Medical Racism from 1619 to the Present: History Matters || Harvard Radcliffe Institute

good afternoon i'm evelyn hammonds i'm professor of the history of science and african and african american studies here at harvard and it's my great pleasure to welcome you to today's discussion entitled medical racism from 1619 to the present history matters this program is a collaboration between the program on race and gender and science and medicine at the hutchins center for african and african-american research here at harvard and also the presidential initiative on harvard and the legacy of slavery and of course the radcliffe institute this is a very timely topic given that the pandemic of covet 19 is engulfing the world and here i just want to take a note that we should all be praying for uh the current situation uh in india and we hope that it is resolved soon so i like our guest historians have been involved in many discussions over the last year where journalists and others have asked us to speak about the lessons that we can learn from the history of past epidemics to help us understand our contemporary situation the pandemic of covet 19 like so many other epidemics has revealed deep and persistent racialized inequalities in u.s society and in many respects these inequalities are tied to structural racism within within many u.s institutions including medicine and public health our discussion today will focus on the history of medical racism covering much of american history through a few episodes and i'm very happy to welcome two of my fellow historians jim downs and susan reverby to share their important work on this topic our format is as follows after my introductions jim and susan will each speak for about five to eight minutes then the three of us will have a conversation for about 20 minutes and of course then we will open up for questions from the audience so please remember to submit your questions through the q a function now let me introduce our speakers susan reverby is the marion butler mclean professor emerita in the history of ideas and professor emerita in women's and gender studies at wellesley college and a visiting fellow in the project on race and gender in medicine and science at the hudson center for african and african americans research here at harvard susan is a well-known historian of american medicine nursing race and women among her many books are an edited collection tuskegee's truth rethinking the tuskegee syphilis study from 2000 and her multiple prize winning examining tuskegee the infamous syphilis study and its legacy 2009. in 2010 her exposure of a 1946-48 u.s public health service study of inoculation syphilis in guatemala led to a worldwide outcry a federal apology to guatemala reports by bioethics commissions in the u.s and in guatemala and multiple lawsuits her latest book published just in 2020 is co-conspirator for justice the revolutionary life of dr alan berkman as her signature line says in her email she is quote repurposed not retired unquote currently she is working on part of the public health advisory group to release aging people in prison in new york to push legislation on elder parole and fairer parole hearings our first speaker will be jim downs and jim is the gilda lerman national endowment for the humanities professor of civil war studies and history at gettysburg college his books include sick from freedom african-american sickness and suffering during the civil war and reconstruction 2012 and currently maladies of empire how slavery colonialism and war transformed medicine which is forthcoming from harvard university press and he's recently been named as editor of civil war history he's edited six anthologies and has published articles and essays in the atlantic the new yorker slate vice the new york times the washington post the chronicle of higher education the la review of books and many others downs earned his ph.d and m phil at columbia university his m.a in american studies also at columbia and his ba in american literature at the university of pennsylvania in to 2015-16 downs was awarded an andrew w mellon new directions fellowship that allowed him to return to graduate school where he gained postgraduate training in medical anthropology at harvard university it is now my pleasure to pass the virtual floor onto jim downs well first i just want to thank evelyn and the team at radcliffe for inviting me to participate in this important discussion uh today i'm going to begin by talking about two of my books in the sort of introductory uh comments the first i'm going to talk about a sick from freedom and this book is important in terms of our discussion today because um in this in this monograph i uncovered a smallpox epidemic which until the publication of this book um historians didn't know and so i pieced together evidence that i found from the national archives and basically uncovered that over 60 000 uh freed people died at the moment of emancipation so in order to sort of understand how this epidemic even blew up and to understand that sort of medical consequences that formerly enslaved people confronted um during the civil war and reconstruction we have to first um understand one major important fact from the civil war that's often overlooked and i'm i'm saying this now from my perch at gettysburg college where i ran this morning on the battlefield where um tens of thousands of soldiers were killed and that typically is the way that we remember the civil war it's a war in which many soldiers heroically died on the battlefields of gettysburg and titom and other theaters throughout the civil war south and north but in actuality uh more soldiers died from disease unrelated to battle they died from what they referred to in the 19th century as camp diseases what we would might refer to today as infectious disease they have died from dysentery pneumonia uh smallpox yellow fever um and then laters cholera so when formerly enslaved people emancipated themselves from slavery they entered into a world that was pillaged by death and disease and so our typical story of emancipation is that three people were triumphant and they were triumphant because they broke free from slavery but the question becomes where did they sleep that night where did they eat where did they find shelter they entered into an environment where more soldiers were not dying on the battlefields of gettysburg but they were dying of pneumonia and dysentery and other infectious disease and without the without basic necessities formerly enslaved people began falling victim to these