Conversations on Healing

Welcome to the Conversations on Healing podcast, where host Shay Beider speaks with renowned healthcare leaders, practitioners, and thought leaders, to explore the world of wellness, the incredible powers of self-care, and what it truly means to heal today. Join us on this journey to become more whole, healed, and connected.

Shay Beider Hello, and welcome to the Conversations on Healing Podcast. My name is Shay Beider, and I’m honored to introduce today’s guest, Dr. Uché Blackstock. Dr. Blackstock is a physician and thought leader whose work is deeply woven with both personal and professional experiences dedicated to addressing the impact of inherited racism and social ideas of difference within healthcare structures. As the founder and CEO of Advancing Health Equity, she leads a transformational organization focused on partnering with health systems to enforce accountability and promote cultural competence. Dr. Blackstock’s groundbreaking book, “Legacy: A Black Physician Reckons with Racism in Medicine”, quickly became a New York Times bestseller, highlighting urgent need to dismantle racial inequities through the voices of those affected. In this episode, we delve into the critical call to action her work demands– challenging the conceptualization of race that perpetuates harmful health disparities. We discuss how many healthcare providers and systems can lack humility and fail to recognize the generational errors and implicit bias that impacts survival and health outcomes. Through a lens of historical experience and data, as well as a beautiful personal life story, Dr. Blackstock reveals how the legacy of slavery continues to influence healthcare disparities today, illustrating the harmful misconception that Black bodies are biologically different in some ways from white bodies. This conversation, rich with insights from Dr. Uché Blackstock, is incredibly important as we strive for a more equitable health care system. Join us as we delve into these vital topics.

Alright, well welcome Uche to the Conversations on Healing podcast. I’m so happy to have you join the show.

Dr. Uché Blackstock Thank you for having me.

Shay So, you have written just an absolutely remarkable book. Your book is called, “Legacy: A Black Physician Reckons with Racism and Medicine”. What I thought was so incredible about the book is that it weaves through your personal story– this story not only of you and your twin sister, but also of your mother and your family. This memoir essentially, like all those lives, but then the intersectionality of those lives with the way that structural racism has so deeply impacted all of your lives. And then essentially– I mean, it’s like at every level– you can see the impact personally, professionally; even you can then see statistically what we know about health inequities and how they’ve directly impacted people within your family, and then others that you’ve worked with as a physician. And I think, too, in my heart, it feels like this is such an important time to be having these conversations, because living at a moment where suddenly we’re hearing from our leadership that we should not be paying attention to diversity, equity, and inclusion. And my heart knows at every level, that means we need to be paying attention to it even more.

Because, in my view, that leadership is deeply misguided, and the direction that we need to be taking is to find ways to both dismantle and then reconfigure systems of medicine that are more equitable. And that’s a huge part of what you write about in the book– what all those structural issues are, and then how do we actually contend with them in meaningful and thoughtful ways? And what does it actually take? Not just creating a committee that says, “We have this committee,” but the level of commitment that’s actually– and time allocation, and money, and resource, and power– that all needs to back that up. So, I am super excited to have an opportunity to talk about such a meaningful body of work.

Uché Thank you. Yeah, I’m very excited to be here. And when I wrote “Legacy”, I started writing it in 2021, and it came out January of 2024. I didn’t know that today, as I’m sitting here, that the book would be even more needed. I knew it was a topic that, unfortunately, was evergreen, but the fact that in this moment we need it more than ever has really struck me– especially over the last few weeks.

Shay Yeah, I know– we are in the middle of a storm with all of it. And so, I want to contextualize your story because I think it’s really important for our listeners to hear about your mom. Your mom is a central figure in the book. In some ways, I feel like the whole book is in honor of your mom in a certain way. I feel that throughout, in the way that you’ve written it, and even in the epilogue and how you talk about her in the epilogue. And so, she was obviously hugely pivotal in your life– as most moms are for all of us. She was a pioneering physician. She attended Harvard, she headed an organization of Black women physicians. And then suddenly, shockingly– and I’m sure at the time, it just felt so out of the blue– she became ill, and you were able at that time to discover it was leukemia.

And then she passed away when you and your twin sister were only 19, and you were just starting your own big academic careers. And so there was this incredible legacy, and you talk about in the book– she had her medical bag that, even as kids, you were trying to peek in and understand. And so, you’d learned from little children of like, “Oh, okay, what is this?” And a part of your legacy is this inherited legacy of becoming a physician that you learned from your mom. And so, I’m interested around what she– I mean, there’s so many formative questions to ask– but how she was able to deeply influence your understanding of what being a woman, and a physician, and a community healer really means.

