Original subtitles

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(camera shutter)

KERN REESE: The Zulu Social Aid and Pleasure Club

is an intricate part of the fabric of New Orleans.

♪ ♪

And it also became a focal point

for social gatherings and for revelry.

♪ ♪

NARRATOR: For the Zulu Club,

Mardi Gras 2020 was supposed to be

what Mardis Gras had been for generations;

a time to let go,

forget about hard times,

and party.

♪ ♪

Happy Mardi Gras, planet Earth!

Come on down! It's a party!

REESE: That Mardi Gras was pretty much like

any other Mardi Gras season.

There was a chance to have fun and a chance to

fellowship and a chance to enjoy the Mardi Gras season.

NARRATOR: But Mardis Gras 2020 would come to mark tragedy

for the city of New Orleans, and soon,

the rest of the country.

♪ ♪

REESE: There was an apprehension

about COVID, but not substantially.

When you were 10,000 people and you're in close proximity

and you're dancing, and all the things that go on,

it possibly could have been a super spread event

that we were not cognizant of.

(sirens blaring)

REPORTER: State officials confirmed

the first Louisiana death due to the coronavirus.

♪ ♪

JAY MARKS: When COVID hit the city,

it hit the Zulu organization extremely hard.

Everyone in the organization is talking about health,

be it diabetes or hypertension,

or high blood pressure.

COVID put that to the forefront for us.

REPORTER: The impact of the coronavirus, uh, outbreak

on members of the famed Zulu Club in New Orleans

after they performed at Mardi Gras is really sort of,

um, helping us focus on the impact of this virus

on the African American community

in this country as a whole.

♪ ♪

♪ ♪

MARKS: We lost 15

to 20 Zulu brothers within a span

of three to four months,

and a lot of those deaths were related

to underlining illnesses.

Some of our brothers just going into the hospital

with pneumonia

and not coming out.

So the, the organization was rocked extremely hard

in a short period of time.

♪ ♪

REPORTER: The breaking news: stay at home, that is the order tonight.

From four state governors as the Coronavirus pandemic spreads.

REPORTER: On Capitol Hill, the nation's top infectious disease experts

told lawmakers coronavirus

is ten times deadlier than the flu,

and that the outbreak will only get worse.

REPORTER: Across Louisiana,

the numbers are simply staggering.

The state has seen the fastest

growth rates in the world.

On Thursday, the numbers soared

to more than 2,300 coronavirus cases

and 83 deaths.

THOMAS LAVEIST: Early in the pandemic, it was

New York and New Orleans were the two places

that were the hotspots.

We had bodies in refrigerated trucks,

and all of the, the horror stories

that we saw in the media was here.

Louisiana was one of the first states

to release the mortality data by race,

and it showed huge disparities

in, um, in COVID death rates.

NARRATOR: The story was the same everywhere:

Black Americans were hit harder by the virus

in part because of all the underlying conditions

that made them more vulnerable to COVID-19.

But the numbers also revealed

a broader reality: in America,

we don't all have the same life chances.

What is it about the conditions in which we allow people

to live that would actually contribute to

and exacerbate this pandemic

in the most vulnerable communities;

the ones that are least able to respond to it?

DAVID WILLIAMS: African Americans had death rates

from COVID-19 that were at least twice as high

to 2.6 times higher than that of whites.

All Americans were in the same storm.

We were not in the same boats.

And the boats of people of color

were just not able to weather the storm.

NARRATOR: People of color

across the board in the U.S. have been negatively impacted

by health disparities that leave them

vulnerable to chronic illness and disease.

Black American communities are among the hardest hit.

EBONY HILTON: African Americans in particular have

higher death rates for cancer.

We have higher death rates at, at younger ages

for heart attacks, for strokes.

These are statistics that have been generational,

and yet we haven't moved the needle to figure out

why is it that these disparities exist.

CAMARA PHYLLIS JONES: We have documented these race associated differences

year after year, decade after decade,

century after century.

And then we put the results on a shelf.

And we don't ask a deeper question.

NARRATOR: The deeper question is why?

Why do we see these vast differences

in health outcomes between Black and white Americans?

♪ ♪

Part of the answer lies deep in the nation's past.

WILLIAMS: As we look back historically, what were

the American beliefs about race?

That Blacks were actually a distinctive species

different to whites,

that a given disease would manifest itself

differently in Blacks than it did in whites.

It is very important

that we recognize that scientists

are part of the larger society in which they were raised.

They have drank the same Kool-Aid,

that is all of the negative stereotypes

and beliefs about groups in society.

And so the larger societies' beliefs about race

and about Blacks and about their inferiority

then shaped the questions that scientists asked.

It shaped the assumptions

that they made as they went about their work.

DONALD YACOVONE: One of the essential elements

in the creation of knowledge

for white Americans

was the expertise of scientists and medical leaders.

Louis Agassiz,

who was a Swiss physician and a scientist

came to America in the 1840s

and was hired by Harvard

and the School of Science was created just for him.

He became so important, he became so dominant,

that Ralph Waldo Emerson thought he would turn

Harvard University into a school of science.

His work was respected throughout the world,

not just the United States, and he said African Americans

represented a separate species of human.

If someone of the stature of Louis Agassiz

said that African Americans represented

a separate species of human, who's going to challenge that?

"Harvard says so, it must be true."

EVELYNN HAMMONDS: They create a scale

that emphasize these differences.

You go from the whitest-- Caucasians,

the Europeans, all the way down to the darkest,

who were considered to be closer to apes.

So Europeans come out on top.

When they observe Black peoples,

they might say they have smaller veins.

They might say that we see that Black people

experience pain differently than white people.

They may be able to stand more pain than white people could.

They connect the physical differences

to other kinds of differences about intelligence,

about behavior, about character.

♪ ♪

By the early 19th century,

um, physicians and these observers

who are trying to understand

how Black bodies, white bodies,

Indigenous people's bodies are different, focus on the skull.

YACOVONE: Samuel Morton in Philadelphia collected over

a hundred skulls of white Americans,

of Native Americans and of African Americans,

or so he said.

Measured their content,

and because of the volume that he measured,

proved, according to him,

that people of European descent deserved to be at the top

of the hierarchy because their brains were bigger.

Therefore, they were smarter.

And people of African descent had smaller craniums.

Therefore, they were less intelligent.

Science proved, according to Morton, that

African Americans were grossly inferior,

designed by God and nature

to do the work of the white man.

Well, that's simply his own creation.

The idea of a race is fictional.

It's a social category

which has, in fact, no scientific basis.

Nothing that modern Americans would recognize as science

was behind what he was doing

and all the other so-called physicians and scientists,

whether it's Agassiz, Morton or anyone else.

JOSEPH WRIGHT: The institution of slavery

was justified by many of the

policies, the approaches

to medical care of the time.

The assessment of lung function is,

is probably a, a very clear example

where Thomas Jefferson posited

in a 1781 treatise based on no science,

that the enslaved

had lesser lung capacity than the enslavers.

NARRATOR: In the 1840s,

Dr. Samuel Cartwright, a Louisiana physician,

set out to prove Jefferson's theory

by experimenting on enslaved men and women

using a device called a spirometer to measure

and compare Black and white people's lung functions.

WRIGHT: He then published in the peer review literature of the day,

his supposedly scientifically proven premise

that Blacks not only had lesser lung capacity,

but that the way to correct it was forced labor.

♪ ♪

VANESSA NORTHINGTON GAMBLE: When you look at the history

of race in American medicine,

you see Black people fighting back

against this theory

about Black bodies are different.

FORD: So one way that Black people have fought back

is by confronting racist research very directly.

Prior generations were clear that they needed to show

that the high rates of disease that Black people experience

were not due to something about their bodies.

It was not due to their race.

It was not due to being Black.

It was due to being subjected to unfair treatment.

