If Only Trust Was Enough
By Dr. Rhea Boyd
Even as this once-in-a-century pandemic lays bare the deadly toll of America’s investments in racism, capitalism, and white supremacy, some still uplift narratives about Black people and “historical mistrust” as a way of making sense of the racial health inequities that continue to emerge. One of the issues with these narratives is that they treat Black folks’ mistrust as the problem, as if trust alone could ever extend lives that have been foreshortened by inaccessible care or return futures that have been stolen by unchecked inequality.
To be clear, trust won’t cover the price of prescription medicines or eliminate costly copays required for specialty services. Trust can't bring vaccines to your neighborhood, conjure up competent clinicians or provide accessible primary care facilities. Trust isn’t even an accepted legal tender that folks can use to purchase health insurance coverage.
In short, trust is neither necessary nor sufficient to procure medical care in the United States.
And the inordinate focus on assessing where Black people fall on the trust/mistrust continuum has come to supplant adequate engagement with the structures that render the Black community vulnerable to poor outcomes and create mistrust. As generations of Black scholars, activists and citizens have noted, it is structural racism, not mistrust of the health care system, that places Black communities in proximity to deadly exposures and yet just outside the reach of life-saving resources and care.
What’s more, the legacy of mistrust within the health care system extends to clinicians and health care systems too. The mistrust that clinicians and systems have for Black patients is less often explored despite potentially having serious consequences. A 2020 Kaiser Family Foundation poll found that more than 1 in 5 Black adults surveyed had a recent experience with a health care provider who didn't believe they were telling the truth. These perceptions underscore the growing evidence revealing racial inequities in the assessment and treatment of common ailments like pain, including in pregnant women and children. When Black patients are not believed, it invalidates their claims of suffering and ultimately renders them vulnerable to humiliation, delayed care, and associated excess morbidity and mortality.
This is a part of the various ways racism works to shape how clinicians and health care systems underserve Black patients — by first disbelieving and then dismissing Black patients’ legitimate needs and concerns.
Right now, we see this happening right in front of our eyes as Black communities have had their reasonable concerns about the COVID-19 vaccines mislabeled as "hesitancy" or mistrust. With an ever-shrinking portion of the populations polled reporting that they would decline vaccination even if eligible, the concerns among those still "waiting to see" are now generally shared across groups. Most Americans want to know about the vaccines’ potential side effects, if the vaccines are affordable, if individuals can get COVID-19 from the vaccine. (Common side effects are mild, and serious side effects are rare. The vaccines are free for everyone; our tax dollars have already paid for them. You cannot get infected with the COVID-19 virus from the vaccine because the COVID vaccines are not live virus vaccines.)
By believing and respecting Black patients’ concerns, health care systems and providers are better equipped to address them accordingly. And that's exactly what's being done through THE CONVERSATION: Between Us, About Us, a national campaign created by Black health care workers to provide Black communities credible and accessible facts about the COVID vaccines. In partnership with the Kaiser Family Foundation and the Black Coalition Against COVID, the campaign builds upon the intimate conversations folks are already having about the COVID vaccines in their kitchens and living rooms and adding health care providers who can speak directly to their concerns.
Since launching on YouTube on March 4th, the campaign has amassed more than 2.3 million views on its library of frequently asked questions (FAQ) videos. And if views are signs of interest, the overwhelming response has been evidence of Black folks’ interest in knowing more about the COVID vaccines. Over the next three months, as vaccine supply increases across the nation, the campaign will also work with community-based organizations to bring this information to Black neighborhoods across the country — to overcome barriers to information like lack of internet access. Campaign organizers also created a tool kit that details how to use and share the informational videos on social media or other websites for free.
Ultimately, if trust alone were enough, any Black person could simply trust their way into longer lives and equal resources. But it is not. It never has been. And it never will be. Black patients’ trust can only result from health care systems comprehensively addressing the problem of racism, in all of its forms, and carefully and lovingly attending to Black patients’ concerns and needs. That is what is being done through #BetweenUsAboutUs, and that is the new standard.
Dr. Rhea Boyd is a pediatrician, public health advocate and scholar who writes and teaches on the relationship between structural racism, inequity and health. In partnership with the Kaiser Family Foundation and the Black Coalition Against COVID, she co-developed the national campaign THE CONVERSATION: Between Us, About Us, to bring information about the COVID vaccines directly to Black communities.