various um issues what happens is the federal government an unprecedented move create something called and i talk about it in the book the medical division of the freedmen's bureau so long before the new deal long before the affordable health care act the federal government did something completely surprising they created a national system of medical care in the south in order to respond to the explosive outbreak of infectious disease they established something close to 40 hospitals throughout the south they employed over 40 positions and they provided medical care to well over 1 million free people but despite this magnificent intervention and this unprecedented intervention a smallpox epidemic exploded at the time of emancipation the earliest evidence that i found uh traces it to washington dc not too far where from where abraham lincoln was penning the initial preliminary emancipation proclamation in 1862 so this is an important point lincoln is thinking about the emancipation proclamation but he's not thinking about the humanitarian questions of how free people are going to survive so the emancipation proclamation is often seen as a military necessity for the north to deplete the southern labor force but there were no efforts no consideration about where free people were to find food and to find clothing and so as a result the smallpox epidemic um explodes in washington dc evidence of it begins to sort of appear according to the archival record in virginia later in the carolinas in 63 and 64. by 1865 the smallpox epidemic has covered um the entire south the numbers um of people dying are astounding uh in the sea islands which are the islands that don't dot the sort of coast of uh charleston and savannah something like 800 people a week were dying in smallpox in washington north carolina 300 people died a week um i found records in mississippi of 500 feet 550 people black people dying per week compared to only 37 white people and so throughout the surviving archival material there is a real um there's a sort of imbalance in the number of people who are infected free people are dying at larger numbers in large part because of the fact that people at this time are blaming the spread of the epidemic on black people themselves they are saying that it's because they are sort of um quote promiscuous and the 19th century understanding of that is that they're intermingling men are living with women they blame the fact that um they're they're dirty they come up with arguments about that they're unsanitary they never take into account that they lack the basic necessities to survive and that what happens is and this is a piece of um u.s political history and u.s history that we don't know that between 1863 and 1865 formerly enslaved people are not permitted to go where they want to go they are according to military parliaments considered to be contraband they are placed in refugee camps similar to the detention camps that we see in the southwest they're congregated in these spaces and then when infectious disease like smallpox blows up it continues to um accelerate among this population and so for white people at this time there's lots of different ideas about quarantine and vaccination and inoculation but the most um tried-and-true way of solving the smallpox epidemic would be to just take peop people that were infected and quarantine them now i used to tell this history all of the time and people didn't understand warranty before cholera i mean sorry before um covet and as a result at that particular time there weren't even they weren't even creating opportunities for black people to quarantine themselves because they were either forced to be on plantations to return to the labor force after the war or they were in these refugee camps so there's a lot of reasons for why the epidemic sort of explodes and i'm happy to talk about it during the q a but a question that i have especially in light of the karen kovet um outbreak is when do epidemics end and so when did the smallpox epidemic end in the in actuality it's hard to actually say when it ends because in 1866 at the moment when it seems to be the num the rates of infection seem to be sort of dissipating formerly and saved people as all americans at this period face a cholera pandemic a cholera pandemic that begins um in asia travels through europe and then makes its way into the united states formerly enslaved people are not only confronting the smallpox epidemic they're confronting a cholera pandemic and then on top of it there's a drought that completely devastates the opportunities for them to return to the agricultural south and to earn a livelihood so when we think about how do epidemics end we think about this bigger question we also have to be concerned about other social and political forces that are happening um that book sort of charts in many respects the health conditions of formerly enslaved people but i was really interested when i was finished with that book why the government was able to ultimately develop an efficacious protocol to stop the cholera the pandemic from infecting both white and black people and that has led me to my second book um maladies of empire and this book is coming out um later um this year in september and this takes a different um analytical position it sort of examines the ways in which doctors learned from explosive outbreaks of epidemics among um enslaved people colonized people conscripted shoulders soldiers muslim pilgrims and many other dispossessed populations in the 19th century and it basically says that doctors learned how to create the tools to develop the field of epidemiology so when we think about epidemiology today the tools that we're using to control the pandemic those originated um during the 19th century as doctors observe the spread of infectious disease among enslaved people and slave ships um on colonized people in the caribbean and in india and then later uh with um soldiers both during the crimean war and the civil war and the reason why i think this is really important um for us today to sort of think about is that we can think in terms of the past in the ways in which people like formerly enslaved people were devastated by pandemics and epidemics but we also need to think about how at the same time science is learning from the wounded science is learning from their infection and that different forms of medical knowledge are growing out of the morbidity and mortality that affected large populations of people so i'm going to sort of stop there i'm going to hand it over to susan i'm happy