Growing up, Uché Blackstock and her twin sister, Oni, watched their mother lead an organization of black female doctors. Inspired by their mother’s example, the sisters pursued careers in medicine and made history as the first black daughters of a woman who graduated from Harvard Medical School to earn a degree from that institution. When her mother died of leukemia at the age of 47, they were determined to continue her legacy.
Uché Blackstock, founder and CEO of Advancing Health Equity, chronicles her journey in medicine and sheds light on widespread inequalities within the U.S. healthcare system in her upcoming book. Legacy: A black doctor takes into account racism in medicine, which is scheduled for release in January. The book, which is both a multigenerational family memoir and an unflinching critique of the American health care system, traces Blackstock’s growing awareness of the growing health disparities facing black Americans. Your battle for health equity found new urgency in spring 2020, when the COVID pandemic hit New York City. Amid the backdrop of the pandemic and the Black Lives Matter movement, Blackstock found renewed power as an advocate for health equity. Now, even as the COVID federal public health emergency is over, she says there is still much work to do to address health inequity.
American scientist spoke with Blackstock about her upcoming book, the impact of racial bias in healthcare settings, and practical steps healthcare professionals and everyday people can take to promote health equity.
(Below is an edited transcript of the interview.)
Why did you choose Legacy like the title of your book?
Me Legacy It has a double meaning. There is the legacy of my twin sister and I continuing the mission of our mother’s work. But there is also the legacy of deeply rooted systemic racism in this country, which has caused Black lives to be harmed and even shortened. Today, people often look at racial health inequalities and say, “This is all based on individual habits,” rather than recognizing that what we are seeing is the culmination of centuries of systemic discrimination. My goal is to connect the dots for readers between this story and discrimination in healthcare settings.
In the book, he discusses several specific cases of how racial bias plays out in healthcare, including racial disparities in maternal mortality and treatments for sickle cell anemia. Can you explain one of those examples to us?
Sickle cell anemia is a very poignant example. In the United States, sickle cell anemia is most prevalent among black people, and there is a disturbing history of non-consensual medical research conducted on black people to study this condition. During my medical residency, I discovered how, as a disease, it has been racialized and is now considered a “black disease,” although it is not a disease that only affects black people. That racialization is reflected in the lack of funding for research to understand and treat sickle cell anemia.
In my own practice, I have witnessed people, specifically Black people, with sickle cell anemia constantly visit the emergency department because systems were not in place to proactively ensure they were receiving treatment and follow-up care. Patients were often mistreated or disrespected because some of my colleagues were quick to label them as drug seekers looking for painkillers.
In one section of the book, you talk about a specific patient who repeatedly came to the emergency room, but was told by his supervisor to turn him away because he was probably an “addict.” That was a very memorable part of the book and also difficult for me to get through.
I know. And I can tell you that he was not just that patient. There were many other patients who had similar experiences. In healthcare settings, patients are often dehumanized. And I don’t think anyone dedicates themselves to health or medicine with the goal of mistreating anyone. But because of the environment in which healthcare professionals are trained and educated, we often hold these beliefs and don’t recognize that we have them. When we interact with our patients, we end up ignoring them, minimizing their concerns, and, in the process, dehumanizing them. It is unacceptable for a patient to experience that.
In 2020 we saw the convergence of two major events: the COVID pandemic and the resurgence of the Black Lives Matter movement following the death of George Floyd. How did those events change people’s perceptions of racism and health disparities in the United States?
By the time I left academic medicine (in December 2019), I was on a mission to build my organization, Advancing Health Equity, and close the gap on racial health disparities. And when the pandemic hit, I was shocked at first, like everyone else. But within a few weeks of working in urgent care, I noticed that all the patients looked like me. And it hit me: everything you’re working toward and working toward right now is being magnified.
At that point, the conversation about racial health disparities became even more nuanced. Instead of people attributing these disparities to inherent differences in Black bodies or our biology, there was a conversation about housing, employment, and access to transportation as risk factors for being hospitalized or dying from COVID. For a long time I felt like conversations about health equity in academia had been isolated. But in 2020 we started having those conversations about the impact of systemic racism on the social determinants of health in the public world.
How can we turn those conversations into implementable interventions to address racism and health disparities?
Those conversations show us that interventions like improving patient protocols and integrating cultural competency into medical staff training are crucial components of the solution, but not the only ones. Reducing health disparities also requires action outside the hospital.
As an example, we should advocate for policies that strengthen workplace protections for essential workers or expand paid sick leave and family medical leave. These interventions actively contribute to reducing health disparities and generally reduce exposure to health risks long before people go to the hospital. There are also opportunities for broad community involvement in these initiatives. These are policy interventions that people outside the healthcare sector can and should actively advocate for.
As a physician and now with his own organization, he has worked from inside and outside the healthcare system to advocate for greater equity. What other advice would you give to people who have only been on the patient side of the healthcare system and hope to help advance health equity?
I would encourage you to reach out to groups like be a hero, which organizes ordinary people to advocate and implement political solutions. Its founder, (the late) Ady Barkan, organized locally around issues such as universal single-payer healthcare, which can improve health outcomes for all people. These types of organizations specifically target patients who have an interest in making a difference. I also believe that supporting health equity is simply about educating yourself about how we got to our current situation in the US, where we have some of the worst health outcomes of high-income countries. It’s about voting for people who promote policies that promote a healthy society.
In my book, I talk about my personal experiences as a Black doctor, and sometimes as a patient, dealing with racism. It’s almost like living in two worlds: I know what it’s like to be a doctor, but I also understand my patients’ distrust of the healthcare system. Therefore, my mission is to empower these patients and affirm their feelings, while making sure they know that there are health professionals and doctors who care deeply that they receive the best care, the most dignified and respectful care that they deserve. .
