Brian Lehrer: Brian Lehrer on WNYC. Now, Dr. Uché Blackstock. Some of you know she was a guest on this show multiple times during the height of the pandemic to talk about the disparate impact of COVID and what to do about that as a physician and as founder of the group Advancing Health Equity. Now, Dr Blackstock has a book, which is about fighting racism in medicine as well as her personal story.

I didn't realize until now that Dr. Blackstock and her mother became the first Black mother and daughter pair to both attend Harvard Medical School. The book is called Legacy: A Black Physician Reckons with Racism in Medicine. Dr. Blackstock, always great to have you on the show. Welcome back to WNYC.

Dr. Uché Blackstock: Hi, Brian. Thank you so much for having me back. I'll just add, actually, I have a twin sister, Oni, who also went to Harvard Medical School with me. Oni, my mother, and I, we all are the first Black mother-daughter legacy from Harvard Medical School.

Brian Lehrer: Would you like to talk a little bit about your mother's journey first, what kind of conditions she grew up in, and how she came to be a doctor and a Harvard Med School grad?

Dr. Uché Blackstock: Yes, it would be an honor. My mother, we refer to her as the original Dr. Blackstock, and she grew up not far from where I live now. She grew up in central Brooklyn, Crown Heights. Born to a single mother, she was raised on public assistance. She had five siblings. She had a very, very challenging childhood. There was a lot of housing insecurity. They were moving around a lot. She was changing schools often, often also having to worry about where the next meal would come from, but my mother was very, very determined and had a strong interest in science and also a strong work ethic.

She ended up actually at Brooklyn College. She was the first person in her family to finish college. It was at Brooklyn College that she had a chemistry professor, a Black man, who encouraged her to apply to medical school. She did and got into all of her medical schools and ended up matriculating at the Harvard Medical School.

Brian Lehrer: What kind of practice did she have?

Dr. Uché Blackstock: After Harvard Med, she actually came back to New York City, trained at Harlem Hospital in internal medicine, and then did a nephrology fellowship. Nephrology is the study of the kidneys at Brookdale Hospital, which is in the East New York section of Brooklyn. She was a nephrologist because as some of your listeners may or may not know, there are very high rates of kidney disease in Black communities as a result of systemic racism. She worked for many, many years at SUNY Downstate and Kings County Hospital.

Brian Lehrer: You and your sister Oni are now MDs yourselves, as you said, both of you. Did you always want to be a doctor because of your mom?

Dr. Uché Blackstock: Yes. Not only was she just such an incredible inspiration, I also think the message that she taught us that you can grow up in these environments that are very, very difficult and have these opportunities to go to a place like Harvard and then actually, you can come back. You can come back to your community to care for your friends and neighbors, to work in service to them. I actually grew up thinking most physicians were Black women because my mother was the-- I know, I know, was the president of the Dr. Susan Steward McKinney Society. She was the first Black woman to earn an MD in New York State.

My mother actually worked with a group of Black women physicians when I was a child to do work in the community, to hold community health fairs, to do diabetes screenings and high blood pressure screenings. I would go with my mother to these fairs. I would go with her to these meetings with these other Black women physicians. My own pediatrician was a Black woman. I didn't realize until I was much, much older that my experience was very rare in that, as I said, I thought most physicians were Black and that they were Black women.

That was my inspiration, seeing these brilliant, dedicated women work in our communities on behalf of our communities. That was the inspiration that both Oni, my twin sister, and I needed to really propel us to also become physicians.

Brian Lehrer: I saw the stat that only 2% of US physicians are Black women. It would have to be three or four times that just to be proportional with the general population. Does the title of the book Legacy have a double meaning pertaining to you and your mom and pertaining to racism in medicine?

Dr. Uché Blackstock: Yes. Definitely, there's that double meaning. As your listeners may know or may not know that our mom ended up being diagnosed with acute myelogenous leukemia when Oni and I-- we were in college. We were sophomores. She died after our sophomore year at the age of 47. She was so young, but by then she really had made a tremendous impact on us.

Part of it is, not just this legacy from Harvard Medical School, which we can talk a little bit more about because it's this idea of Black exceptionalism that I'm very immensely proud of, but I also recognize that there are so many other people like my mother who could have made it to Harvard Medical School but did not because of systemic racism and because of poverty. Also, this legacy of my sister and I being able to carry on our mother's-- essentially her health equity advocacy work, health equity is a newer term, but the work that my mother and these Black women physicians were doing in our communities in the '80s and '90s, that was health equity work.