to talk more um during the q a and other points okay okay hi um good afternoon thank you again um for this opportunity i really um appreciate it um and i'm grateful to evelyn and to jim um for sharing this so as the covid pandemic raged and then the vaccines became available there was much media discussion of the so-called mistrust of the health care system and government by african americans over and over the words tuskegee and the syphilis study that took place there are mentioned i want to briefly explain why this has happened and what the limits are of the way the terminology has been used so let me briefly explain what actually happened between 1932 and 1972 the united states public health service recruited these men and uh and others like them approximately 400 with late stage syphilis that means they were supposedly no longer contagious and 200 without the disease as the controls to study what happened when the disease was left untreated and based on the assumption that the disease was different in blacks and whites instead the men were told the aspirins iron tonics and vitamins they were being given even a diagnostic spinal tap was treatment for their bad blood a colloquialism for syphilis and other diseases blood draws were taken every few years as well to check on the men not to give them the disease as is often claimed often by using these photographs particularly this one when it's cropped so that all you see is a white hand on a black arm and even though it's a blood draw it often looks as if he's being infected by the physician in the picture um and the families were also given money for burials if they agreed to autopsies nothing was actually hidden about this study there appeared in at least a dozen medical journals over the years and black doctors and nurses were the primary face of the study to the men the study only stopped in 1972 after an intrepid sexually transmitted disease investigator horrified by it and unable to get the government to end it gave the story to a newspaper friend it exploded across the media leading to a federal report a lawsuit congressional hearings and lifetime health care to the remaining men and some of their wives and children in 1997 a group of us were successful in lobbying then president clinton for a formal apology while a handful of the men were still alive ever since 1972 tuskegee has lived on through rumors books plays movies poetry music and in the lessons that bioethicists teach about what not to do indeed in both 2006 and again this year tuskegee made its way into two different saturday night routines um where african-american hesitancy around either medical care or vaccinations for covert are spoofed we know what this is the characters played by keenan thompson and hugh laurie cry out in the 2006 skit tuskegee tuskegee even when the doctor is offering routine medical care and even as if they don't have to explain anything else the same time as the tuskegee study was ongoing the u.s also worked with the guatemalan government in the late 1940s on the study to see if penicillin would serve as a prophylaxis for syphilis and other stds that is if it could help people who already had unexposed sex might have become infected but hadn't advanced disease yet this study unlike tuskegee's was kept hidden until i actually found and then published the details of the study in 2010 in this case the government actually did infect prisoners mental patients sex workers and soldiers in guatemala with these diseases including unfortunately and this is a pretty painful uh slide to show you men's penises and women's cervixes to induce the infection and in this picture they're not measuring the man's penis they're actually looking at the size of the sore that can develop when you have um syphilis when i shared my paper with the cdc it eventually made it up the chain of command to the white house leading to front page stories here and in guatemala because there was a formal apology to guatemala from the obama administration a bioethics commission report and now some ongoing lawsuits so this um slide is just a quick comparison of the two studies to just remind you about what happened in guatemala the subjects both men and women are given sexually transmitted diseases not all the subjects are given penicillin not everyone becomes infected but not everyone is absolutely cured if they become infected in tuskegee it's only african-american men who already had the disease and were supposed to be not in late uh not infectious but um some of them may well have been and their wives and sexual partners may or may not have been treated at the time the men were supposed to be kept from treatment other you my book some of them in fact made it out so tuskegee more than the study in guatemala however has remained in the american political vocabulary since 1972 because there's a larger population to carry it forward and for a series of other reasons i'd be glad to discuss but even when invoked to somehow explain african-american quote-unquote mistrust that has been revived with discussions of covid it is i think when people invoke it a way to talk about racism not to dwell on the history or even to know the details for the historical lessons i think are that are really important and the ones that are usually ignored are some of the following that is if you think about it if there had been 30 acres and a mule and as jim has demonstrated even better medical care after the civil war the men's families might not have stayed in tuskegee and had other economic choices that would have led them off the land if the men had had access to decent health insurance they would not have been as vulnerable to the offer of the public health service of free medical care if there had been more sex education condoms available and public health there would have not been so much syphilis if racist assumptions about biological difference hadn't existed the study would never been done in the first place and i want to conclude too by reminding you that even though they were both black doctors and nurses central to sustaining the study we need to remember that just having racial concordant patients and healthcare providers is not enough to stop the structural problems we face so in the end i think we have to consider the way structures of racism get into the healthcare system and shape its outcomes not just in the seeming memory of medical horror that ended nearly 50 years ago and now i'm going to turn it over to evelyn um for the discussion thank you susan thank you jim um these are your work all of your work