Diversity in Science

Addressing Medical Mistrust within Black and Indigenous Communities

By Shu‘ayb Simmons

Introduction: Medical Mistrust Within Black and Indigenous Communities Looking Back: Medical Violence Towards Black and Indigenous Communities

Close your eyes for a second and imagine you are in the waiting room for a checkup. You patiently sit, waiting for the nurse to call out your name so that you can begin walking into the doctor’s offi ce. But, upon entering, you see your trusted doctor ready to inject you with dangerous substances. Sound like a nightmare? For Black and Indigenous peoples, who were the subjects of many non-consensual experiments in the past, this is a real fear. Even currently, healthcare quality is disparate across the racial majority and minority groups. Th ese transgressions fomented feelings of medical mistrust within Black and Indigenous communities. Th is article aims to discuss the existing medical mistrust within Black and Indigenous communities and provide potential avenues to mitigate its consequences. Medical mistrust is a noticeable lack of trust and suspicion with the medical system,1 usually caused by the medical system itself. It can stem from various sources, for example, a lack of education—a socioeconomic barrier—can lead to medical mistrust. A key factor behind medical mistrust, however, is history. Communities previously betrayed by the medical system are less likely to trust healthcare. In a study published by the American Journal of Public Health, it was found that Black individuals are more likely to distrust physicians than their white counterparts.2 Th is mistrust proves detrimental in the long term as Black, and Indigenous individuals are more likely to under-utilize psychiatric help.1,4 In this manner, medical mistrust is a social determinant of health. It plays a role in racial disparity across illnesses,2 so much so that it intertwines with long-term non-adherence to HIV medication among Black males positive for HIV.3 Th e primary victims of medical mistrust are Black and Indigenous

Getting into it: Medical Mistrust

communities and, to a lesser extent, sexual minorities.1,4

To understand the basis of medical mistrust in Black and Indigenous communities, we need to look back at historical acts of medical violence against these populations. Th e Black populace has been subject to much medical violence and betrayal by healthcare, the most prominent and evident of which is slavery. Another particularly stark example is the Tuskegee Syphilis Experiment, which ran from 1932 to 1972. Here, scientists tricked 600 men (399 with syphilis, 201 without) from a Black community in Tuskegee, Alabama into participating in an observational study under the pretense that it was a “bad blood” treatment. As the virus took its course, they were observed and not given penicillin even as the symptoms grew more severe. Out of the experimental group of 399, only 74 survived. Funded by the U.S. Public Health Service, the Tuskegee

Experiment is now regarded as an ethically egregious study that violated countless bioethical principles of research. However, the melody of this and all other medical pain lingers on in Black communities.

Similar acts of medical violence against Indigenous communities exist as well. Canadian Indigenous people were disproportionally forcibly sterilized under the Sexual Sterilization Act of 1928.5 However, forced sterilization of Indigenous peoples is not merely a thing of the past; in 2017, 60 Indigenous women from Saskatchewan sued their provincial government for coercion into imposed sterilization.6 Th e Indian Act of 1876 is also an act of medical violence that played an axiomatic role in fostering medical mistrust within Indigenous populations. Th is act gave all the First Nations’ health responsibilities to the federal government,7 eff ectively stripping these communities of their agency. Although changed, the Indian Act still exists today. Within medical research, the Havasupai diabetes project is a key example of medical violence and betrayal against Indigenous communities. In 1989, the Havasupai Tribe in Arizona donated blood to researchers at Arizona State University to search for a link to diabetes–a disease ravaging the community–but used the samples to search for markers of other illnesses.8 Altogether, these numerous acts of medical violence compound and play a substantive role in propagating medical mistrust. Moving Forward: The Consequences of Medical Mistrust and Repairing the Trust

Medical mistrust aff ects the likelihood of Black and Indigenous individuals seeking help, aggravating prominent disparities.9 To reduce the trickle-down eff ects of medical mistrust that further racial disparity, the fi rst step is to acknowledge the issue and educate oneself on its historical background. As medical researchers, it is paramount that we consider healthcare history towards Black and Indigenous individuals, especially when conducting clinical research. In doing so, we favour equitable health outcomes and actively show Black and Indigenous communities that healthcare is trustworthy, cognizant of prior misdeeds, and racially conscious.

References

1. Jaiswal, J., & Halkitis, P. N. (2019). Towards a more inclusive and dynamic understanding of medical mistrust informed by science.

Behavioral Medicine, 45(2), 79–85. 2. Armstrong, K., Ravenell, L., McMurphy, S. et al. (2007). Racial/ethnic diff erences in physician distrust in the United States. American journal of public health, 97(7), 1283–1289. 3. Dale, S. K., Bogart, L. M., Wagner, G. J., Galvan, F. H. et al. (2014).

Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV. Journal of Health

Psychology, 21(7), 1311–1321. 4. Aboriginal Multi-Media Society. Compiled by Shari. (2013).

Racism, mistrust keep Aboriginal people from health care. Ammsa. com. 5. Black, A., Rich, R., & Felske-Durksen, C. (2021). Forced and coerced sterilization of indigenous peoples: Considerations for Health

Care Providers. Journal of Obstetrics and Gynaecology Canada, 43(9), 1090–1093. 6. CBC Radio Canada. (2018, November 13). Indigenous women kept from seeing their newborn babies until agreeing to sterilization, says lawyer. CBC Radio. 7. Government of Canada. Indian Act, 1876 R.S., c. I-6, s. 1. 1876. 8. Sterling, L. (2011). Genetic Research Among the Havasupai: A

Cautionary Tale. AMA Journal of Ethics, 13(2), 113–117. 9. Mental Health America. (2019). Black and African American communities and Mental Health. Mental Health America.