The other meaning of legacy is this rather horrific, and I'll be very transparent and honest about this, legacy of medical racism that is deeply, deeply rooted in our country's history that's based in slavery, that's based in Jim Crow, that's based in this idea that Black people are somehow biologically different than people of other races. A lot of those myths and notions have actually unfortunately been perpetuated over the last several centuries and today actually impact how Black people receive care. Those factors are implicated in actually the worsening racial health inequities that we see today.

Brian, despite there being advances in innovation, technology, and research, we are still seeing today in 2024 worsening of health outcomes for Black people. I know people have heard of the Black maternal mortality crisis. Brian, myself with my Harvard College and Medical School degree, I'm still five times more likely to die of pregnancy-related complications than my white peers.

Brian Lehrer: Why would that be? Can you unpack that a little bit for our listeners? You with your education, with the fact that you're a practicing doctor, you would be very knowledgeable about how to go through pregnancy and childbirth, would your risk really be that much higher than a white woman in America? You individually?

Dr. Uché Blackstock: Yes. To unpack that a little bit, I know people have heard of these more famous affluent Black women like Serena Williams, who also talked publicly about being diagnosed with or having symptoms of a blood clot in her lungs and speaking to her medical team saying that, "I'm having these symptoms," and they didn't even listen to her, one of the greatest athletes of all time.

What we see from the data, and we see it anecdotally too, but people always want the data. We see the data that often in healthcare interactions that Black patients are often not listened to. Their concerns are minimized, ignored, or dismissed. We see that often leads to delayed diagnoses, misdiagnoses harm, or even death. There's that whole issue of Black patients just not being listened to.

There's also this other issue of the impact of everyday racism that professional status, educational level, socioeconomic status, does not protect Black people from, that there is something that Arline Geronimus, the public health researcher, has written about this idea of weathering, the chronic wear and tear on our bodies as a result of living with everyday racism, interpersonal and systemic, that even someone like me I am not protected from, and that wears the body. It ages the body prematurely so that when a Black birthing person like me when I become pregnant, I'm placed at a higher risk.

We also see that Black people in this country, we have some of the shortest life expectancies which we die prematurely in this country. It's not just about what happens when we interface with the healthcare establishment. We know that systemic racism also impacts other social institutions like education, employment, access to healthy foods, access to green space. All of those are what we call the social determinants of health. We know that systemic racism is a driving factor for those.

What we are seeing in these statistics, these horrible statistics that Black people like Black men have the shortest life expectancy, that Black babies are still more than twice as likely as white babies to die in their first year of life which, Brian, is a wider disparity now than 15 years before the end of slavery-

Brian Lehrer: Wow.

Dr. Uché Blackstock: -is a result of--

Brian Lehrer: How could that be? Result of-- Go ahead.

Dr. Uché Blackstock: It's a result of centuries of deeply embedded racism that has actually chronically deprived our community. Even me, I'm one generation removed from growing up on public assistance. We also know, Brian-- There's something else that I wanted to share. I don't go into it too much in my book, but there's a field of study called epigenetics. This idea that chronic stress, whether it be from living in poverty or living under systemic racism, it actually changes gene expression.

While we know that race itself is a social construct, living with the stress of racism can actually influence gene expression. We think that it's implicated in the high rates of diabetes among Black people, autoimmune disease, inflammatory diseases like heart disease or atherosclerosis. That essentially makes us sick. Brian, living in this country for Black people, it harms us. We even see that in people who are Black immigrants.

When they first come to this country, they actually have health outcomes that are very similar to white Americans, but after one or two generations, their health outcomes actually worsen to the same level as Black Americans.

Brian Lehrer: Listeners, I wonder if we have other Black MDs listening right now who want to talk about racism in medicine and how to fix it with Dr. Uché Blackstock. 212-433-WNYC. Or any Black patients, that would be every person, [chuckles] we're all patients sometimes, with experiences or stories or policy proposals or anyone else for Dr. Uché Blackstock, whose new book is called Legacy: A Black Physician Reckons with Racism in Medicine. Call or text 212-433-WNYC, 212-433-9692.

I want people to know that part of the book describes a segregated hospital system as you witnessed and experienced it as a doctor between NYU's Tisch Hospital and Bellevue, which is part of the New York City public hospital system. The hospitals are basically next door to each other on 1st Avenue in Manhattan around 30th Street there. What did you see?

Dr. Uché Blackstock: Brian, this is something that I think all health professionals working in these hospitals are aware of, but we don't talk or we haven't talked publicly about it, but it's the fact that you have two hospitals, literally blocks apart next door to each other, where the level of free resources, the level of even sometimes care is so profoundly different.