NARRATOR: Dr. James McCune Smith,

the first Black physician in the United States,

used his medical degree to speak out

against using racial difference in medicine.

JAMES MCCUNE SMITH (dramatized): The illogical conclusion

has been adduced that there is a permanent difference

between these two races.

This argument is about as conclusive

as if we were to select all the white men in this city

who have gray eyes, and to argue

that because the color of their eyes differs

from that of the remainder,

therefore the two classes belong to different races.

NARRATOR: As early as the 1850s,

Black doctors pushed back against racial medical theories.

Dr. John S. Rock,

a physician educated at the American Medical College

in Philadelphia,

pointed to the real reason for the poor health

of enslaved Black people.

The horrible living conditions of the plantations

on which they were forced to live.

♪ ♪

Besides measuring the lung capacities of enslaved people,

Cartwright invented a disease to maintain slavery.

HAMMONDS: One of the things-- he noticed a problem

that plantation owners had indicated to him

is sometimes that slaves try to run away.

(dogs barking)

(distant hollering, barking)

♪ ♪

He coined the term drapetomania

and he says, "That's running away disease."

Slavery is their natural condition

so if they want to run away from their natural condition,

then we have to think about that as a mental condition.

FORD: It essentially was a made up disease,

but it naturally reflected the ways that

racism operated within

the medical community and broader society at the time.

They sincerely believed that Drapetomania really does

characterize something peculiar about those Black people

who would venture off the plantation

and try to live a life of freedom.

HAMMONDS: Now that he's claimed it as a disease, how do you treat it?

Well, you enforce

your labor practices on them even more.

You whip them more, you make them more submissive.

You make them

more accustomed to their state,

their natural state.

So it is a justification for increasing discipline

and physical beatings on the slave,

the enslaved peoples.

NARRATOR: After Emancipation,

pseudo-scientific racial theories continued to grow.

One theory

was that Black Americans would become extinct.

Freedom was not "natural" for Black people.

Now that they were no longer enslaved,

they would simply die out.

GAMBLE: One of the major proponents of this

was a man by the name of Frederick Hoffman.

Hoffman worked for Prudential Life Insurance,

and for many years,

Prudential Life Insurance did not insure Black people,

because the company believed

that Black people were going to die out.

Frederick Hoffman wrote a book,

and what Hoffman said was that Black people

were going to be extinguished.

FREDERICK HOFFMAN (dramatized): Previous to emancipation,

the Negro enjoyed health equal,

if not superior to that of the white race.

A higher death rate must be considered

an evidence of race deterioration,

tending toward a condition in which

gradual extinction of the race take place.

NARRATOR: In a scathing book review,

scholar and activist, W.E.B. Du Bois

challenged Hoffman's ideas

in a prominent scientific journal.

W.E.B. DU BOIS (dramatized): The question, therefore, first arises,

where did Mr. Hoffman find material sufficient

in quantity and quality

to form the basis of so momentous deductions?

One cannot, however,

agree with the author

that this excessive death rate threatens the extinction

of the race.

Compared with death rates elsewhere,

it is not remarkable.

FORD: Though they may seem absurd to us today,

these determinations became embedded

in scientific theory and methods.

Every prescription, every course of treatment

is based on evidence that has these

assumptions woven throughout them.

NARRATOR: Among those who embraced these false medical theories

was Dr. J. Marion Sims, a 19th century doctor

who would become known as

"the father of modern gynecology."

RADIO ANNOUNCER: The DuPont Company of Wilmington, Delaware

makers of better things for better living

through chemistry presents the Cavalcade of America...

NARRATOR: Sims' reputation extended far beyond the medical profession.

Nearly 70 years after his death,

he was celebrated in a radio program

featuring one of Hollywood's biggest stars.

RADIO ANNOUNCER: Tonight's "DuPont Cavalcade" stars Ray Milland

as a pioneer surgeon of the 19th century: Dr. J Marion Sims.

It mostly focused on his establishment

of a woman's hospital in 1855,

and his encounter with

an Irish woman by the name of Tilly.

J. MARION SIMS (dramatized): The woman's hospital was opened at last,

and as I began my story with my housemaid Tilly,

so I'll bring it to a close with her.

Only now, as I fondly hoped, Tilly has become my nurse.

GAMBLE: Talk about a whitewash.

There was nothing about the enslaved women

who suffered at Sims's hands.

Nothing at all about

the, the surgeries on the enslaved women.

SIMS (dramatized): Oh, you're going to be a fine nurse, I know, Tilly.

TILLY: (sighs) A knight in shining armor.

That's what he is, a regular Sir Galahad.

(birds twittering)

WANDA BATTLE: James Marion Sims was born in 1813

and he died in 1883 at age 70.

So here this marker calls him

the "Father of Modern Gynecology."

The marker says,

"he cured the considerate hopeless malady

gaining him fame as a benefactor of women."

NARRATOR: Monuments like this one in Montgomery, Alabama,

were erected in Sims' honor across the nation.

HAMMONDS: Sims is trying to understand how to give a treatment

to women who have prolonged labors

and they end up with these tears that are called fistulas.

What he decides to do is to take some slave women

and began to try to figure out

how to fix these tears,

which meant that he was,

uh, on a regular basis

doing extensive operations on these women,

surgeries on these women.

The health of Black women was not important to him.

What was important to him that he could use them

to answer the questions that he was trying to answer.

HARRIET WASHINGTON: Vaginal fistula,

a horrible complication of childbirth;

horrible, painful infection.

A Black woman with that vesicovaginal fistula

couldn't work.

She was of no use

to her master.

People had tried to cure vesicovaginal fistula,

and he knew that there were white women with it

who would pay to be cured, and there were slave owners

who would pay to get these women back into productive labor.

HILTON: Dr. Sims, he performed surgeries on them

without any use of any type of pain medicine.

During that time, we knew ether was an ability

to anesthetize the body

to allow for surgeries to be done.

NARRATOR: An enslaved teenager named Anarcha

was operated on 30 times.

She and two other enslaved teenagers named Betsey and Lucy

endured torturous and humiliating operations.

WASHINGTON: We're talking about years of these women

having their genitalia sliced by scalpels

and sewn together, then falling apart again.

Sims would allow other doctors to come

and watch these surgeries transpire.

NARRATOR: Sims himself documented an operation on Lucy.

She endured an hour under his knife,

crying and screaming out in pain.

SIMS (dramatized): Lucy's agony was extreme,

and I thought that she was gonna die.

The poor girl on her knees bore the operation

with great heroism and bravery.

WASHINGTON: To say that it was courage

implies heavily that it was voluntary, but it was not.

If you are a slave that refuse to do your master's will,

you could be beaten, you could be injured,

you could sometimes even be killed.

So saying no was simply not an option.

NARRATOR: The man who came to be revered

as the "Father of Modern Gynecology"

was influenced by what was by then

a long tradition of racist pseudo-science.

What made that possible is that deep belief

that Black women didn't experience pain

the same way as white women did.

The slave women are different. Their bodies are different.

(distant cheers and applause)

Does this sound like a man we want to celebrate?

CROWD: No!

MACK: Does this sound like a man we want to commemorate?

Mr. De Blasio, tear down this statue!

MAN: Take it down!

(cheers and applause)

NARRATOR: After a decade of organizing,

local activists have fought back to dismantle

the relics of Sims' controversial legacy.

Some of the monuments have begun to come down,

but his beliefs are still alive in the medical profession today.

HILTON: It would be one thing if that was a,

kind of notion that died along with Dr. Sims,

but unfortunately, we see studies that show that

medical students and residents

were still reporting there was some innate difference

in the way that we were born between Black and white people.

NARRATOR: In 2016, a study of medical

residents' and students' beliefs found that many thought

Black people felt less pain than whites.

This false belief can significantly

impact the treatment that Black patients receive.