is is absolutely fascinating and crucial and um i just wanted to start uh by asking us asking both of you to think about and muse on this particular question um how can how does history help us in this contemporary moment i am mindful of the fact that um in this moment at least over the last year right it seems that the work of historians of medicine has never been more relevant than it has been today i mean we've all been on numerous uh webinars like this we've been on local media international media and this is you know this is important and it's important that the work we've all done is is is finally getting i think you know quite just recognition but at the same time um as we are right in this this epidemic ourselves uh how are you thinking about the role of history in this moment is it to be used in the ways that many journalists ask us to do to give them the lessons from the past that's going to help us understand better the present or is it a way for us to help ask people to think harder about the past um i can start if you want um so i um so one of the things i think that's really interesting is that when we um thought there was going to be a major uh flu pandemic in 2007 um the united states government gave some money to a group of historians to look at what had happened during the 1919 uh to 1918 to 1920 flew pandemic and they came up with the information that's being used over and over again now um about um uh what happened with what's called non pharmaceutical interventions it's the fancy term for saying quarantining uh closing the schools the commerce so the the reason that the government could say we need to do this is because they use the history that had been developed that showed that people on the west coast who closed more quickly survived better that pandemic than um then the people in philadelphia had a big parade and then everybody got sick so one of the ways that history has been used immediately now has been um using that particular set of studies but what i think is really interesting is the same year that that paper was published there was another paper that said when we face a pandemic we have to really think about who's going to be the most vulnerable and how do we reach out to them what kind of special conditions do we need to think about how do we manage this that paper got ignored which i think is really interesting so i think one of the things we have to think about is which part of what history gets picked up so as evan and i evan and i just wrote this piece about this about like the way tuskegee gets used um and what we argued is this historians who both both of us have written about tuskegee we've noticed that people just say oh black people don't trust the health care system and it's because what i call sometimes the holy trinity now of three studies so it's tuskegee what happened with dr sims who operated on slave women in the 19th century and then the henrietta lacks story and the use of her cells so all those things get thrown in as if some journalist or some medical person now understands everything that happens to black people and they can be really use the history to explain um the problem rather than understanding all of the structural reasons that this happened about understanding the 2007 report that suggested if we had worked with community-based um groups more quickly so in massachusetts for example we opened up these giant vaccination places in places like gillette which if you live in roxbury and don't have a car isn't so easy to get get to start the vaccinations in um community centers i have a friend who runs the brazilian immigrant center for example here in boston and people who are undocumented um for example have been using um that place to get their their vaccines but it wasn't a place we started if we had started there we could have understood the history better and we could have stopped some of the spread right so i would just pick i would just pick up on the point that susan said about quarantine and lockdown so when the quarantine first in the lockdowns first got announced last march it was um basically a brand new concept to most americans to most people throughout the world but not to most historians um and some of the debates that happen around uh quarantine mostly this sort of balance between public health and the economy are not new so it was really important i think to have historians in the room at that moment in large part because when the quarantine first started it was almost treated among a lot of people and this goes back to susan's point as a kind of a joke and i and i don't mean for the people that oppose it i mean even for the people that supported it right the time to turn you know big banana bread with their families to turn their garages into fitness centers people instagramming i like the downtime and as a historian i immediately thought about as susan said in that second paper the most vulnerable populations that would be most affected negatively by um quarantine and i thought about i was living in new york at the time i was thinking about the families in public housing five people living in a one bedroom apartment in an apartment complex shared with a hundred other families using one elevator and then being euphemistically labeled essential workers and so immediately i was freaking out about quarantine and saying this is actually dangerous and even in the 19th century before germ theory and before people even understood microbiology people argued that quarantine should have a beginning start date and stop the end and and cuomo never had a stop date and so on one level you're saying well you don't want the infection to spread so i'm not saying that but what does it mean for people who are having to share an elevator that are that are crowded into public housing that are being euphemistically referred to as essential workers who in new york city people are banging on pans and pots saying wow this is such great work that you're doing but then totally shocked when rates of infections um are skyrocketing among black and brown people and in large part those rates of infection i could see without sounding like here i have my wizard ball and i'm imagining or predicting or even being completely negative but as a historian it was very clear to me because this had happened in the past that those marginalized populations have often been deployed in the 19th century as my book my new book shows as washer women as hospital workers and they're constantly being forced out there to do the work but they then become the most vulnerable