Mistrust of medicine, doctors is a public health challenge [column]

The COVID-19 pandemic may be getting fewer headlines these days, but its impact lingers, particularly in communities of color. Vaccine hesitancy is a major public health challenge.

Despite efforts to boost vaccination rates, many Black and Latino Americans remain skeptical due to deep-seated medical mistrust — not ignorance or anti-scientific beliefs.

We must not only recognize this mistrust, but also maintain accountability through competency, not blame.

The Tuskegee syphilis study, spanning 1932 to 1972, was a clear example of betrayal of Black men with syphilis. Those who participated in the study were intentionally left untreated without their knowledge of their syphilis status. They lived with syphilis for years, despite there being a cure, just to see what the infection does to a person.

In addition, the U.S. syphilis study in Guatemala was run from 1946 to 1948. It involved American researchers deliberately infecting vulnerable individuals (prisoners, sex workers, orphans, etc.) with syphilis and other sexually transmitted diseases without their consent.

These experiments, both sponsored by the U.S Public Health Service, ignored major ethical concerns such as autonomy and informed consent to exploit these marginalized groups for research.

The consequences of these medical betrayals exist as a collective memory in communities of color and are passed down through the generations. These past incidents of exploitation fuel the skepticism of new medical initiatives.

Recent studies have shown that Black patients, in comparison to white patients, are less likely to receive adequate pain treatment, even if they exhibit the same symptoms.

Similarly, Latino patients may face language barriers and fears of being subjected to stereotypes when they seek care.

This was especially evident during the COVID-19 pandemic, when these two groups had disproportionately higher rates of mortality because of decreased vaccination and treatment access compared to other groups.

Why should communities of color trust a public health system that has repeatedly failed them? Disparities in care exist between groups but, unfortunately, they do not stop there. People of color have historically been excluded from ethical medical research and clinical trials, meaning their population is not accurately accounted for. Intentionally excluding them leads to ineffective or harmful treatment outcomes.

It can seem as if there is no middle ground for communities of color: They are either completely ignored or exploited.

Public health campaigns do not take historical events into account when advocating for new treatments. Simply saying a vaccine is safe is not sufficient to convince all people to take it. Community leaders should try to work with public health officials to spread necessary information. Hearing it come from a trusted person could help the information resonate accurately with marginalized populations. The public health system must acknowledge past mistakes while addressing how to go forward.

Acknowledgment of the concerns people have about mistrust is critical to rebuilding the trust that has been broken. Transparency with open and respectful dialogues is key. Knowing where concerns exist and allowing for critiques will create a sense of trust between communities and health care providers.

It is important not to just focus on a one-time outreach effort such as the one that took place during the COVID-19 pandemic. Instead, we need systemic, long-term alterations to outreach.

Public health efforts should be long-term investments, including equitable health care access, increased diversity in research and accountability for past and present injustices in medicine.

These systems must acknowledge the root causes of mistrust to improve the health outcomes of marginalized communities.

One way to build trust would be to increase diverse representation in health care. If patients see a doctor or a public health official who looks like them, they are more likely to feel heard and understood. Beginning with the medical education curriculum, cultural competence and sensitivity should be taught throughout the health care field.

An education that covers historical injustices, implicit bias and effective communication tailored to diverse populations is an absolute necessity. This can allow professionals to be able to respond more appropriately to the population they are working with. Policies that address disparities such as affordable health care or language accessibility must be prioritized. Without structural and systemic change, mistrust will continue.

Anyone can become educated on health care inequities by seeking trusted resources, such as the National Institute on Minority Health and Health Disparities. We should research, support and vote for leaders and policies that advocate for equity in health care.

The next pandemic will come. Are we ready for it? Can we ensure that every community, regardless of race or ethnicity, trusts the health care system enough to protect itself? The time to start rebuilding that trust is now.

Claire McQuade graduated from Franklin & Marshall College this spring.