Some of the false beliefs

about biological differences

that we explore are things that are

Black people's blood coagulates more quickly.

Their nerve endings are less sensitive.

They age more slowly.

That they have thicker skin than white people.

Um, even things, like,

they're able to detect movement more easily.

What we found is first that half

of the medical students and residents endorsed at least

one of these false beliefs.

So among white medical students and residents

who endorsed more of these false beliefs,

they thought that the Black patient

would feel less pain than the white patient

and they were less accurate in their treatment recommendations

for the Black compared to the white patient.

FORD: That actually is surprising to a lot of people,

to know that, here's proof that racism

still exists among those

who altruistically, at least let's presume that,

go into medicine.

They still nevertheless carry these racist, uh, beliefs.

In part because those beliefs are in the literature,

in the evidence space,

and in the way that the field practices.

♪ ♪

NARRATOR: False beliefs about racial differences

have been so widespread, that in 2017,

Pearson Education, a leading educational publisher,

was forced to apologize for publishing a nursing textbook

with false and biased information about

how to treat patients of different races.

I'm Tim Bozik and I lead global product development

at Pearson, and I want to apologize.

In an attempt to help nursing students think through

the many facets of caring for the patients,

we reinforced a number of stereotypes

about ethnic and religious groups.

It was wrong.

NARRATOR: The book made stereotypical claims

about a number of groups.

"Blacks," it read,

"often report higher pain intensity than other cultures,"

and "they believe suffering

and pain are inevitable."

We've removed the offensive information

from the eText versions of the book,

the most recent printing of the book,

and any future print editions of the book.

NARRATOR: But the damage had already been done.

The textbook had been in distribution across the U.S.

for three years.

That disparity in thought process

leads to a disparity in health outcomes and treatment

and protocols that are for Black Americans,

and we see it on a day-to-day basis.

(sonogram thrumming)

NURSE: Look at here.

Look at those lips.

(sonogram thrumming)

NARRATOR: One area in which

racial disparities are especially stark

is maternal health.

Black American women face some of the

worst health outcomes in the U.S.

during pregnancy and childbirth,

in part because of racial bias in medical treatment.

VERONICA GILLISPIE-BELL: History has affected

how we deliver care.

And so, we don't believe Black women

when they say they're having pain,

when they say they're having headaches,

when they say they're having different symptoms.

It's really ironic

that the very bodies that have been experimented on--

um, Black women--

that we would suffer today,

not benefiting from...

presumably, the knowledge that will come from

that, that pain, that suffering.

NARRATOR: 80% of pregnancy-related deaths in the U.S.

are considered preventable,

and Black women are three times more likely than white women

to die during pregnancy or childbirth.

Black women also experience pregnancy-related complications

at disproportionately high rates.

MELODY SEGUE: Going into the second trimester,

I started to notice swelling in my hands and my feet.

And at the beginning of the third trimester,

I started to experience shortness of breath.

My blood pressure was taken and it was elevated.

I had no idea there was anything to be concerned about.

Those are all signs of preeclampsia

and any individual coming into the healthcare system

should be evaluated for preeclampsia

with those symptoms.

When the blood vessels get tighter,

that's what causes our blood pressure to be elevated.

And with preeclampsia, particularly in pregnancy,

when those blood pressures get elevated

and those blood vessels get smaller, then we,

one: don't have as much blood flow going to the baby,

but then for moms, we don't have as much blood flow

going to other areas like the kidney,

the liver, the brain.

If we don't evaluate it and treat it at that point,

it can go on to be eclampsia,

which is elevated blood pressures

that then leads to seizures.

♪ ♪

SEGUE: The day that my son was born,

the doctor did an ultrasound,

and then she looked kind of concerned

and she said, "We're having this baby today."

She says, "Well, there's no amniotic fluid

"around the baby except right at the umbilical cord,

"and he's a breach, so,

"we're going to the O.R.

"You're going to have a cesarean,"

and, you know, "we need to get the baby."

I was in the O.R. within an hour,

my husband was there with me.

I heard the baby cry,

which is so beautiful. (chuckles)

I found out after delivery that I had preeclampsia,

the symptoms of preeclampsia, which...

which are swelling in your hands and feet,

you can have shortness of breath,

and high blood pressure.

I had all three.

♪ ♪

All of the diagnoses were not on the table,

and if they were, they weren't explained to me.

I was not a partner in my own care.

♪ ♪

GILLISPIE-BELL: I had some shock in realizing

that this had happened to me as well.

I was about 25, 26 weeks pregnant.

I went to the hospital and I told them, you know,

"I'm having pain. It's coming and going.

I think I'm maybe contracting."

And they said okay.

So they put me on the monitor,

and in that space,

I did not feel comfortable

saying "I think something may be going on."

It doesn't matter what your title is,

it doesn't matter what your socioeconomic status is.

I am Dr. Gillispie. I'm a Black woman,

and so while it is sad, it's not shocking,

it's... unfortunately it happens way too often.

EXPECTANT MOTHER: I can see him.

NURSE: You can see him?

He has his hand right up there...

NARRATOR: The single greatest factor

determining the quality of the maternal care

Black women receive is race--

despite education,

wealth, or even fame.

REPORTER: Tennis star Serena Williams

and her husband, Reddit co-founder Alexis Ohanian,

recently welcomed into the world their daughter.

Williams recently told "Vogue" magazine

how she self-diagnosed a life-threatening emergency

after giving birth.

NARRATOR: Williams recognized the signs of blood clots

that she had suffered before,

so she guided her doctors on how to save her life.

GERONIMUS: Even though she's this wealthy famous woman,

and has allegedly the best healthcare

in the world,

they finally listened because she was Serena Williams.

Most women they wouldn't listen to, most Black women.

World champion sprinter Tori Bowie

was a force of nature on the track field,

but at the age of only 32

and while she was eight months pregnant,

she apparently went into childbirth at home

and died alone.

Bowie's death was ruled natural,

and the report stated that there had been

possible complications,

including respiratory distress and eclampsia.

Sadly, her story is not unique.

SKANES: The fact that we see women of color dying

despite socioeconomic status lets us know that there

is a level of bias somewhere in our system.

HILTON: What is it that lets our voice

not carry the same weight when we say something is wrong?

Education is not protective for us.

Income level is not protective for us.

As a double Board-certified anesthesiologist,

I spent 13 years after high school

to earn this degree,

and at the same time, my child

is twice as likely to die

than a white woman with a third grade education.

KAI FRAZIER: Do you want to hand me stuff out of here

and we can start going through that.

I can start...

Let's see.

We can put...

You can probably put this in there.

FRAZIER (voiceover): This is my first baby,

and looking forward to it.

I wasn't sure if I was going to have kids.

I was, you know, kind of indifferent.

I found a great partner, we decided we would have kids.

Either the 20th or...

FRAZIER (voiceover): I was well aware by moving to Alabama,

I was in the region that statistically,

has a higher Black mortality rate

in labor and delivery.

NARRATOR: Maternal mortality in the state of Alabama

is among the highest in the nation.

Dr. Heather Skanes decided to do something about it--

opening the first freestanding birthing center in the state.

Good afternoon, Ms. Bailey.

(voiceover): A lot of people ask me,

why would you start a birth center as an OB-GYN?

I think sometimes you have to create

the culture that you want to see.

I started my private practice first in 2021,

and my goal was to create a space in which

women of color were the center of the narrative.

Girl down.

IFAFOLAWE STACEY FLUKER: Kai and Burgess.

How are you all doing?

We're ready to see you. FRAZIER: Good, good. BURGESS: All right.

How are y'all doing today?

FRAZIER: Doing good, doing good.

Y'all look fabulous. Oh, thank you so much.

FRAZIER (voiceover): I didn't wanna go into

a hospital for my healthcare visit, so,

being able to go to a small office

full of Black women has been fantastic.

This is an example of your uterus.

