On the surface, this year’s theme for Black History Month, Black Health and Wellness, seems timely as the country continues to grapple with COVID-19, and reckons with its racist past and present. But the health challenges in the Black community are only not a 2022 problem: the pandemic has put a spotlight on disparities that have been present for centuries, inequities deeply rooted in structural racism. Even the theme itself is pre-pandemic, chosen by the founders of Black History Month, the Association for the Study of African American Life and History (ASALH), in 2019.
In 1926, ASALH’s founder, Dr. Carter G. Woodson first established “Negro History Week” in celebration of racial pride. But it wasn’t until sixty years later, in 1986, that the U.S. Congress, in a joint resolution of the House and Senate, designated the month of February as “National Black History Month.” President Ronald Reagan issued a Proclamation that would, “make all Americans aware of this struggle for freedom and equal opportunity.” Although Black history should not be confined to a month, February is a time to highlight the extraordinary contributions Black Americans have made to American culture, medicine and science, and to our soul as a nation.
I reached out to Black leaders in the Los Angeles community to discuss many of the current issues, ranging from food deserts to historical mistrust of the medical community; the stark rates of maternal and infant mortality; and the need for Black mental health providers.
Lisa M. Richardson, M.D.
Clinical Assistant Professor of Family Medicine, Vice-Chair for Diversity, Equity and Inclusion for the Department of Family Medicine at the Keck School of Medicine of USC.
One challenge the Black community has faced during the pandemic is a traditional distrust of the medical establishment, said Faculty Physician Lisa M. Richardson. Nowhere has this been more acute than in the vaccine hesitancy that has persisted among African Americans – and Richardson attributes it to a stark lack of representation in health care and the media. Only 4% of U.S. doctors and less than 7% of medical students are Black, despite comprising 13% of the U.S. population. This underrepresentation is particularly harmful for a number of reasons. Studies have shown that Black patients have better health outcomes and experience greater quality of care when they’re seen by Black physicians.
“In light of the multiple generational impacts of trauma, wellness becomes a key issue for African Americans. However, their experience in the health care system has been re-traumatizing in itself due to lack of access to care, lack of cultural sensitivity, implicit bias, and inappropriate treatment regimens. This has generated an overall mistrust in the health care system,” Richarson said. Wellness, rather than being a central issue or key issue, has been elusive for African Americans due to the aforementioned problems in our health care system. It is vital to have adequate representation for African Americans within our health care system.”
Richardson said one source of mistrust was the Tuskegee experiment. Originally called the “Tuskegee Study of Untreated Syphilis in the Negro Male,” the 1932 study initially involved 600 Black men and was intended to record the natural history of syphilis in the Black population. The participants — 399 with latent syphilis and 201 others who were free of the disease — were recruited by the false promise of free medical care. They were only told they would be treated for “bad blood,” a colloquial term used to describe a host of diagnosable ailments. In actuality, participants received no treatment at all, even after penicillin became the recommended treatment for syphilis in 1947. The experiment continued for 40 years until whistleblower Peter Buxtun leaked information about the study to the New York Times. Details of the tragic maltreatment and abuse of Black participants were published in a front-page story in November 1972, ending the Tuskegee study. By this time the story ran, only 74 of the participants were still alive. The impact of the study was not limited to the men, but extended to their families and children. When the study was finally shut down, 40 of the participants’ wives had been infected, as well as 19 of their children.
“People talk intergenerationally about what has happened before in the past, it hasn’t been that long ago,” Richardson said, adding, “It is within my lifetime, [the experiment ended] when I was a child.”
Only 3% percent of psychologists in the U.S. workforce identified as Black, making it challenging for Black Americans to find a provider who resembles them or who may have shared life experiences.
“Although we’re improving on seeking mental health care, I think that access to care is a problem. The stigma of accessing care is an issue,” Richardson said. “Just having to disclose that information is pretty personal on anybody’s level. Nobody really wants to mention a mental illness, but let alone in the African American population where there’s less access to care, less access to psychiatrists that might look like you, where you might feel more comfortable going to a psychiatrist.”
Chief Deputy Director at Los Angeles County Department of Public Health
COVID-19 impacts Black communities in L.A. County disproportionately, said at Los Angeles County Department of Public Health Chief Deputy Director Megan McClaire, adding that it is in part related to Black residents living in overcrowded housing or holding positions as essential workers who were not able to mitigate the risk by staying at home all day.
As the Los Angeles County Department of Public Health works to combat and eliminate those inequities, McClaire said the department is focusing on factors that impact health beyond individual characteristics.
“The health disparities that we see within our county are driven by a series of upstream factors related to historical divestment in communities, marginalization, racism and that when we see disparate impacts around a series of different health conditions, whether it be hypertension, diabetes, asthma, and now most presently COVID, we continue to unveil the fact that these inequities that we see are historic in nature and are by design,” McClaire said.
Because of a historical distrust in government, McClaire said the LADPH has had to rely heavily on a broad network of community organizations, faith-based organizations and local leaders. Even before vaccines were available, the LADPH implemented the community health worker outreach initiative.
“We funded up to 14 different organizations throughout the course of the pandemic,” McClaire said. “Some of them being Black-led and many of them being Black-serving, really leveraging an existing peer network.”
Knowing there were limited vaccines available, the LADPH set up point distributions in areas that were typically under-resourced or with limited access to direct care, including Antelope Valley, Inglewood, and Pomona as well as mobile vaccination efforts throughout the county.