Uché Yeah, I think– obviously, right now I’m 47 years old, so I’m the age my mother was when she passed away. When I was 19 and she passed away, she was just my mother, and I loved her dearly. But writing the book really gave me an opportunity to acknowledge her and all of her complexity– thinking about really how difficult it was for her to grow up in poverty. Here I live in New York City, in Brooklyn, New York. My mother grew up 15 minutes from where I live now, under very different circumstances– not knowing when the next meal was going to come, having to move often, just always being worried about their financial situation. And despite all of that, just was incredibly determined and was very bright, and ended up being the first person in her family to graduate college. And then had a wonderful chemistry professor who saw her potential and said, “You should apply to medical school.”

And she did– got into all of her medical schools and ended up at Harvard Medical School, which obviously was wonderful, but at the same time was a challenging experience for her because it was a culture shock. She was like a fish out of water. And I mentioned in “Legacy” that she was in class with people whose parents had written the textbooks they were using, and another one had won the Nobel Prize in immunology. And she came from such humble beginnings. But I think what I learned the most from my mom is that after Harvard Medical School, she came back to New York City, trained here, and then worked in the same neighborhood that she grew up in. Essentially, tending to her– her patients were her neighbors. And I think that she had this very unique perspective in that she understood very, very well where her patients were coming from.

She understood what their lives looked like. And what I learned from that is that you could go to attend a very prestigious institution and still really come back and work in service to your community. That’s the lesson that I learned as a little girl. And I also had the opportunity to see that so many physicians actually were Black women growing up. And because that’s who I was exposed to– that’s who lived on my block, that’s who my pediatrician was. So, I didn’t realize that that was not the reality for most people, but it was my reality.

Shay And you take time in the book to say she was both exceptional, but also you don’t want to paint her as exceptional because you’re trying not to reinforce this narrative that you just have to work so hard and you can be exceptional, and then you can make it work. And what you’re saying is there were a lot of other people that had similar qualifications to her who just didn’t get through because the system didn’t allow it. And that there were certain things that she just got lucky on, too, where there was an opening because of a certain– you talk about the way that your parents were able to get their first house. It was just very fortunate that a number of things lined up to make that possible, when ultimately they would’ve been denied the ability to get a mortgage and have home ownership, which is so important. And so, it’s kind of this reckoning with– she was extraordinary–you see it–but not to make her extraordinary as a way of saying that, as a way of not identifying all of the other structural things that kept people like her out of those positions.

Uché Yeah, exactly. And I think for a very long time, I didn’t really appreciate that, the nuance of that. It wasn’t until I was older and was a practicing physician and went through a lot of things that my mother had gone through, but I didn’t have her to talk to about that. And then even reading some of her previous writing– the essays that she wrote. She wrote a chapter in a book called, “Women in Medical Education” called a, “Black Woman in Medicine”. I was able to use some of her writing in the book, in “Legacy”, and just reading about what she had gone through and recognizing that although she had been very successful, it wasn’t an easy journey by any means at all.

Shay No, and you share some beautiful stories that, for our listeners who want to take the time– which I would highly recommend that they do– to read “Legacy”, there’s a richness with which you portray some of those stories and what she actually experienced. And honestly, it is remarkable on a certain level, the strength of her spirit. There had to be an incredible spirit inside of your mom to be able to achieve what she was able to achieve in those 47 years that she had on this planet.

Uché And I do feel like the book is really an opportunity to share her voice, to share who she was with the rest of the world. It is such an honor to be able to do that. So yes, there are many people in our Brooklyn community who knew her well, loved her, and respected her, but really, the opportunity that I had in writing this book– and essentially writing a love letter to her and sharing her with the world– it’s tremendous to me.

Shay You can really feel that– it comes through. And your mom also taught you about what we today would call structurally competent and culturally responsive care. And you describe in the book what that means: that the entire complex nature of the patient’s background and the social context in which they live, work, love, and pray is considered, right, when you’re doing an intake and an evaluation. And we still know that the single greatest determinant of health is your zip code. So it’s still– we are at base level on a lot of this stuff. And so, I’m curious about how that understanding of providing the kind of care that you saw your mom modeling and providing in the community– how that’s informed your own choices about how you’re practicing today.

