The Racial Divide in American Medicine: Black Physicians and the Struggle for Justice in Health Care

McBride, David

doi:10.1093/jahist/jaaa192

Cited by 3 publications

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“…The centuries‐long legacy of enslavement, oppression, discrimination, and stress suffered by African Americans continues to have pervasive adverse effects, including access to healthcare and risks of disease. Structural racism and discriminatory practices remain major targets for political action, advocacy, research, and health policy (Braveman & Gottlieb, 2014; Colen et al, 2017; deShazo, 2018). Less well known or understood is that people of West Central African descent are not only at increased risk of certain diseases but also of reduced risk of other diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Williams et al (Williams et al, 2019) have proposed that socioeconomic factors alone do not account for racial and ethnic inequities in health and that racism is a fundamental cause of adverse health outcomes for racial and ethnic minorities. For each of the primary domains of racism affecting mental and physical health outcomes-structural racism, cultural racism and individual-level The legacy of 400 years of slavery, violent oppression, discrimination, and emotional stress suffered by African Americans, and the struggle for access both to receive and provide health care, continue to have pervasive effects (Braveman & Gottlieb, 2014;Colen et al, 2017;deShazo, 2018). The COVID-19 pandemic in 2020-2022 also disproportionately affects African Americans; across the United States, COVID-19 mortality rates in predominantly black counties have been sixfold higher than in predominantly white counties (Yancy, 2020).…”

Section: S Truc Tur Al R Acis M and He Alth Dis Paritie Smentioning

confidence: 99%

“…The legacy of 400 years of slavery, violent oppression, discrimination, and emotional stress suffered by African Americans, and the struggle for access both to receive and provide health care, continue to have pervasive effects (Braveman & Gottlieb, 2014; Colen et al, 2017; deShazo, 2018). The COVID‐19 pandemic in 2020–2022 also disproportionately affects African Americans; across the United States, COVID‐19 mortality rates in predominantly black counties have been sixfold higher than in predominantly white counties (Yancy, 2020).…”

Section: Structural Racism and Health Disparitiesmentioning

confidence: 99%

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Understanding health disparities affecting people of West Central African descent in the United States: An evolutionary perspective

Mawson

2023

Evolutionary Applications

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Human populations adapting to diverse aspects of their environment such as climate and pathogens leave signatures of genetic variation. This principle may apply to people of West Central African descent in the United States, who are at increased risk of certain chronic conditions and diseases compared to their European counterparts.Less well known is that they are also at reduced risk of other diseases. While discriminatory practices in the United States continue to affect access to and the quality of healthcare, the health disparities affecting African Americans may also be due in part to evolutionary adaptations to the original environment of sub-Saharan Africa, which involved continuous exposure to the vectors of potentially lethal endemic tropical diseases. Evidence is presented that these organisms selectively absorb vitamin A from the host, and its use in parasite reproduction contributes to the signs and symptoms of the respective diseases. These evolutionary adaptations included (1) sequestering vitamin A away from the liver to other organs, to reduce accessibility to the invaders; and (2) reducing the metabolism and catabolism of vitamin A (vA), causing it to accumulate to subtoxic concentrations and weaken the organisms, thereby reducing the risk of severe disease. However, in the environment of North America, lacking vA-absorbing parasites and with a mainly dairy-based diet that is high in vA, this combination of factors is hypothesized to lead to the accumulation of vA and to increased sensitivity to vA as a toxin, which contribute to the health disparities affecting African Americans. vA toxicity is linked to numerous acute and chronic conditions via mitochondrial dysfunction and apoptosis. Subject to testing, the hypothesis suggests that the adoption of traditional or modified West Central African-style diets that are low in vA and high in vA-absorbing fiber hold promise for disease prevention and treatment, and as a population-based strategy for health maintenance and longevity.