This whole entity of the balloon.

SKANES: Right now,

we're the only birth center that's operating.

We're the first licensed birth center

in the state of Alabama's history.

JO CRAWFORD: Jayla, are you ready?

SKANES: You have to be a low-risk candidate,

meaning you don't have any specific chronic conditions

like high blood pressure, diabetes, anything like that.

And you have to get to full term.

So you have these muscles

on the side of your uterus that contract...

SKANES: Most of what we know about obstetrics has come from

the art of midwifery.

And what the actual contraction is.

♪ ♪

(crying)

SKANES: When I look at my data

from before I had midwives to after, you'll see

increase in the vaginal birth rates,

decrease in the epidural usage, decrease in interventions.

That's been shown in many ways in randomly controlled trials

that you have better chance at a good birth outcome

if you have a doula or midwife when you're Black.

NARRATOR: From the 19th to the early 20th century,

Black midwives played a large role in providing care

to Black and poor white women

who had no access to hospitals.

(baby whimpering)

Then, things began to change.

SKANES: There is this shift in the narrative about midwifery.

One of the ways that people chose to do that

was to say that it was dangerous for people to be at home,

and a lot of it was steeped in racism,

that they, midwives, were Black,

they were uneducated, that they were dirty,

that they were causing deaths,

and that just wasn't the truth.

It's documented that there were midwives

who had caught thousands of babies

and who had less than one death in their whole careers.

NARRATOR: Despite midwives' effectiveness,

Alabama banned midwifery in 1976.

But after a decades-long grassroots effort,

the state began licensing midwives again in 2017.

But now, only a handful of them are Black.

Always find where the back is first,

which we know because we feel feet here,

and she says the back is over here. Okay.

Kicking has been over here.

FLUKER (voiceover): Currently, I'm a doula, a birth companion,

and with the birth center,

I get to get my hands a little bit closer

to my ultimate dream, which is midwifery.

(indistinct talking)

♪ ♪

When I envisioned my delivery,

I never envisioned it in a hospital.

I wanted to give birth in a birthing center

because I wanted to make sure that we had

the least amount of medical intervention as possible.

(water shifting)

Kai means ocean and water.

I wanted to have a water birth.

♪ ♪

(indistinct talking)

(low groans)

One thing that I love about Oasis is that

it's small enough to where

women really have the opportunity

to develop a relationship with her birth team.

♪ ♪

SKANES: People are down here fighting for their lives,

and the birth center is a part of this larger

grassroots effort to create a new culture in Alabama.

I would say that we are at a critical junction

as far as maternal health in this country.

Of all the developed nations, the U.S. is at the bottom.

♪ ♪

GILLISPIE-BELL: This is supposed to be a time of joy,

where your outcome is supposed to be

a healthy mom and a healthy baby,

and we're seeing Black mothers die at a rate

higher than that of their white counterparts.

And so I think as providers in the healthcare system,

we have to be aware of all of these things

and make sure that we're creating a safe space

for our patients to speak up,

and that we're also creating a space where they are heard.

NARRATOR: In maternal health and other disciplines,

doctors rely on new technologies

to help them care for patients--

using massive data sets of symptoms,

medical histories, and test results.

All of this data is analyzed

using algorithms-- computer-based formulas

that guide how physicians diagnose

and treat their patients.

WRIGHT: The use of the algorithms is

to really standardize or systematize the way that we

process and use

a wide array of information.

And I would say that the--

this is part and parcel

of the practice of medicine.

This is not... these are not

some esoteric tools.

♪ ♪

Algorithms are used every day in every setting

by practitioners to make decisions.

NARRATOR: Reliance on mathematical algorithms

and artificial intelligence is exploding,

but America's history of racial bias

is sometimes baked in.

CAMERON WEBB: Over the last few years,

we've started to identify

that any time these tools

incorporate race,

then we have to ask

the question, what is actually the role of race?

And is it the appropriate proxy

or measure to include in this algorithm?

NARRATOR: One example of how

race-based algorithms put Black patients

at a disadvantage in receiving life-saving treatment

is pulmonary function tests.

The spirometer, utilized by Dr. Samuel Cartwright

in the 19th century,

is still being used to diagnose lung disease today.

(inhaling)

HILTON: This test measures

what is the lung volumes of a person, right?

And we see that

there was an adjustment made again for race.

Historically, they said that we had

a lower lung function than white people.

WRIGHT: The roots of that work

live on to current day

in the way that we assess lung function

in spirometry.

Anyone who's blown into that...

tool, that machine, to assess lung capacity,

has had their race baked into the actual machine.

NARRATOR: What this means is that Black and white patients

with exactly the same test results

are diagnosed differently by the algorithm,

to the disadvantage of Black patients.

(taking deep breaths)

HILTON: A white person hit that same mark,

they would be considered to have lung disease,

and you will be considered to be normal.

So those interventions to try to better your lung function

or identify what it is that's causing

your lungs not to work, were not made.

And so when we're thinking about lung transplants,

and we're thinking about how to get you on medications

to help improve your lung function,

that was denied for Black people,

delayed for Black people, and given to white people.

WRIGHT: It's only until

just recently that the American Thoracic Society

made their recommendation

that race should be removed

in spirometry testing.

NARRATOR: While algorithms are

indispensable diagnostic tools,

the racial biases programmed into them,

coupled with documented medical mistreatment of Black people

have led to an overall distrust of the medical system.

During COVID-19,

this distrust became a national public health issue.

REPORTER: Health officials around the country

are working to reverse declining vaccination rates.

Recent data shows that roughly a quarter of Americans

are not inclined to get a COVID vaccine.

That number is believed to be higher

in the African American community.

NARRATOR: By the end of April 2021,

when all adults in the U.S. were eligible

to receive the COVID-19 vaccine,

about 41% of white Americans

were not vaccinated against COVID,

compared to 54% of Black Americans.

Some of this vaccine hesitancy

was cited by researchers

as stemming from historical experiences

of discrimination and injustice.

REESE: I know of people

who didn't trust the vaccine.

They thought if you take the vaccine,

it'll make you sick,

it'll give you COVID.

Or it'll give you something else,

and as a result,

they wouldn't do it.

We have been

subject to all kinds of experiments.

That history obviously gave people apprehension.

NARRATOR: Discussions of distrust often cite an infamous study

conducted on Black men in Tuskegee, Alabama

beginning in 1932.

These images were produced as part of

a U.S. Public Health Service campaign

to raise awareness about syphilis

and its prevention in southern communities like Tuskegee.

WASHINGTON: U.S. Public Health Service

put out a call

saying anybody who's sick and needs a doctor,

come to see us.

And people flocked. Hundreds of people came.

But they didn't come up

with things to ameliorate Black health.

Instead, they wanted to research syphilis.

What did they want to find in particular?

They wanted to prove

something that 19th century doctors had said,

that syphilis would affect Black people

differently than white people.

♪ ♪

GAMBLE: There was a belief that

with the last stage of syphilis,

that white people got more neurosyphilis

because they used their brains more.

And, you know, Black people didn't use their brains,

the theories went,

and that they had more cardiac complications.

And in order for there to be

scientific evidence for these theories,

there had to be experimentation.

♪ ♪

DAVID HODGE: These men thought they were being treated for

what was called at that time bad blood.

Bad blood was a kind of

grab bag term for all blood diseases,

like diabetes

and hypertension.

NARRATOR: In fact, they were not to receive any kind of treatment.

Instead, the government doctors withheld treatment

so they could study

the long-term effects of untreated syphilis

on Black patients.

HILTON: They all had wives, they also had girlfriends--

they were young men.

And so we had the infection of women as well.

And we allowed for children

to be born with congenital syphilis,

all because the U.S. government wanted to see

what happens when we don't treat this illness.

NARRATOR: These Black patients were denied treatment for 40 years,

even after it became known in 1943

that penicillin cures syphilis.