to the attack so i i i really felt that historians could really say a lot about quarantine and also i felt that there was a huge the whole thing got completely politicized like if you even questioned quarantine you were considered a conservative i was like i'm not a kid like i am not a conservative like i feel like you know but i was just asking some simple questions but it becomes so ideologically infused that we couldn't even ask questions and then who suffered black and brown communities throughout the country and then also when we're talking about racism too and i don't want i want to make sure that we're also noting this because i thought of this in when i was when i did sick from freedom pop indigenous people on reservation who have been quarantined similar to formerly enslaved people high rates of infection are spiking among that group and so that's another population that we weren't looking at or thinking about because everyone was like you know feeling themselves with you know um embracing quarantine and thinking that they were doing the right the right thing yeah i mean i think i i think uh for me um watching and being a part of it um at the same time so of course when when i'm writing about in my case the history of diphtheria that's something that that's you know so urgent a sense of urgency about it happened in the 19th century right but to think about covet as a historian while you're in it right and you and i was often sitting and watching television and saying that's not the right question that's not the right question you're not looking at this and you're not looking at that and the question is not everybody should social distance but what makes social distancing possible right and who can social distance under what circumstances how is that going to effectively help control the spread of the disease and so for me my historical questions were ones that you know slowly but surely began to filter into much of the public discourse but but in the beginning in the first instances those were not the questions being asked and so i i think that was that that made it feel sort of a strange kind of disjuncture um for me um in those early you know almost about a year ago um this very uh week so the second point i want us to turn to is um medical racism um my colleague here at harvard at the school of public health nancy krieger and her team just published an article just last week of a study that showed that if you look at over 200 000 articles published over the last 30 years in the journal of the american medical association the british medical journal the lancet and the new england journal of medicine less than one percent included the term racism anywhere in the text and it appear this is a stunning study it just came out last week in time magazine it's also published in more detail in health affairs um you know we've talked we talk a lot about it all three of us have examined the role of institutional and systemic racism in medicine and science but i actually was truly shocked by this this new study and so it's asking us i think to think hard about whether or not this moment where many people are claiming is a moment of racial reckoning will be a moment of appreciation uh will it will we take what we've learned uh from this uh pandemic and actually begin to recognize the actual state of affairs in american medicine with respect to racism and so i just wanted you all to turn to that and and comment and reflect on on this point okay um i'll try um so um but i'm also an optimist so that you have to uh take it um from that uh position but i think we're in a very different moment and i think it's the awful actually conjunction of the sort of almost pornographic um envisioning of black death constantly either at the hands of the police i mean think about the way in which we all had to watch over and over the killing of george floyd so we're at the moment where we're both watching all of this death and we're looking at the statistics about who got sick and so i'm i'm hopeful that this awful moment will actually help people think going forward what medicine could and couldn't do what causes these things i for example um i'm working with a group in new york that's involved in trying to mitigate some of the horror of mass incarceration by looking at parole reform for example in new york state and particularly the paroling of elder um men who have been and women who have been in prison for years and so we're trying to argue that in fact there's a public health problem around mass incarceration so it isn't just an issue of social justice or of anti-racism but also public health in what happens when you keep people imprisoned especially when there's an infectious disease um and they don't trust um the way they could get the if they're going to get um vaccinated at all they can't trust it so i'm hoping that all of this momentum at this moment of time of both all of this death will lead to a larger discussion about what else can be done and i think the only way that can happen um i mean in my experience of doing this now for geez it must be almost 50 years i hate to think about this i've been doing this since the late 60s um is for people to understand that there are things that you can actually do because if you just say to people well all these structures of racism and then everybody goes oh you know how can i fix the police housing and i think what we're seeing is different organizations and different people understanding that the old reforms didn't work that we really actually have to do something really serious and that we have to fight for those things and i think there are lots more younger people who get that a lot more quickly than some of us took us a lot longer to get to that point i think there are more people of color um in um in the professions that also can help um drive it i mean i think it's just amazing younger people you know frankly got educated by us and so there's multiple generations now of people who understand some of these issues um and so i'm hopeful that we are at a particular moment but i think we've got to seize the time so i i would i would just say quickly two things as in terms of moving forward and thinking about structural racism if we think about the past the ways in which a lot of times the medical community does in fact want to think about rates of infection among black people are to think about infectious disease so uh there will be studies about hiv aids there will be studies about sexually transmitted infections there won't be studies as much about infant mortality