All language subtitles for NOVA.S52E09.Critical.Condition.Health.in.Black.America.1080p.WEB.h264-BAE_track3_[eng]

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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.

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.

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

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.

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

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

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.

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.

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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♪ ♪

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