At the end of her April 18 Vanderbilt Discovery Lecture on race and racism in American health care, Vanessa Northington Gamble, MD, PhD, was asked, “Will we ever get to a place where equity will be accomplished?”
Gamble, an internationally known advocate for equity and justice in medicine and public health, responded without hesitation. “If I did not believe we could get there,” she said, “I would not be able to get up in the morning.”
She continued, “I firmly believe the only way it won’t happen is if we stop trying. We have to stand tall, and say, ‘This is important … We are not going to back down.’”
Gamble is University Professor of Medical Humanities at the George Washington University in Washington, D.C, the first woman and first African American to hold the endowed faculty position.
In a talk sponsored by the Vanderbilt Medical Scientist Training Program, she described the deeply flawed yet lingering concept in American medicine that ascribes racial disparities in health status to inherent biological differences, rather than to environmental and sociological factors.
Gamble began her talk with a description of the yellow fever epidemic of 1793, which wiped out 10% of the population of Philadelphia. At the time, it was widely believed that Black people did not get infected by what is now known to be a mosquito-transmitted disease.
Thus, after wealthier white people fled Philadelphia to escape the fever, city leaders called upon the free Black population to tend to the sick and bury the dead. Yet the sacrifices made by Black citizens were ignored and even vilified in published accounts of the epidemic.
In response, Absalom Jones and Richard Allen, prominent members of Philadelphia’s African American community, published a blistering reply. They challenged the theory of racial immunity to yellow fever, pointing out that Black people also died of the disease — many while caring for white people.
“Our distress has been very great,” they wrote, “but much unknown.”
In the years after Emancipation, an increase in tuberculosis among Black people in the South was attributed — in scholarly works and leading medical journals — to anatomical and physical differences, innate mental characteristics, and even to immorality that followed the abolition of slavery.
Again, there was pushback. African American physicians and social scientists, notably W.E.B. Du Bois, contended that “pulmonary consumption” was not an inherent trait, but was driven by socioeconomic factors and racism. Something could be done, they argued. Improved sanitation. Adequate housing. Education. Providing economic opportunities for those mired in poverty.
Yet racist beliefs persisted, and only seemed to harden during the Jim Crow era. One of the most infamous examples was the study of untreated syphilis in Black men conducted by the U.S. Public Health Service in Tuskegee, Alabama, from 1932 until it was halted in 1972.
Not only was the study an egregious violation of research ethics and of the rights and human dignity of the research subjects, but it was based on the belief that syphilis was a different disease in Black people.
Yet it did not include a white control group, noted Gamble, who chaired the committee leading the campaign that obtained an apology from President Bill Clinton in 1997.
Today efforts are being made to address the errors of the past. The New England Journal of Medicine is publishing a series of perspectives by historians and social scientists that examine the enduring legacy of historical biases.
“We’re still fighting this battle,” Gamble said. “We’re trying to discover how to talk about race in a way that does not talk about biology, and how Black people are different. People realize there is a problem.”
For a link to the video of Gamble’s lecture and to access previous Discovery Lectures, go to https://www.vumc.org/discovery-lecture-series/upcoming-lectures.
