial history. What are some other examples of racism and the legacy of public health?

“It's really difficult to think of our field, public health, without thinking about all of the benefits of medicine and public health that we all enjoy that have come at the expense of socially marginalized communities. And those experiences are not only experiences outside the health care sector. 

So for instance, we can think about the segregated hospitals of the Jim Crow era within the field. However, there is a corollary. So we have segregated professional societies, segregated schools of public health and of medicine. These factors contribute to the lack of trustworthiness, which in turn leads to the sense of mistrust.”

The health care community often asks how they can get Black people to trust them. Is it possible?

“It absolutely is possible. Black people, like everyone else, have their own well-being at heart. And in fact, one way to think about it is that there is a tremendous level of resiliency, having survived so many different challenges over the generations. 

In fact, the research shows us time and time again that Black people are eager to take the advice of trusted health care providers. 

The key is to recognize that mistrust is really a symptom. Mistrust is not the root of the problem. And so if mistrust is the symptom, then we must deal with the problem, the need to make our institutions more trustworthy.”



Larry Perel


Tara Atrian