♪ ♪

It is morally wrong

to have a drug that works

and refusing it to a particular population

for no other reason than because they were Black.

NEWS REPORTER: It's decades late,

but finally a president apologizes for experiments

that used Black men as guinea pigs.

What the United States government did was shameful,

and I am sorry.

HODGE: During COVID, each and every day,

we saw multiple times where the name Tuskegee was mentioned

associated with vaccine hesitancy,

vaccine reluctance.

Many Black and Brown people, all they know is

that something took place

and it wasn't good.

WRIGHT: When the COVID vaccines became available,

I had a front row seat to hearing

from patients about their hesitancy.

The justifications were

well beyond the Tuskegee experiment.

That is what...

the lightning rod is,

but I found the roots to be

in a broader inherent

mistrust of the system.

♪ ♪

NARRATOR: Centuries in the making,

bias in the treatment of Black Americans

inside the medical system is still being felt today,

contributing to the wide and persistent

racial disparities in health outcomes in the U.S.

At the same time,

researchers increasingly point to the impact

of social and environmental factors

that undermine Black people's health

before they reach the doctor's door.

♪ ♪

LAVEIST: Certain communities

have an infrastructure

that can facilitate a more healthy lifestyle:

good restaurants,

good quality housing, good schools.

Other communities have an infrastructure

that facilitates ill health:

less availability of quality foods,

more pollutants in the community that they live in,

less availability of healthcare.

NARRATOR: This kind of residential segregation,

steeped in racism,

has detrimental health effects.

Residential segregation

refers to policies of the late 19th and 20th century

that determined where people could live

based on their race.

FABER: These policies largely excluded

Black people and Black neighborhoods from

home ownership opportunity, and also encouraged

white Americans to leave those neighborhoods.

♪ ♪

NARRATOR: These policies help deepen

the unequal and poor conditions

that exist in many segregated Black American communities

to this day.

MARTIN LUTHER KING JR.: We found not only slums,

which is a real problem,

but ghettoized conditions.

Chicago really is one of the most segregated cities

in the United States in housing.

♪ ♪

We sent Negroes in large numbers

to the real estate offices in Gage Park.

Every time Negroes went in,

the real estate agent said, "Oh, I'm sorry.

"We don't have anything listed.

(children playing)

Now you can find something somewhere else."

And it was always back in the ghetto,

but they didn't have anything.

And then soon after that,

we send some of our fine white staff members

into those same real estate offices,

and the minute the white persons got in,

they opened the book-- "Oh, yes. Well, we have several things,

Now, what exactly do you want?"

(applause)

ANSELL: Those neighborhoods became

the Black and Brown neighborhoods

that we see today,

of concentrated

poverty and segregation.

♪ ♪

Those conditions were driving

the poor health I was seeing.

♪ ♪

(rumbling)

NARRATOR: More than 8 million Black Americans

live in food deserts--

areas where people have

limited access to affordable, healthy food.

For them, like residents of Chicago's segregated West Side,

the consequences are not only unhealthy,

but can take years off of a person's life.

♪ ♪

(indistinct talking)

HAYES: The neighborhood,

they are on limited income,

so you got to be able to keep the prices down,

but if you can't buy a product in bulk,

it's hard to keep the prices down.

So it's definitely a challenge.

And a lot of times, we just end up with

lower quality goods or no goods at all.

LARDE (voiceover): Are those the only frozen meats that you have,

that are in that one back there?

Yeah. Right now, yes ma'am.

Okay.

WEBB: What we have is these

really high-calorie, low-quality foods

people with lower incomes

are forced to consume,

and that actively

accelerate the process of them being sick.

Uh, her insulin, Lantus.

WEBB: You see more diabetes,

higher cholesterol, higher blood pressures.

The combination of those three,

you see more heart disease,

and then you see

the bad outcomes that come with that.

HAYES: You forced to make decisions

of what you need the most.

And a lot of times, you go for the cheaper products,

which are usually the lower quality products.

I can't get the same price

Whole Foods gets for the product.

So if they're charging seven bucks,

I'm going to have to charge nine.

There's definitely a need for

fresh goods and fresh groceries

in these neighborhoods.

So, we try the best we can, and that's all we can do.

PAYEL GUPTA: We know that all of these processed foods

are the reason

this country is suffering from this obesity epidemic.

♪ ♪

When you have obesity,

you have more inflammation in your body,

and any of that extra weight can cause

not only inflammation, but it can inhibit

the way that you take a breath, even.

Your diaphragm is not able to expand as much.

There's a clear link between asthma and obesity

and other chronic lung conditions.

CARL LAMBERT: Patients, they will go towards

what's closest to them.

They're eating things like fast food

because there isn't a fresh food market that's nearby.

And we have to be really careful not to

put blame on patients for

making the choices that they're almost forced to make.

ANSELL: Let's give a hug.

(voiceover): How do you begin to, as a doctor

or as an institution,

address those neighborhood conditions?

What we did was to lay out life in Chicago

along the L tracks,

because it resonated

that if you lived in the Loop,

you're more likely to be white,

more likely to be wealthy.

You could live to be 85.

But if you go down the Blue Line, right past Rush,

two or three stops, you land in

one of the lowest life expectancy neighborhoods

in the city.

And then when people say, well, what are the reasons

for that premature mortality?

Is a lot of people thought was gun violence

and homicide...

...but it was cardiovascular disease and cancer

and diabetes

accounted for more than 50% of that.

We needed people to think about it differently,

the root cause of this was structural violence,

structural racism, and economic deprivation.

LAMBERT: So you're gonna feel some pressure.

(voiceover): Food is medicine,

but you have to have the lens

of the patient that's in front of me.

What sort of access to healthy food do they have?

ANSELL: We've gotta start focusing

on the structural conditions in the neighborhood

around food.

And we thought, what could we do to improve the conditions?

And then one day, one of the only

food stores left Garfield Park.

It's been almost one month

since the boards went up and the doors to the Aldi's

in West Garfield Park closed for the final time,

seemingly without any warning.

NARRATOR: Aldi cited "poor sales performance

and increased expenses" for the store closure.

PROTESTORS (chanting): Food is a human right!

We won't leave without a fight!

NARRATOR: Rush University Medical Center

joined forces with residents

to protest the closing

that had made access to healthy foods even more scarce.

Come get your free food! NARRATOR: The action led to a community grocer initiative.

ELIZABETH ABUNAW: There's over a half a million Chicagoans that live

in neighborhoods and communities

where affordable, fresh,

healthy food is not a given.

I don't call them food deserts.

I call it what it is, it's food apartheid, um,

access to affordable fresh food is wholly unequal

and it breaks down along racial lines.

♪ ♪

What I wanted to do

was give people a shopping experience

that would delight them.

Delight them with all

of the wonder that is food.

Forty Acres Fresh Market is an independent,

Black woman-owned grocery business

that operates in the city of Chicago

and close western suburbs.

You are what you eat.

All of those sayings are absolutely true.

Food drives your health,

and all we're saying is that we deserve the options

to have more control of that where we live.

NARRATOR: Community grocers in Chicago and other cities

are trying to reverse the effects of food deserts.

But other factors,

also linked to America's history of racial segregation,

can have just as big of an impact.

WILLIAMS: One of the things that has happened historically

in the United States is that

when neighborhoods were demarcated

as places where Blacks should live,

they became places where

you could build a freeway,

places where you could

set up trash dumps

and other undesirable neighborhood characteristics.

And that has happened across the United States,

that the places where Blacks live

are places where there's a higher level

of exposure today to physical

and chemical toxic substances.

NARRATOR: The communities of West Oakland, Hunters Point

and Richmond, California make up what's known as

the Toxic Triangle.

The area is bound by shipyards,

oil refineries,

and a matrix of freeways spewing diesel,

truck exhaust and other pollutants into the air.

