TY - JOUR
T1 - Examining the role of family history of us enslavement in health care system distrust today
AU - Dean, Lorraine T.
AU - Smith, Genee S.
N1 - Publisher Copyright:
© 2021 Ethnicity and Disease, Inc.. All rights reserved.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - African Americans
KW - DAEUS
KW - Enslaved persons
KW - Patient acceptance of health care
KW - Racism
KW - Trust
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U2 - 10.18865/ed.31.3.417
DO - 10.18865/ed.31.3.417
M3 - Article
C2 - 34295129
AN - SCOPUS:85111575709
SN - 1049-510X
VL - 31
SP - 417
EP - 424
JO - Ethnicity and Disease
JF - Ethnicity and Disease
IS - 3
ER -