Lorraine T Dean1,2, Genee S Smith3. 1. Departments of Epidemiology, Health Policy & Management, and Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. 2. Department of Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD. 3. Department of Environmental Health & Engineering, and the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
Abstract
Objective: Black/African American people have long reported high, albeit warranted, distrust of the US health care system (HCS); however, Blacks/African Americans are not a homogenous racial/ethnic group. Little information is available on how the subgroup of Black Americans whose families suffered under US chattel slavery, here called Descendants of Africans Enslaved in the United States (DAEUS), view health care institutions. We compared knowledge of unethical treatment and HCS distrust among DAEUS and non-DAEUS. Design and Setting: A cross-sectional random-digit dialing survey was administered in 2005 to Blacks/African Americans, aged 21-75 years, from the University of Pennsylvania Clinical Practices in Philadelphia, Penn. Participants: Blacks/African Americans self-reported a family history of persons enslaved in the US (DAEUS) or no family history of persons enslaved in the US (non-DAEUS). Main Outcome Measures: HCS distrust was measured by a validated scale assessing perceptions of unethical experimentation and active or passive discrimination. Methods: We compared responses to the HCS distrust scale using Fisher's exact and t-tests. Results: Of 89 respondents, 57% self-reported being DAEUS. A greater percentage of DAEUS reported knowledge of unethical treatment than non-DAEUS (56% vs 21%; P<.001), were significantly more likely to express distrust, and to endorse the presence of covert (eg, insurance-based) than overt forms (eg, race-based) of discrimination by the HCS. Conclusions: DAEUS express greater HCS distrust than non-DAEUS, patterned by awareness of unethical treatment and passive discrimination. Understanding how long-term exposure to US institutions influences health is critical to resolving disparities for all Black/African American groups. Rectifying past injustices through reparative institutional measures may improve DAEUS' trust and engagement with the US HCS.
Objective: Black/African American people have long reported high, albeit warranted, distrust of the US health care system (HCS); however, Blacks/African Americans are not a homogenous racial/ethnic group. Little information is available on how the subgroup of Black Americans whose families suffered under US chattel slavery, here called Descendants of Africans Enslaved in the United States (DAEUS), view health care institutions. We compared knowledge of unethical treatment and HCS distrust among DAEUS and non-DAEUS. Design and Setting: A cross-sectional random-digit dialing survey was administered in 2005 to Blacks/African Americans, aged 21-75 years, from the University of Pennsylvania Clinical Practices in Philadelphia, Penn. Participants: Blacks/African Americans self-reported a family history of persons enslaved in the US (DAEUS) or no family history of persons enslaved in the US (non-DAEUS). Main Outcome Measures: HCS distrust was measured by a validated scale assessing perceptions of unethical experimentation and active or passive discrimination. Methods: We compared responses to the HCS distrust scale using Fisher's exact and t-tests. Results: Of 89 respondents, 57% self-reported being DAEUS. A greater percentage of DAEUS reported knowledge of unethical treatment than non-DAEUS (56% vs 21%; P<.001), were significantly more likely to express distrust, and to endorse the presence of covert (eg, insurance-based) than overt forms (eg, race-based) of discrimination by the HCS. Conclusions: DAEUS express greater HCS distrust than non-DAEUS, patterned by awareness of unethical treatment and passive discrimination. Understanding how long-term exposure to US institutions influences health is critical to resolving disparities for all Black/African American groups. Rectifying past injustices through reparative institutional measures may improve DAEUS' trust and engagement with the US HCS.
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