I had no idea the magnitude of pollution

from the Port of Oakland and the three freeways

and the industrial businesses in West Oakland.

I live on a thoroughfare

of 7th Street and I'm two blocks

from the entrance to the Port of Oakland,

so trucks run through 7th Street 24/7.

NARRATOR: Margaret Gordon moved to West Oakland in 1992

and has seen the impact of the air quality

on the people of Oakland.

The exhaust makes its way into her home,

and she says it's made her sick.

GORDON (voiceover): You open up your windows,

it, it can start collecting,

and it collects the higher the ceiling is.

That's where it collects at.

On your Venetian blinds... on your car,

people think it's dirt.

It's from the tailpipe of trucks, trains,

ships as a cumulative impact.

(ship horn blares)

I use an inhaler.

I use an inhaler daily

or sometimes twice daily.

NARRATOR: Gordon suffers from chronic asthma,

but that only motivated her to fight for cleaner air

in her community.

She co-founded the West Oakland

Environmental Indicators Project.

GORDON (voiceover): I started getting involved real heavily in community

activities around environmental justice,

that's when the clock started ticking

for me to understand asthma

and relationship to pollution.

♪ ♪

NARRATOR: She's worked with local environmental organizations,

to monitor the air

and map pollution "hot spots" in her neighborhood,

using new technologies.

Studies have documented high concentrations

of nitrogen dioxide, nitric oxide,

and black carbon-- pollutants linked to increased

cardiovascular and respiratory diseases.

GUPTA: Diesel fumes

and fumes from cars,

produces something called particulate matter.

The smaller the particle,

the more easily it can get into your airways.

NARRATOR: In West Oakland, emergency room visits for asthma

are 76% higher than the county average.

GUPTA: Black individuals are two to four times more likely to die

from their asthma compared to white counterparts.

NARRATOR: A Black child born in West Oakland

has a life expectancy of 73 years,

while a white child born in Oakland Hills,

a community just six miles away,

will be expected to live 15 years longer.

GORDON: We have this unequitable situation

of who breathes what in the city of Oakland.

That's always been a major thing.

How to reduce these emissions

from the port and from the freeway.

(seagulls squawking)

NARRATOR: Across the bay from West Oakland

is a community living in the shadow

of the Hunters Point Naval Shipyard.

(explosion)

Just after World War II,

ships that survived atomic bomb testing

in the Marshall Islands were brought to Hunters Point.

Where they were sandblasted to rid them

of radioactive material.

That sand was then left to seep

into the ground, contaminating the entire area.

SUMCHAI: We are looking at a staging area

for soils that are likely to be radioactive.

There's nothing, you know, that stops

a wind gust from disseminating this soil.

They're supposed to be covered

and they're supposed to be contained.

DEREK TOLIVER: As residents that live here,

do we get worried about being exposed to it?

Absolutely, because it becomes airborne.

You know, once anything becomes airborne,

it's spreading.

NARRATOR: The shipyard was designated a toxic superfund site in 1989.

But in the decades since,

the cleanup has been plagued with delays

and faulty test results, and as recently as 2021,

the navy found radioactive objects,

and admitted

that toxic groundwater posed a threat

to the longstanding African American community

that settled in Hunters Point to work at the shipyards.

SUMCHAI (chuckling): I have a love-hate, you know, relationship with it.

My dad used to bring photos home of the ships that he worked on,

and, uh,

you know, so I've been exposed to it since I was a little girl,

and, uh, you know, it's just a tug of war of emotions.

Our findings show that people who are living

with the half-mile perimeter of this

superfund system are endangered.

You know, they have body burdens,

they are nutritionally deficient.

They have secondary diseases.

Many of them have more than one disease,

you know, that's associated with toxic exposures,

you know and this is just a very, very serious situation.

It's a situation that can't be ignored.

NARRATOR: More than 11 million Black Americans

live in close proximity to pollution-emitting facilities

or one of the nation's 1,800 toxic superfund sites.

These places have been linked to higher rates

of infant mortality, cancer,

and lung and heart disease.

Monitoring to detect and document exposure to toxins

in these communities is critical.

SUMCHAI: Anything in, uh, green is radiation contaminated.

NARRATOR: Dr. Ahimsa Porter Sumchai has been conducting

tests in the Hunters Point community since 2019.

We have screened people who have

ten to 12 toxins in their body,

in concentrations above, you know, what is allowable.

HARRISON (voiceover):: I took the test with Dr. Sumchai

and it was, um, I was kind of blown away.

What was found in my body was lead, rubidium,

cesium, cobalt, which is a metal,

mercury, platinum and plutonium.

The way it was explained to me is that through my

urinalysis, that, that it's in my bones.

♪ ♪

ICILMA FERGUS: If people live in certain environments where there's

a high level of pollutants and toxins,

you're gonna have more adverse outcomes

and you're gonna have that lower life expectancy.

NARRATOR: Health risks to Black American communities don't end

with toxic sites and food deserts.

The very same communities have fewer

primary health facilities

and a dangerous shortage of doctors.

ELAINE BATCHLOR: We have a separate and unequal

healthcare system in this country.

If you live in an, in an affluent community

like Santa Monica or Beverly Hills or Hollywood,

you have ample access to physicians.

If you look up the number of licensed primary care physicians

in Compton, there are only 22 listed.

♪ ♪

NARRATOR: In these communities, hospital emergency rooms often become

the primary source of care.

Blow out a little harder. (exhales)

Good, one more time.

BATCHLOR: Our hospital is located in an area

of Los Angeles that has over a million residents

who are primarily people of color,

Black and Brown and low income.

The community is missing almost 1,500 physicians.

NARRATOR: The acute shortage of healthcare professionals

in Black and Brown communities is due

in part to the economics of healthcare in the U.S.

Say, "Ah." Ah.

BATCHLOR: We know that there are providers who want to serve poor people,

but physicians can't sustain a practice in South L.A.

You're just gonna head on down to those red chairs on the left

and the right and they'll call you from there, okay, all right.

BATCHLOR: Most of the residents

who live in the community are covered by public insurance.

Medicaid pays very low rates for physician services

compared to commercial insurance that many people get

through their employers,

and as a result, there aren't enough doctors

and not enough access to primary care.

OSCAR CASILLAS: Because there's a lack

of urgent or same day appointment care

or next day appointment care,

or same-week appointment care,

the emergency department becomes the de facto

form of care that people in this community are left seeking out.

These are the type of things that lead

to higher amputation rates,

higher rates of uncontrolled diabetes and hypertension,

dialysis, kidney failure,

heart failure, strokes, and all the things

that we see at higher rates in this community.

NURSE: Oh, you got it. You're strong.

Yeah. Okay.

NURSE: You want me to scoot your back up?

Are you okay? Are you comfortable? You're okay?

Just like this. All right.

Seeing Dr. Hall

for a lot of months and we're saving this toe.

BATCHLOR: Diabetic amputations are the number one

surgical procedure we do in our hospital.

The diabetes mortality rate is 72% higher

in South L.A. than in the rest of California.

Are you having any pain?

Not today.

MYRON HALL: When things become more chronic

in terms of wounds, especially diabetic foot wounds,

we find that

50% of the people that have a below knee amputation

will die in five years.

Your sensation is still pretty good

and your circulation is good,

'cause I can feel your pulse.

All right. Yeah.

I didn't know that would ever

stay wounded as long as it's been wounded.

And how it started is... a nightmare.

BATCHLOR: If you live in one of those affluent communities,

you have good insurance,

you have good access to high quality prevention, treatment.

Even if you advance to the point where you have a wound,

you also have access

to comprehensive wound care,

which can prevent an amputation.

MAITA KUVHENGUHWA: Hello, sir.

How you doing?

Okay, so...

(voiceover): I think that

a lot of hospitals

in underserved areas

are dealing with the same things that we are.