For example, in the Bellevue ER, we see mostly people of color, we see mostly immigrants, people who are uninsured or underinsured. We see people waiting very, very long times to be seen by a health professional. We also see them waiting a very long time for follow-up appointments. I also noticed-- This is something that is an informal practice that our EMS workers often they would bring certain types of patients to the Bellevue ER and not bring those to the Tisch ER. Because if they brought, for example, a patient that was intoxicated or unhoused to the NYU ER, they would be reprimanded by the staff.

That is this kind of two-tier system of how we're treating patients. At the NYU ER, we had mostly people who-- They were mostly white, they were mostly insured, better staffing, more specialists there, quicker follow-up, more resources. Then, obviously, there's this whole issue that I write about, and that actually has been written about more extensively in The New York Times about these nonprofit hospitals like NYU that have disparate care for VIP patients where VIP patients get a whole other level of care where you get--

When I was working in the ER, I would receive multiple calls. I was the head ER doc. If a VIP patient was coming in, they would get a room immediately. I would have to call all of their specialists. They would get admitted to the hospital much quicker than other patients.

Brian Lehrer: What's the path to more equity in the hospital system then? Is it a Bernie Sanders or a Canadian-style single-payer system in America, or is it more complicated than that?

Dr. Uché Blackstock: No. Actually, Brian, and it's something that I write about in the book, I am for Medicare for all, a single-payer universal healthcare system. The reason why is because we see that-- Literally, Brian, we are one of the only high-income countries that has the very worst health outcomes, and we spend the most on healthcare. That's because we have a for-profit decentralized system of how we arrange healthcare. I don't think healthcare should be for-profit. I think health healthcare should be a human right.

I think that we need to really look at how poorly Americans are doing in the current system health-wise. It's not just Black people and people of color. All Americans are doing poorly. During the pandemic, we actually had a decrease in life expectancy, and other high-income countries did as well. However, those countries have been able to recover and their life expectancy has begun to increase again. In the United States, our life expectancy continues to decline, and that is for everyone of every single racial demographic group. We're seeing increase in suicide, increase in overdoses. We'd had the most number of deaths from COVID. We are not doing well as a country.

I always say that when we have policies that are inequitable, for example, employer-sponsored health insurance, we know that people who are service workers, who are disproportionately Black and other people of color that they are often in jobs that don't offer them health insurance, that don't offer them paid family and sick leave. We need to think about health in all policies, and part of that I strongly believe is single-payer universal healthcare.

Brian Lehrer: We'll continue in a minute with Dr. Uché Blackstock. At this point in the show, we often invite different groups of people with different life experiences to call in on different kinds of things. A little while ago, I gave an explicit invitation to other Black health professionals, MDs, and we have folks calling in to dialogue with Dr. Blackstock. We'll take those calls and continue with Dr. Uché Blackstock, author now of Legacy: A Black Physician Reckons with Racism in Medicine, right after this.

[MUSIC - Marden Hill: Hijack]

Brian Lehrer: Brian Lehrer on WNYC with Dr. Uché Blackstock, founder of Advancing Health Equity and author now of Legacy: A Black Physician Reckons with Racism in Medicine. Leslie in Central Jersey, you're on WNYC with Dr. Blackstock. Hi, Leslie.

Leslie: Hi, Brian, and hi, Dr. Blackstock. I just want to say I'm a regular listener. For Dr. Blackstock, I've been following both you and your sister, and I just want to say I'm in awe of you both and thank you for your service to the community. I called in-

Uché Blackstock: Thank you so much.

Leslie: -because you asked-- I am a Black female physician, practicing and living in Central New Jersey. We live with microaggressions and macroaggressions on a regular basis in my hospital. In addition to interacting with patients and obviously providing the best care that I can, I see a bit of doubt about my credentials. Will they be safe around me or taking my advice or what have you?

The most difficult thing I would say though is my interaction with colleagues who may doubt my credentials or-- We have a residency program where I've had residents interrupt me while I'm speaking to patients, or I've overheard my physician colleagues discuss patient care and they lack the type of empathy that we are taught to show toward our patients.

Brian Lehrer: Let me jump in. We put a lot of very specific things on the table, and I want to get a couple of other calls on in our remaining time. Dr. Blackstock, talk to Leslie.

Dr. Uché Blackstock: Dr. Leslie, I completely empathize with you. Now these experiences that I think we know we all go through or that I write about in the book that I was-- I've never been asked so much by my patients, especially when I was at Tisch by white patients, like where did I go to medical school and where did I train or about my educational pedigree. What I would say is, these environments are so very, very difficult for us. We want to stay in them, we feel like our presence is needed, but we get these questions doubting our abilities from everyone, from our colleagues, from our patients, even from--

When I was in academic medicine, even my residents would give me a hard time in a way that I don't think that they gave other attending physicians. Part of what I write about is that these institutions are very toxic to us, and we need to hold them accountable for how we are treated. As Black health professionals, we need to be in environments where we can thrive and not just survive. Right now, we are not there yet.