or asthma or other kinds of issues that are affecting black people that are not necessarily posing a threat to the larger public so i think we have to be also careful about this call for you know including ideas about racism and to be mindful that we shouldn't just be focusing those studies on infectious disease but we should actually be thinking about the problems that plague black people now as far as that study is concerned as a historian i'm a little worried about that study based on this new book that i'm doing that i just did on the origins of epidemiology if i did a keyword search from 1755 to 1866 and i said where are the black people in the formation of epidemiology i would have two articles what i've noticed oftentimes in thomas trotter's work in stephen hale's work is an early chemist steven house i'll just give you this one example is thinking about the use of ventilators as a way to promote the fresh supply of air everyone knows his final draft study his final study is what people turn to as evidence of ventilators are important his second draft no one looks at is actually a study on slave ships and so in other words slavery and the enslaved people at the at the holds of those bottoms of those ships were useful evidence to actually prove the efficacy of ventilators but if you just do the keyword search you will not find that and yet as i uncovered in my book the medical scientists at the time are using cases of black people trotter study scurvy right and then when he publishes the count does he say he was on on the brook ship the slave ship no he says a multitude of cases so he then uses a clinical language that erases the subjectivity of black people so in other words i think my own i'm not criticized to that that articles they think it's important is to say that just because it doesn't appear in the title or in the keyword search doesn't mean that black people people of color colonized people indigenous people weren't the evidence that the medical profession is used and no yeah and i think that's what i want to get and that's what this book i mean that book was like i mean talk about trying to be a historian it's a detective was to read through the tracks and i have to tell you like honestly like super huge props to harvard university press and to the the editors there the weeds of robinson that went through those records with me to check because honestly it was unbelievable how that actually plays out well i mean i think what's going to happen is this study will be a springboard to um different kinds of work including the historical work that needs to be done and the point you just made is something that all of us as historians have noted the ways in which the sort of evidence of of uh and the use of of black bodies to move forward medical innovation and theory and practice but not be acknowledged in any way shape or form is something that we're very familiar with so i think putting it all together is going to give us uh i i think will give us a a fuller and richer understanding of what has what has occurred and what it means to say systemic racism and medicine we have to turn to the questions now oh my goodness there are lots of them and i will try my best uh to um see if i can um um uh give something that gives some of the questions that um uh that can that we can continue to talking about the points to make there's a question about um that's that uh ask when we look back on the current pandemic will we see it as successful due to the vaccines or will the narrative be that many people died unnecessarily and highlight the inequities of the u.s health care system well it depends on whether you're watching cnn or fox news don't you think um as the answer to that i mean it's a little historians hate to do predictions right but uh so i i do think that that because of the politics it's gonna be really hard to know what people are going to pick up i mean what evelyn and i have discussed and we um we're hoping that one of the things the pandemic has done is buried at least some understandings that it is something inherent in black bodies that makes them more vulnerable to disease that there's been so much more discussion about what evelyn talked about and what jim talked about that is about is what it means to be an essential worker what it means to live in crowded housing etc and how that makes you vulnerable to illness so we're hopeful that that will make a big difference as we um as we go forward and more studies will do that i mean at the beginning some of you may know this um there was not even race data being kept on who was getting sick and dying with cobit and it was only the push by epidemiologists before that actually even happened jim did you ever thought about it i don't have anything to do with the great christians do that great so i think um here's one um is i think some of the some of the questions are coming together asking about the role this is sort of in your in your lane susan about how to think about the role of black health professionals with respect to tuskegee and you made also a point about moving forward um and um so do you want to comment on that um right i mean um we all know for example that um you know that that it it makes a difference we know that there are studies that show if people have racially concordant um physicians or nurses or health personnel that it helps them feel more comfortable sometimes get better care but sometimes not get better care it depends on where where people are tuskegee would not have happened as all of us know who've written on the history if the african-american physician at tuskegee at the hospital in tuskegee if african-american nurse named eunice rivers laurie had not been to go between the men in the public health service and we all know that every oppressed group um has people in it um who are the go-betweens um them and um the oppressors and that that's always been true on the other hand i think it really matters if places where people feel that they are um getting trustworthy care really helps um make a difference so i think that does matter i mean as i said like the example of the shots being given vaccinations being given at the brazilian immigrant center for example or in local churches um and community centers makes a big difference um and people feel somewhat safer but i think that it's just that it's no guarantee we used to say um long before issues around trans and gender in the women's movement we used to say all um all sisters are women but not our women are sisters and i think it's that concept um about you you