Um, and I can tell you that

things are not equal.

Is it okay if I listen to your heart and your lungs?

(voiceover): My patients tell me

stories about how they've been discriminated against

how they've been to other hospitals,

and people didn't take them seriously.

BATCHLOR: Studies have shown that the language

that providers use

to describe Black patients in medical records

is different from the language they use

to describe other patients,

and that it is more derogatory

and it tends to describe the patients

as being less compliant and more problematic.

Those obviously shape not only how that provider interacts

with the patient, but how others tied to

that network of care are going to interact with that patient.

And one cannot help but wonder how

that affects the interactions.

Just, you know, the kind of dignity.

Sometimes it feels like we're asking certain patients

to exchange their dignity for the care that they get.

KUVHENGUHWA: I have had um, an experience

with systemic racism, actually, when my dad had his stroke

and he was airlifted to a tertiary care center.

They thought that he was just some guy off the street.

They didn't realize that he was a doctor,

and so they were treating him in one way until the family

showed up and we said, "No, he was a surgeon.

He was operating yesterday before he had this stroke,"

and then suddenly everything changed.

So it actually made me really sad

because I'm, I was thinking

if my dad weren't a doctor, he would get substandard care.

If we weren't advocating for him,

he might get substandard care.

So it opened my eyes a lot.

Good afternoon, ma'am.

Good afternoon. KUVHENGUHWA: How are you?

I'm okay, Dr. K, how are you?

KUVHENGUHWA: I'm excellent.

So I wanted to introduce you to Dr. Shibata.

Hi, Dr. Shibata.

SHIBATA: Nice to meet you.

So he is one of our internal medicine residents.

So when she first arrived,

her entire left lower leg from the knee down

was severely swollen.

Her white blood cell count...

I would say that the goal of the residency program here

is multiple-fold.

Um, first we need to fill a physician shortage

of over 1,000 primary care and specialists

here in South L.A.

(voiceover): So we're trying to train people who will hopefully be willing

and able to serve the community when they graduate.

We need to train a more diverse healthcare workforce.

We need to have more physicians of color.

And two weeks ago I got this cold...

GILLISPIE-BELL: So the data shows that when

there's concordance of race

between the patient and the physician,

meaning the same race,

that there is a level of trust that is immediately

established because we know we have shared experiences.

Um, there is data also that shows that there are

improved health outcomes for Black individuals

that have a Black primary care provider.

They have better health outcomes.

LAMBERT: There's plenty of physicians who are not Black

or Brown who do the best job that they can,

who do a solid job of caring for people

that do not look like them.

But at the same time, we have to be honest

that there is a lack of representation in our workforce.

I, I couldn't have no better other doctor.

Thank you Dr. K. You're very welcome.

Sorry.

I know you've come a long way

and you're almost at the finish line.

Almost ready to go home. Yes.

So, we just gotta get you there.

(voiceover): I feel like the patients here really deserve

high quality care.

Um, and that's what I strive to provide.

(voiceover): We're not short changing people here.

We aim to provide the best.

(on camera): Hello, hi ma'am.

PATIENT: Hey! How are you?

♪ ♪

♪ ♪

(laughter, excited chatter)

NARRATOR: Only 5.7% of medical doctors in the U.S. are Black.

Many of those doctors graduated from a historically Black

medical school, such as Charles R. Drew

University of Medicine and Science in Los Angeles.

(cheers)

(applause)

MITCHELL: It's my absolute

deep personal honor

to participate in your official

white coat ceremony today.

(cheers and applause)

GUPTA: Your white coat ceremony

is kind of your initiation

into this really important part of your journey

in your life,

into what you're gonna do for the rest of your life.

MITCHELL: And I look forward with all that I have

to be at your graduation ceremonies when we all

officially address you as doctor-- thank you.

(cheers and applause)

ROBERTO VARGAS: This model emphasizes person-centered, team care,

integrated long-term treatment approaches

to diabetes and comorbidities

and ongoing collaborative communication

and goal setting between all team members.

NARRATOR: A new generation of doctors is being educated in a new way

to understand the connections between social conditions

and health outcomes, and to confront bias head on.

SABRINA MONTGOMERY: We're learning a lot about implicit

bias and medical racism, even as Black and Brown people.

You know when they first brought it up, I was just like,

"We don't have implicit bias,"

but you know they had us take certain, like,

tests to just see.

And everyone has some level of implicit bias

and it's our responsibility

to really, like, work on those things.

♪ ♪

VARGAS: You guys talked to your standardized patient.

He had diabetes,

and you know, he was a little bit reluctant, but the goal was

not only for you to interview that person

and to find out what were his barriers and why he,

you know, what was going on with his diet,

but to also think about those contextual issues

that are gonna potentially inhibit his likelihood

of having a good outcome.

MONTGOMERY (voiceover): We're taught how to actually interview patients

and really learning how to sit,

how to lean in, because the more you're able

to connect with the patients,

the more that they're able to open up to you,

the more they're able to tell you.

WEBB: You wanna create the best doctor you can create.

It's so critical that

we are introducing doctors into our society

who don't have those same flaws that prior generations had.

There are so many studies

that have shown that when medical schools introduce

this idea of inequity,

of discrimination, of disparity early on in the curriculum,

they create doctors who are

more likely to try to address those dynamics.

♪ ♪

LAMBERT: There's a lot of beliefs,

racist beliefs about Black people and Black bodies,

and certainly you don't want

that in the medical healthcare realm

because lives are at stake.

You literally will kill people.

NARRATOR: Training new doctors

to counteract bias is an important step forward.

Even as clear scientific evidence has been building

for decades against the old false racial theories

especially thanks to a groundbreaking research project

begun in the 1990s.

REPORTER: Pure human DNA, the building block of life.

And in this, the greatest human science project ever,

they grow the DNA

and separate its parts

so a computer can read its chemical sequence.

BILL CLINTON: Today, the world is joining us here in the East Room.

We are here to celebrate the completion

of the first survey of the entire human genome.

Without a doubt, this is the most important,

most wondrous map ever produced by humankind.

NARRATOR: The Human Genome Project

sequenced three billion base pairs of our DNA.

The genetic material that makes us human beings.

Continued genetic research provides definitive evidence

that there are no meaningful biological differences

among what we call races.

HAMMONDS: It became clear that we are one people

and there are certain kinds of differences between us

even at the genetic level,

but they do not represent the kind of differences

that we associate the old term of race.

So all human beings have genes for skin color,

and those genes are expressed

in different ways among different groups of people

and individuals, depending on their ancestry,

depending on the geography, depending on a number of things.

But there is no gene for race.

We knew even in advance of the Human Genome Project,

of the unity of humanity.

But because of prevailing social,

political and economic forces,

we kept insisting on differences and significant differences.

GERONIMUS: The Genome Project helped to debunk the idea

that there's anything genetically biological

about being Black

that would cause these poor health outcomes

across the board.

There's just nothing to suggest,

if you really look at the science or the genome,

that while individuals may have predisposing genes

to specific diseases that they,

they don't correlate with skin color genes.

LAMBERT: So why are Black people

suffering from more disease?

We've talked about, about there's systems where

you're not getting access to healthy foods,

healthy air, proper access to healthcare professionals.

Another thing that I would say is there is such a thing as

being Black in America.

GERONIMUS: Black Americans face what I might call

the neon lights

of systemic racism.

These are the things like greater rates of poverty,

discrimination in jobs, working longer hours,

having physically more demanding jobs, medical underservice,

having educational underservice,

living in disinvested

areas that now subject you to environmental racism,

to just a whole range of stressors that are due

to the disinvestment in your communities.

♪ ♪

FORD: It comes at

so many different levels.

We experience it interpersonally

in the treatment we receive when we're in the store,

walking while Black,

driving while Black,

living while Black.

Many of us

carry the sense that we have to be

twice as good to get half as far.