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Section: Discussionmentioning

confidence: 99%

Section: S Truc Tur Al R Acis M and He Alth Dis Paritie Smentioning

confidence: 99%

Section: Structural Racism and Health Disparitiesmentioning

confidence: 99%

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Understanding health disparities affecting people of West Central African descent in the United States: An evolutionary perspective

Mawson

2023

Evolutionary Applications

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“…During this time, the American Medical Association (AMA) constructed or was complicit in the use of multiple barriers to keep Black physicians outside mainstream medical institutions, such as refusing to recognize Black delegates at state and national medical society meetings and supporting segregated medical education. 5,[8][9][10] These racist and exclusionary practices added challenges for Black individuals hoping to enter the field of medicine and depressed the numbers of Black physicians. 5,8,10 One concrete example of the AMA's anti-Black practices during this period of medical professionalization is in the pages of the American Medical Directory (AMD).…”

Section: Introductionmentioning

confidence: 99%

“…5,[8][9][10] These racist and exclusionary practices added challenges for Black individuals hoping to enter the field of medicine and depressed the numbers of Black physicians. 5,8,10 One concrete example of the AMA's anti-Black practices during this period of medical professionalization is in the pages of the American Medical Directory (AMD). 8 In 1906, the AMA began large-scale efforts to compile and publish a medical directory, listing all credentialed physicians (not just AMA members) by city, county, and state.…”

Section: Introductionmentioning

confidence: 99%

US County-Level Variation in Availability and Prevalence of Black Physicians in 1906

Chrisinger

2024

JAMA Netw Open

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ImportanceBlack physicians are substantially underrepresented in the US health care workforce, with detrimental effects on the health and health care experiences of Black individuals. These contemporary gaps can be traced to the early days of the medical profession using the first edition of the American Medical Directory (AMD).ObjectiveTo identify state- and county-level patterns related to the training and availability of Black physicians relative to their White counterparts in the 1906 AMD.Design, Setting, and ParticipantsFor this cross-sectional study, data for 41 828 physician entries in 18 US states in or adjacent to the South as well as the District of Columbia were extracted from the 1906 AMD and aggregated to 1570 counties. Data analysis was performed between September 2023 and January 2024.ExposuresCounty-level exposure variables included population density, racial composition, and illiteracy rate among US-born White residents as well as an index of terrain ruggedness and the number of lynchings in the previous decade. Median values of physicians’ distance from place of practice to place of medical training (by race of physician) were also used as an exposure variable.Main Outcomes and MeasuresThere were 4 county-level outcomes: (1) presence of any Black physician, (2) proportion of Black physicians per Black population, (3) proportion of White physicians per White population, and (4) community representativeness (reported as the community representativeness ratio). The cross-sectional analysis used generalized additive mixed models with state-level random effects.ResultsAcross 1570 counties, Black physicians comprised 746 (1.8%) of the 41 828 physicians in the dataset. Black physicians tended to train further from their place of practice than their White counterparts. The proportion of Black physicians per 1000 Black residents was 0.08 compared with 1.62 for White physicians; these proportions varied substantially by state. At the county level, the presence of any Black physician was associated with percentage Black population (odds ratio [OR], 28.94 [95% CI, 9.77 to 85.76]; P ≤ .001), population density (OR, 2.63 [95% CI, 2.03 to 3.40]; P ≤ .001), and distance to the nearest Black medical school (OR, 0.62 [95% CI, 0.42 to 0.92]; P = .02).Conclusions and RelevanceA variety of structural disadvantages are illustrated in this cross-sectional study of county-level sociodemographic and geographic characteristics associated with the prevalence of Black physicians in the earliest days of the profession. To demonstrate its broader utility for health disparities research, the dataset has been made publicly available with a visualization platform.

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Isis Current Bibliography of the History of Science and Its Cultural Influence 2023

2023

Isis

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The Racial Divide in American Medicine: Black Physicians and the Struggle for Justice in Health Care

Cited by 3 publications

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Understanding health disparities affecting people of West Central African descent in the United States: An evolutionary perspective

Understanding health disparities affecting people of West Central African descent in the United States: An evolutionary perspective

US County-Level Variation in Availability and Prevalence of Black Physicians in 1906

Isis Current Bibliography of the History of Science and Its Cultural Influence 2023

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