know the gender as we well know gender and um skin tone doesn't always guarantee that people's consciousness really matters if someone once said it isn't you know when we had this arguments in the women's movement about things like this we used to say it doesn't matter who you want to sleep with it's who you're willing to die for that actually matters that the great political line here's a question for you jim um i'm interested in how professor downs is thinking about the ways in which doctors use the infection of racialized bodies to construct epidemiology within the context of such racialized science so maybe also as the 19th century star shift in disease theory from miasma to microbes so you know so i think the question is pointing to that that there's already an kind of pre-existing uh notion of of bodies that have been racialized and and how um how did the doctors actually um how do you think about the ways in which the doctors use this pre-existing notion of racial differences in bodies to construct epidemiology i know that's your whole book but maybe a brief answer yeah so just the the quick the quick answer would be to just sort of think about how things like slavery all of a sudden created conditions that allow doctors to observe the spread of infectious disease among large populations of people so how did a slave ship or colonial plantation in jamaica allow doctors to witness the spread of an epidemic and to sort of test what protocols worked and which didn't and so oftentimes these doctors in jamaica and even in india and parts of the mediterranean are looking at sanitation and they're trying to sort of think about how unsanitary environments lead to the spread of disease and they're not necessarily following back on this notion of the racialized body they're actually saying it's a result of polluted water or they're looking at how does an epidemic all of a sudden start and then how does it end and so what happens is that in a plantation in jamaica they're able to observe it in a way that they can't observe it um in the uk and so what happens ultimately with the civil war is that the doctors in the american civil war learn from florence nightingale and the british epidemiologists but then they insist that there's a difference about racial bodies and they make an argument about racial bodies but the early cast of these doctors are more interested in the fact that slavery and um colonialism and war have created these new social environments because prior to this where would we see these new social environments tenement houses hadn't been constructed yet and so these um these new built environments are allowing doctors to witness the spread of infection so they're they're they're counting the number infected they're counting the number who survived they're thinking about preventative protocols so it's less about the individual body and more about the collective body and what was surprised me was that they weren't actually making this kind of argument about the racialized body and so what my book is also trying to say is that we have to think about the notion of the racialized body appears at certain moments within the history of medicine it's not a constant it's definitely something in the 1890s it's definitely something at the bell curve in the 1980s it happens but when doctors are trying to develop epidemiological ideas they're more concerned about how the environment okay thank you um i think this is a good question for us um the question is can you speak to how historians could also make clear that there were people who spoke up in the past not just now about the impacts of racism on health so to make to make clear that uh there's no excuse as is off stated now that this is just how people thought back then we really shouldn't be imposing our president's ideas on what happened in the past but really speak to how the long histories of racism and health make clear why structural approaches are needed for repair and prevention right so i think one of the recovery processes that we have done as historians is to highlight that there were always these kinds of conversations i mean you know you could make an argument that w e d du bois should be known as an epidemiologist as well as one of the fathers of american sociology um i could make that argument that his studies on health care looked at all of the structural reasons that there have been people all along who have said look the reason we're sick or this is happening is because of housing or racism or we can't get to a physician so none of this is new and i think one of the things that's um really important is to teach that um i've taught a course for example on the history of health activism that tried to look at this over time i have a i have colleagues at columbia at the public health school also teach that so i think those kinds of questions of where does change come from um in the health care system as in all political life what's the relationship between activism and and social change in health so just the plug for a second the the book that i just finished called a co-conspirator for justice the physician i wrote about um toward the end of his life was involved in hiv care and what he realized at the turn of the 20 into 2000 was that there was all this discussion about the need for prevention but treatment was happening in the global north but not in the global south and so he organized a group in new york called health gap the health global access project that worked with something called the treatment action campaign in south africa between um those two groups started to cooperate and they pushed to change um what was happening around intellectual property around the ownership of the antiretrovirals and made it possible for generics to be made so that eventually they could get into the global south and the group that he started 20 years ago is still operating and today actually was part of a rally in new york in washington around the issue we're facing again which is how do we stop the control of the intellectual property on the on the on the vaccines so that they can get into places like india and south africa much faster yeah exactly so i would just give examples from uh my first book and my second book so alexander agusta um in my books from freedom was a black doctor who traveled from canada went down to savannah in order to uh basically set up a freedmen's hospital for newly emancipated slaves and what he did was he argued against the fact that natural causes or the natural racialized body was the reason for high rates of smallpox