That also is a form of chronic stress for us,

a burden that we're constantly carrying.

It's that we are being hypervigilant

in response to the racism

that pervades every facet of our society.

It's racism through multiple pathways,

but it's also racism due to

the stress of being Black.

(indistinct shouting)

GEORGE WALLACE: I draw the line in the dust

and force the gauntlet before the feet

of tyranny, and I say segregation now,

segregation tomorrow and segregation forever.

(cheers and applause)

GAMBLE: I went to medical school at the University of Pennsylvania.

There were times where people thought I was the maid.

(indistinct shouting)

On your face!

This is a no (bleep) zone.

CAMERAMAN: Mm, not really. Oh, is it?

Stop recording.

CAMERAMAN: Please don't come close to me.

Please take your phone... Please don't come close to me.

I'm calling the cops. Please, please, call the cops.

Do you have a receipt for this sir?

I got you on-- yes, sir.

Show me. You got it in your hand, sir

In Chicago, now, a woman claims a CVS drug store manager

called police on her

when she tried to redeem a coupon at his store.

REPORTER: The incident, just the latest in a string of episodes

caught on camera

of white people calling the cops on Black people

for everyday activities

like these two Black men arrested at Starbucks

shortly after one of them tried to use the bathroom.

I'm gonna tell them there's an African American man

threatening my life.

CAMERAMAN: Please tell them whatever you like.

GILLISPIE-BELL: When I was pregnant and I saw that it was a boy,

I immediately freaked out.

I was like, how am I gonna protect this Black boy

in the United States of America?

That is a level of stress in discussing with my friends

that are not Black, that they never even thought of.

(sirens blaring)

WILLIAMS: I am a professor at Yale University.

I'm leaving work at the end of the day,

and then there are bright lights in my face,

and I turned down my window and I said,

"Why am I being harassed?"

And he is upset that I'm using the word harassed,

because he's just doing his job.

One of the scales I developed

is called the Everyday Discrimination Scale.

It asks people,

in your day-to-day life,

how often you are treated with less courtesy than others,

treated with less respect than others.

That people-- you receive poorer service than others

in restaurants or stores,

that people act as if they're afraid of you.

Just these little day-to-day indignities.

Today, there are more than 450 published

peer-reviewed papers from around the world

in the medical literature documenting

that everyday discrimination leads to worse health.

Pregnant women

who report everyday discrimination,

Black women give birth

to lower birth weight infants.

Persons who report high levels of everyday discrimination,

more likely to develop diabetes, breast cancer, hypertension.

The science is now overwhelming that discrimination

is one type of stressful life experience that is pathogenic.

And what we mean by that, that is causing disease

and death on a large scale in the United States.

GERONIMUS: When you're chronically being challenged by your environment,

by societal explications,

by danger of various kinds, whether it's literal

danger or a possible threat, there's a degree of vigilance

that if you're Black in America, you need to have all the time.

Every part of your body is affected

down to the cellular level.

LAMBERT: There are hormones in that cortisol

that's released in your body, that's like your stress hormone.

If there's consistent

racial stress and strife and such,

that hormone stays elevated

and that leads to chronic conditions.

♪ ♪

JACKSON: There is a concept called biological age.

So you have your chronological age,

which is your actual age,

and then you have your biological or physiological age,

which is the age of your organs, the age

of your vascular system,

for example, the age of your kidneys.

And they don't always coincide,

the chronological age and the biological age.

And what we're seeing is that in

places where there is high stress

and great unpredictability, it tends

to increase the aging rate

on different parts of the body.

And at the ends of chromosomes,

we have something called the telomere.

GERONIMUS: Our chromosomes keep safe our genetic material,

and part of how they keep them safe

is they have these sort of caps on them

that are certain length.

They are there to protect your cells

and your DNA in particular.

And so as more and more damage happens to your body,

you lose some of that telomere length until a point where

the telomeres are too small to protect your coding DNA.

JACKSON: That means that that chromosome is aging,

and the older the chromosome,

the more frayed the ends are.

NARRATOR: Telomere shortening is a normal cellular process

involved in aging that occurs in all individuals.

But the phenomenon is accelerated

when people face high stress and difficult life situations.

GERONIMUS: At some point when the telomere lengths get very short,

either the cells die, or even worse,

they become what I call zombie cells.

They no longer can replicate.

They just sort of roam around your tissues and organs,

and your bloodstream letting out what are called cytokines

that can lead to cancers, can lead to autoimmune diseases,

and in their own way,

damage you across a variety of body systems.

♪ ♪

This human biological process that is a result

of being oppressed in a society and living with

chronic stressors

of all kinds, I named weathering.

The term "weathering" was meant to suggest

that you're both weathered by the storm

that you're exposed to

and you weather that storm.

It's that active, effortful coping.

♪ ♪

WILLIAMS: Imagine a drop of water

falling from the rooftop of

this building to the concrete sidewalk below.

And if water drip today, there's no big deal.

But if day in day out, week in, week out,

month in, month out, there's a steady drip,

drip, drip of water,

the concrete sidewalk will become weathered.

It becomes eroded by the constant exposure to adversity.

WEBB: There is a physiological toll

of being Black in America.

And when you have that aggregate stress over the life course,

we absolutely know there's an increase

in high blood pressure,

heart disease, shorter lifespan.

And for individuals who identify this

this, uh, experience with

discrimination or racism,

they have higher systolic blood pressures

at the end of the day.

So folks who say, "I am being discriminated against",

and it's their perception of discrimination.

So I don't care what somebody think,

if somebody says, "I wasn't discriminating against you,"

it doesn't matter, right?

Somebody's perception of that discrimination

leads to higher blood pressures at the end of the day.

WILLIAMS: When you're Black in America, there is a ceiling

on how much health you can achieve.

If you are high in income and education,

you have better health

than Blacks who are worse off,

but you don't do as well as whites.

And I'll give you one other dramatic example.

A study

of physicians who graduated

from medical school, all Black,

from Meharry Medical School,

all white from Johns Hopkins,

about the same time in late 1950s and 1960s.

25 years later,

they're all medical doctors working in the United States.

But those Black doctors have more health problems.

And if they get sick, they're more likely to die.

HILTON: We look at African immigrants.

Their health outcomes

are actually better than white Americans.

It's not until their children and their children's children

are living here for an extended period of time

that their health outcomes then become

of what Black Americans health outcomes are now.

And that leads you to think, then what's the difference?

It's not genetics.

♪ ♪

HAMMONDS: At the end of the story, it's racism.

It's not race.

Racism is a systemic way of ignoring the lived experiences

of various people in this country.

And for many of us, for Black and Brown people,

it's racism that this is

really harming our lives,

and our health.

WEBB: If you look at all

these systems, all these structures,

all these social drivers,

the tie that binds so many of them is the

pathological existence of racism

in our society

and our fundamental inability as a nation

to name it, to call it out,

and to make it public enemy number one.

♪ ♪

WILLIAMS: What can we do as a society

to raise awareness levels of everyone?

That the way we treat

people on a day-to-day basis,

failure to treat others with dignity and respect

that each person deserves, has consequences

for their health.

FABER: Looking at this history, we very much know

what we did to create an unequal society.

And acknowledging that

and dealing with that

is the only path forward.

WRIGHT: It will require

those who are training now

to have a different mindset that does

include the history of how we got here.

We're having conversations today that have not

been had in 400 years,

if you think about the history of this country.

♪ ♪

We are peeling back the way that healthcare

should be practiced going forward.

We're not going to fix this tomorrow,

but it's cliché that a journey of a thousand miles

begins with, but a single step.

We're taking those early steps.

FORD: There's so many preventable deaths.

There's so much preventable suffering.

But we often choose to look away.

So, um,

the only way I think we can

begin to address it is to begin to address it,

and we have to do that right away.

♪ ♪

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