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Systemic Barriers

Historically in the United States African American people have experienced harm and

mistreatment. Even after the signing of the emancipation proclamation in 1872(?). Many

emancipated slaves did not have the basic skills to be function members of society. Skills such as

reading comprehension ,writing etc. These types of barriers prevented African Americans from

accessing and utilizing many resources available to them. More specifically the medical field and

its professionals. Research has shown that there is a level of medical mistrust among healthcare

professions and African American people. The start of this mistrust could be cited back to the

Tuskegee Syphilis. While this may be an example this is not the source. Many factors play into

this mistrust, things such as lack of health literacy and intergenerational beliefs. In the article

“Under the Shadow of Tuskegee: African Americans and Health Care'' Dr. Gamble takes a

deeper look at the historical implications that come prior to the Tuskegee Syphilis study. In this

article the author implies that the idea of African American people as human guinea pigs is

nothing new and that Tuskegee was not the first time it has occurred. The author states “Black

Americans’ fears about exploitation by the medical profession date back to the antebellum period

and the use of slaves and free Black people as subjects for dissection and medical

experimentation (Gamble, 1997)”. The experimentation was nothing short of pure torture, being

perpetuated by the nation's earliest physicians. While this experimentation was basically torture

there was no one to object or protect the enslaved person because in the eyes of there enslaver

they were replaceable objects that did not need protecting. Black people were defenseless to the

torture they endured while enslaved, in a sense powerless and had no control over their own

bodies. This may be when the mistrust began of placing their health in the hands of others,

especially physicians who did not believe they experienced pain the same as they did. In

communities of newly freed people there was a common belief or folklore of a night doctor. This

“night doctor” was said to come and capture any African American people he would

encounter(Gamble, 1997). Most believed they were experimented on or killed, and their bodies

would be studied. Also, the bodies of African Americans would be taken from graves and

shipped to northern medical schools to be studied. As time progressed unfortunately the

treatment did not improve. When African Americans went into hospitals during the late 20th

century, they often received the poorest care, and they were given the poorest rooms (Gamble,

1997). This along with other factors pushed Black physicians to advocate for the treatment of

Black people within professional circles. In the 1920s and 30s Black physicians pushed for

additional measures that could help combat the medical racism harming African American

people. Measures such as African American ran hospitals , additional research into diseases that

disportiantly affect Afrcian Americans. While the professionals asking for help did not get much

traction the federal government stepped in. In 1923 the federal government pledged an African

American run hospital that would serve the African American populations in the area. While

there were disputes between local whites and blacks between who would control the hospital the

local blacks gained control of the hospital. Nine years later this hospital was one of the facilities

used by the federal public health services when they conducted the infamous Tuskegee Syphilis

study. The treatment coupled with the prejudice and discriminatory practices was enough to

overtly damage the relationship between medical professionals and black people. This historical

mistreatment of African Americans carried on for generations and made accessing quality care

that much more difficult. This historic treatment of African Americans was not forgotten or

forgiven.

Factors Surrounding Access to Health Care

African Americans experience difficulties accessing care before they even step foot in a

healthcare facility. Difficulties such as social determinants of health and health literacy. Social

determinants of health are the conditions in which people are born, grow, live, work and age that

shape health. These conditions make up for 75 % of one's health (O’Brien, 2019) . The five key

areas are Economic Stability, Education, Social and Community Context, Health and Health

Care, Neighborhood and Built Environment (O’Brien, 2019). Economic Stability is based on

one's ability to earn a steady income that allows them to meet their health needs. Education is

based on the level and quality an individual has accessed. Social and community context is based

on an individual's community engagement, support systems ,stress and overall social integration.

Health and Health Care is based on an individual's access to health care , access to primary care,

and their level of health literacy. Most people are affected by more than one of these areas. For

example, if a person does not have a steady income. They are less likely to have stable housing

and healthy food choices. The cycle of poverty begins at home which can lead to the inability to

afford or access health care (O’Brien, 2019). In 2019, the share of Blacks in poverty was 1.8

times greater than their share among the general population (O’Brien, 2019). Blacks represented

13.2% of the total population in the United States, but 23.8% of the poverty population (O’Brien,

2019). This means that millions of Americans across the nation experienced higher stress ,

poorer diets ,decreased opportunities for exercise, diminished access to medical care , and

limited transportation. These conditions all affect health and oftentimes when people do make it

into seek medical care they are not properly screened in these areas. Health Literacy is the degree

to which individuals have the capacity to obtain, process, and understand basic health

information needed to make appropriate health decisions(O’Brien, 2019).” This level of

understanding can lead to a sense of intimidation when seeking care and discourage people from

coming back.

LHL prevents optimal health system and insurance navigation, affecting health care access and

health outcomes

limited educational opportunities, racism, health system mistrust, and a lack of culturally tailored

health information and services are health literacy barriers for this population

health care providers may not recognize the extent of this health literacy gap. One study reported

that physicians overestimated the health literacy scores of 54% of African-American patients,

compared with 11% of non- Hispanic White and 36% of patients of another race/eth- nicity

References

Gamble, V. (1997). Under the shadow of Tuskegee: African Americans and health care.

American Journal Of Public Health, 87(11), 1773-1778. doi: 10.2105/ajph.87.11.1773

O’Brien, K. (2019). Social determinants of health: the how, who, and where screenings are

occurring; a systematic review. Social Work In Health Care, 58(8), 719-745. doi:

10.1080/00981389.2019.1645795