infection and he pointed to the fact that they that the sanitary conditions and the poor condition the poor housing conditions often resulted from it and then in my most recent book i was actually surprised by this um thomas trotter who wrote about scurvy and wrote about all of the enslaved africans dying at the bottom of the uh slave ships actually testified uh in to the british government about how the institution of slavery had an effect on the mind of black people that then made them susceptible to disease so he actually gave a very sympathetic uh understanding i mean he eventually becomes an abolitionist but he'd be a very sympathetic understanding of why they were dying and it was a result of the fact that slavery had done such harm to their mental and emotional um outlook that it made them susceptible to disease so you're right there are these examples of people um in the past who are saying wait a minute uh we can't sort of fall into this traditional way of thinking of innate um vulnerability right and we need to actually look at what's causing um high rates of infection and it's often structural forces in the same way that we're seeing covet cases increasing i mean because i think one of the pieces i just want to add because when we talk about racism and medical racism we also have to be talking about class because this is not just race we're also seeing class in the covet epidemic but we're just calling it race and be careful to make distinct yes right right it's actually both right it's actually booked right thank you so um this is a question i think is a good one to um to end on in this last few minutes that we have the um audience member asked it is always a struggle to deal with the question of the purpose of using history and how we use it and how would your panelists suggest we use this history should we use it in a targeted way and at specific times to understand specific issues or should this history be told and known widely and if known widely how do we answer the question to what end and let me take a stab at that one good for you i actually think i i mean i'm a big proponent that this history needs to be known widely and understood in the broadest possible context of american history i think it's important uh to know the history in order to understand how to think through uh challenges that face us in the present to understand that we can make change change has happened over time as historians are constantly worried about and thinking about and i think that the thought that change can't happen over time is something that can easily get lost and that's why understanding the history there always have been voices speaking out against uh particular forms of bias and discrimination certainly in medicine and in science uh it's important it's important for us to know now but what those voices are uh the claims that those voices made i think those are important parts but it also i think deeply helps us to understand that we can you know ha we can do things differently we are not bound by what appears to be uh structures that seem unchangeable and unavoidable uh and so that for me is why the history matters so let me let each of you have a word on that i was i was going to say if you think about the the political storm around the new york times the 1619 um project that has happened um that is an attempt to retell american history not from 1776 but from 1619 um it tells you how powerful this history is and how afraid those in power are of our telling the truth um and so i think um we have to make attempts to do i mean one of the things that's been great actually frankly about zoom is that we can reach you know lots more people on these kinds of things or on podcasts than we could if we just gave a talk you know in an auditorium with 300 people in it for example so i think this is an opportunity for us to use this moment to do more popular um versions as much as possible to speak in multiple kinds of forms i think it's really interesting that nancy krieger's group published both in health affairs that is that goes out to sort of healthcare professionals and in time magazine at the same time i think is really interesting and important and i am a firm believer that we have to write really careful history histories for each other and for the details but then we can take that material and make popular forms jim maybe you should talk a little bit about what you're doing around that kind of work but i think that that's really crucial right so um a couple a couple of things i'm working with susan um on a larger documentary on racing medicine so that's one way of doing it and i and i have done different um sort of publishing and trade places mainstream places to have that information widely disseminated but i actually think the solution is really simple it can just be added to existing curriculum and when i i talk about my book i i'm often uncomfortable in one way you wouldn't think it if you just watched the first 15 minutes you'd be like that guy's really self-aggrandizing but in actuality i'm going to ask you to be succinct because we okay you just need one sentence there was a smallpox epidemic that's it that's just one sentence added to an existing textbook our chapter and so it's really easy to just add this material to existing textbook curriculum thank you thank you both um this has been a wonderful conversation uh before we close i want to thank the members of the radcliff institute leadership society and the annual donors who are watching this afternoon and we appreciate your generosity in supporting the programming that that makes uh this kind of programming available to the public and we thank you and also please i thank jim and susan for always having an engaging and enlightening and thoughtful conversation and responding to the questions as well and also think to the audience oh my goodness there was no way we could get to all the questions that we had this afternoon but it just shows that uh i think that these kinds of questions that we're asking about the role of history while we're all living in the midst of a pandemic raising many interesting and important things that we need to continue to talk about so thank you very much and i hope you have a good afternoon you

Channel: Harvard Radcliffe Institute

Views: 7,830

Keywords: Harvard Radcliffe Institute, Radcliffe Institute, Radcliffe, Harvard, Harvard University, Legacy of Slavery, medical racism, systemic racism, vaccine hesitancy, health equity

Id: XCSRlWkKIEw

Length: 58min 40sec (3520 seconds)

Published: Wed May 12 2021