A Legacy of Mistrust
March 4, 2025
Black History Month is a time to reflect on the resilience, achievements, and struggles of Black Americans, including their experiences within the healthcare system. The relationship between Black communities and U.S. medical institutions has been shaped by both progress and deep-rooted injustices. Acknowledging this history is not about dwelling on the past—it is about ensuring that the lessons learned lead to meaningful change. Without exposing these issues, the cycle of distrust and disparities will persist. From medical experimentation without consent to the ongoing disparities in treatment today, Black Americans have long faced systemic obstacles in healthcare. Recognizing these realities is essential to understanding how we move forward toward equity and accountability.
One of the most infamous examples of medical abuse against Black Americans is the Tuskegee Syphilis Study. From 1932 to 1972, the U.S. Public Health Service studied the effects of untreated syphilis in Black men in Alabama without informing them of their diagnosis or offering available treatments such as effective antibiotics like Penicillin. These men, many of whom died or suffered severe health complications, were deceived into believing they were receiving free healthcare.
Another horrifying case is the story of Henrietta Lacks, a Black woman whose cervical cancer cells were taken without her consent in 1951. Her cells, known as HeLa cells, became one of the most important tools in medical research, leading to countless breakthroughs, including the development of the polio vaccine and cancer treatments. Yet, her family was neither informed of what happened with her cells nor compensated for the exploitation of her biological material.
These examples, alongside numerous cases of unethical experimentation documented in Harriet Washington’s book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, have cemented a justified skepticism among Black Americans toward the medical field in the United States.
The effects of historical medical abuse are compounded by ongoing systemic racism in healthcare. Black patients, particularly Black women, often face discriminatory treatment based on deeply ingrained biases. Studies have shown that medical professionals are less likely to believe Black patients’ reports of pain, leading to under-treatment and medical neglect.
Black women, in particular, have faced dangerous levels of implicit racial bias in maternal healthcare. Despite socioeconomic status or education levels, Black women in the U.S. are three times more likely to die from pregnancy-related complications than white women. Recent studies, including those by the Kaiser Family Foundation (KFF), have shown that these disparities persist even when controlling for factors such as income and education, highlighting the significant role racism plays in maternal health outcomes.
When the COVID-19 vaccine became available, Black Americans were less likely than other racial and ethnic groups to get vaccinated (59% vaccination rate). This hesitancy was largely fueled by historical trauma and deep-seated mistrust of the medical system. A study by the National Institutes of Health (NIH) found that Black communities were less likely to receive COVID-19 testing and vaccinations, with Black women—who often serve as the primary healthcare decision-makers in their families—expressing the most concern. Given the history of medical mistreatment, their skepticism was not unfounded.
The distrust of the healthcare system among Black Americans is not just a response to individual incidents but a manifestation of intergenerational trauma. The concept of transgenerational trauma suggests that groups who have endured collective suffering, such as slavery and systemic racism, pass down the psychological and emotional effects to future generations. This trauma can result in reluctance to seek medical care, which in turn contributes to health disparities and poorer health outcomes.
According to the American Psychological Association (APA), similar effects have been observed in Indigenous communities, where historical trauma has led to distrust of governmental and medical institutions, further perpetuating cycles of inequality and poor health outcomes.
Despite efforts to address these disparities, recent (2025) Federal policy shifts threaten to reverse progress in maternal and child healthcare. With the funding cuts and policy rollbacks, Black women and other marginalized groups may face even greater obstacles in accessing quality care.
Fortunately, Black health care advocates like Dr. Nicole Rochester, as well as other health care and patient advocates, are working to combat these issues by empowering Black patients to navigate the medical system, advocate for themselves, and receive the care they deserve. The importance of patient advocacy and education cannot be overstated in addressing these ongoing challenges.
Rebuilding trust in the healthcare system requires more than just acknowledgment of past wrongs—it demands structural change. This includes:
Black Americans deserve a healthcare system that serves them equitably, with respect and dignity. Until systemic racism is eradicated from medical institutions, the legacy of mistrust will persist, continuing to put Black lives at risk. The fight for healthcare justice is not just about policy—it’s about life, dignity, and the right to thrive.
Wishing everyone good health and healthcare,
Lee
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