“We’re providing people with resources [and] also eliminating barriers for folks. We work with community-based organizations that help people with transportation and help people actually register. Some organizations even drove people to our different vaccination sites,” McClaire said.
COVID-19 has highlighted many points of health inequity that preceded the pandemic. But McClaire is hopeful that the resources and relationship connection related to requests for resources and aid, including mental health support, additional resources related to renter and tenant protections, and food security will continue beyond the COVID-19 response.
Dr. W. Marvin Dulaney
President of The Association for the Study of African American Life and History
For ASALH President Dr. W. Marvin Dulaney, February is a time to address the health challenges facing Black communities, celebrate the contributions of Black Americans to medical care and health care advancements, and reflect on the history of exploitation and maltreatment of Black people in medical science.
Certain social determinants of health, or the external environmental factors that influence health outcomes, such as poverty, income inequality, food insecurity, and environmental hazards have grave implications for both health risk and health insurance coverage for Black Americans. COVID-19 exacerbated these pervasive inequalities, Delaney said, brought home how these disparities have affected the Black community more than any other group in the country.
Dulaney is struck by the fact that 20 years of effort into improving healthcare access in the African American community have fallen woefully short of the mark. Black Americans are at greater risk for COVID-19 infection, hospitalization, and death compared to non-Hispanic white people. This is a result of other conditions that affect health, including socioeconomic status, access to health care, and exposure to the virus related to occupation, according to the Center for Disease Control.
Certain stigmas surrounding physical and mental health care in the Black community — as well as mistrust and fear of seeking care — are modern vestiges of systemic racism in health care.
“Particularly in the African American community, no one wants to be thought of as being crazy or needing to see a psychiatrist to deal with mental health issues,” said Dulaney.
Only one in three Black adults who need mental health care receive it, with 63% of Black people believing that a mental health condition is a sign of personal weakness.
Beyond mental health care, Dulaney says there is a feeling of invincibility when it comes to illness, and explained that many Black American men see routine medical care as superfluous because of historic exclusion and mistrust of the white medical establishment. Dulaney also cited the Tuskegee experiment as a main source of fear.
“Not having the tradition of going to the doctor or going to the dentist, [Black males] just sort of stumble along until eventually, we get heart disease, we get diabetes and we get some of these other killers that affect us Black men, primarily more so than others,” he said. “African American men have some of the worst health outcomes in the country. It’s primarily because they don’t take care of themselves.”
Dulaney himself grew up without the tradition of routine care and did not see a dentist until he was 21-years-old. He hopes that Black History Month 2022 will educate Americans about the cause of racial health inequalities and bring about positive change.
“We’re hoping people will not only just sit and listen and learn, but would take action,” Dulaney said. “And that action can come in a variety of ways.”
These don’t have to be great leaps, he says, but small strides in the direction of progress. Such steps include more Black Americans getting vaccinated, more routine health care and doctors visits, and greater voter participation in the Black community in support of candidates that believe in equal access to medical care.
Dr. Astrid Williams
Environmental Justice Program Manager with Black Women for Wellness.
An often overlooked area of Black Womens’ health is the personal care industry. The chemicals in personal and hair care products are the hidden costs of beauty, both in maintenance and in health, explained Environmental Justice Program Manager with Black Women for Wellness, Dr. Astrid Williams.
“It’s the unsexy thing,” said Williams on the detrimental effects of self-care products targeted toward Black women. Women of color use more beauty products and are disproportionately exposed to worrisome chemicals compared to white women, according to a study by the American Journal of Obstetrics and Gynecology. Black women spend more on cosmetics including skin-lightening creams, hair straightening treatments, and feminine cleansing and hygiene products.
“We are still in the after-effects of trying to maintain a European standard if you will,” Williams said. While Black women are a key market group for cosmetic companies, there are fewer products available for this group that are made without hazardous ingredients. In an analysis of beauty and personal care products marketed to Black women, about one in 12 was ranked “highly hazardous” on the scoring system of EWG’s Skin Deep® Cosmetics Database, with the worst-scoring products being hair relaxers, colors, and bleaching products. Fewer than one-fourth of the products marketed to Black women scored low in potentially hazardous ingredients, compared to about 40% of the items marketed to the general public. These potential hazards associated with product ingredients include cancer, hormone disruption, developmental and reproductive damage, allergies and other damaging consequences.
“Black women [are] the most overexposed and under-protected,” Williams said.
In addition to harmful products are toxic ideals surrounding self-care that are propagated on social media, Williams explained. Many “solutions” and wellness trends circulating on TikTok and Instagram are often exclusionary of marginalized communities.
“Self-care can be just taking a break, taking a nap, saying ‘no,’ not overwhelming yourself, taking a cup of tea, buying yourself roses. It doesn’t have to have a high, huge price tag to it,” she said, adding that audiences should not fall victim to the trap of care comparison. “Self-care is subjective; Whatever it means for you that’s going to help you to feel well in yourself.”
Another key element of self-care and wellness is proper nutrition, and one of the major challenges facing the Black community is food insecurity. There are a number of “food deserts” in Los Angeles, areas devoid of produce largely due to a lack of grocery stores or other healthy food providers, that affect predominantly Black neighborhoods at disproportionate rates. For example, South Los Angeles has a higher proportion of African American residents, fewer healthy food choices, and more fast-food restaurants than West Los Angeles, according to a study by the American Journal of Public Health.
“They say your body is your temple,” Williams said. “And so I think the issue that we’re facing is having access to quality food and resources because if you don’t feel well, you’re not able to care for yourself and for those who you may be responsible for.”