Brian Lehrer: Leslie, thank you. Please call us again. Here's another doctor. Donald in Brooklyn. Hello, Dr. Donald, you're on WNYC.

Dr. Donald Moore: Hi. I'm Dr. Donald Moore, a friend of the Blackstock family, and I've been around in practice and in Brooklyn for over 35 years. I want to thank Uché for writing the book that I was planning to write. I think the term legacy hits so many chords for so many of us. I think the important part that she has mentioned and expressed so eloquently in her book, the whole scientific racism, and of course, the other aspects of it is the medical apartheid, which we are still experiencing as physicians.

I want to highlight a point that Uché touches on her book. She talks about her mother going to Harvard way back in the '70s and '80s. I went to Harvard for the same program her mother went to, Health Careers Summer Program. That was a consequence of affirmative action. That's how her mother got there. That's how her mother got back to Brooklyn and contributed and created these two wonderful doctors. I want to shout out to her just to point out that she's doing the right thing. I think it's great.

Brian Lehrer: Dr. Blackstock, you know this guy?

Dr. Uché Blackstock: Yes, yes. Dr. Moore. I've known him since I was a child. Dr. Moore, you made me very teary just in what you said. Thank you for emphasizing that Dr. Moore also knew my mother very, very well and can speak to how wonderful she was, but it's true. I had a Washington Post excerpt of my book last week where we talked about this Flexner Report, the report that closed five out of seven of the Black medical schools in 1910, and that has led to what's estimated in a ratio of between 25,000 and 35,000 Black physicians.

I actually drew a parallel to that in the recent SCOTUS decision on race-conscious admissions and how it could have a similar ripple effect. Affirmative action, I'm very proud to say, has impacted me and my family. It's helped us do the work that we can do. I'm very, very proud to say that it's a policy that is needed in a reparative way, but we also have to look at what's happening, currently these anti-DEI measures, the SCOTUS decision as I mentioned, because it is going to impact who gets into medical school, who gets into college to study pre-med.

It can ultimately have that same ripple effect that the Flexner Report had in 1910, which has led to, again, this erasure of Black physicians who could have cared for hundreds of thousands of Black patients who could have mentored Black students and trainees and who could have done research on behalf of Black communities and help. I'm so glad that Dr. Moore mentioned that my mother benefited from these affirmative action programs, this pre-health program that she was in before matriculating into Harvard Medical School and Dr. Moore did as well.

Dr. Moore, I am so grateful for you and all the service that you've provided to our community over the last 35 years in Brooklyn.

Brian Lehrer: We've got two minutes left in the segment and in the show. Maybe you want to talk about what the heart of your work is at the organization that you founded, Advancing Health Equity, and the fact that you left the medical system as it exists to found this and where that leaves doctors who are still working within the system.

Dr. Uché Blackstock: I know. Brian, thank you so much for that question. I may get a little bit emotional answering it because I never thought that I would have to leave academic medicine. I thought that that was going to be where I would spend the rest of my career, but it became very clear to me towards the end of my tenure at NYU that I could not stay, that it was-- Because of racism and sexism, I was being silenced and muzzled in my DEI role. I realized I had to leave in order to do the work that I wanted to do authentically. I really said all academic institutions are like that to some degree.

I founded Advancing Health Equity, it'll be five years old in March, to work with healthcare organizations and institutions that actually want to do the work. We started out with trainings around health equity and anti-racism, but we know trainings are not sufficient. We go in and we do interviews with leadership, focus groups, with staff, leadership coaching. We help them plan strategy around health equity so that we can build more diverse inclusive workplaces in those organizations and also to ensure that the care they are delivering to Black patients and other patients of color is quality and equitable.

I feel like through advancing health equity, I can now do the work that I've always wanted to do and to do it in an authentic way, which often these organizations don't allow us to do it in. I'm not saying-- At the end of the book, it's a call to action to different groups, and I write to Black health professionals, to Black physicians. I say, "I'm not telling you to leave academic medicine. You have to do what is right for you."

I knew that leaving was the right decision for me, even though I initially felt guilty about it because I was leaving our students, but what I realized in the long term was that I was providing them with another vision for a pathway that they could take to making a difference in our communities.

Brian Lehrer: You got it in just under the wire. [chuckles] Thank you for that heartfelt answer and call to action, and for the book, and also for all your previous appearances here during the pandemic when you were so helpful to so many people. Dr. Uché Blackstock, her new book is called Legacy: A Black Physician Reckons with Racism in Medicine. Thanks so much.

Dr. Uché Blackstock: Brian, thank you so much for having me. You are a treasure.

Copyright © 2024 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.