Uché Sure. Yeah. I think it was just this understanding that part of practicing medicine, or part of being a healer, is not just knowing which medications to prescribe. There’s that emphasis on that in medical school, right– on the science of it. But really, I think what is incredibly important, and what I actually had to learn on my own along the way– and reflecting back on my mom, it just kind of solidified it– was that we really need to have a very holistic model for how we care for people, this recognition that they are part of communities, and that we know that what happens on a community level has the biggest impact on how healthy somebody is. That is not something that I learned in medical school. That’s something I had to learn later on, practicing– when I was trying to figure out how come the patients I was seeing, especially during my residency at a public hospital here in Brooklyn, New York, where I was seeing so many people who were uninsured and underinsured, coming in with diabetes that was poorly controlled, that very high blood pressures, coming in with end-stage kidney disease– and recognizing that it wasn’t about these poor individual decisions that people make about their health or what to eat. That really, it was about what was happening in their community.

And so, that’s a lesson that I had to unlearn and relearn, that I hoped, through “Legacy”, through writing this book, that the reader walks away with– that we really need to think about health in a more holistic way. That it’s not just about telling people to eat healthy, to exercise, to not drink alcohol. That there is so much more to that.

Shay And you talk about, again, connecting it to your mom– she liked to run, she actually ran marathons, was a very good runner, it seems. But she’d wake up really early before work and school and all the things, and she couldn’t just walk out the door and go run in the neighborhood, and even drove a distance to get to a park where it seemed like it was safer. But that even then, as a child, you were always relieved when she came back– that she’d made it safely.

And so, there’s so many pieces of that, right? And you talk in there about hearing gunshots as a child in the neighborhood. And today, we talk about green spaces. You talk about in the book about how far you had to drive to get the kind of healthy produce and stuff, and that your mom created a garden to try to then create some healthy produce that you had quick and easy access to. And all these things– in public health (my master’s is in public health)– we’re starting to take more seriously now, but there’s so much room for growth still around. If there’s violence in your community, if you don’t have easy access to healthy food and all you can get to is fast food, that has a huge impact. And if you don’t have green spaces– which now we know have a lot of very positive benefits; to be in nature can have a number of very positive benefits– all of those are then assets that are stripped mined from a community when you don’t have those assets. And then also, you talk in the book– another important public health component– is the community where, why did your mom get cancer? We don’t definitively know that, right? But you do know that in the community where she grew up, there’s some linkages, right, to radiation. And so, which communities tend to have the highest toxicity, tend to have the most industry? They tend to be the most impoverished. So there’s– again– you see it how it plays out: the way we’ve socially constructed things, and then it’s not an accident when illnesses created in those communities.

Uché Exactly. And I think it’s interesting, because I wrote about growing up in my neighborhood– I loved our neighbors, I loved our neighborhood, even though it was rough. And it wasn’t until I got older that I kind of connected the dots. But the things that you mentioned– about how we had to go to another neighborhood to go to a grocery store. Also, my parents didn’t feel comfortable sending us to the public schools in our neighborhood. And I had seen several people be shot. Really, it was difficult. And I was trying to figure out: Why is my neighborhood so different than other neighborhoods that are just probably within a five-minute drive? And it wasn’t until I got older that I learned about discriminatory housing policies like redlining from the 1930s. And I learned that my neighborhood was a formerly redlined neighborhood. So, it had been deprived of just the basic resources needed to make people safe and healthy. And also recognizing that the neighborhoods that were redlined in the 1930s of the same neighborhoods today that have the very worst health outcomes. So, really making sure that the readers had an understanding that there’s always a reason for everything– things don’t happen by accident or by mistake. That when we look at how healthy people are or how unhealthy they are, it could be traced back to a policy change. It could be traced back to a reason related to either education, housing, transportation– it’s all related.

Shay And you tell a story in the book that’s very moving, where, like you said, your education was being outsourced– you were being sent to other communities where you were able to get a higher quality education, which was obviously your parents were trying to do the best for you, to give you the best possible education. And then one day, one of these families who lived in– it sounds like– a probably incredibly different neighborhood from the way that you had described it, offered to drop you off at your house. And you didn’t feel comfortable having them see that part of your life. And then you ended up walking in freezing cold for several blocks, just so they could drop you off somewhere else. And the piece that’s, I think, so hard to hear in that story– because here you are, a young person– but already there’s such a deep sense, which you describe, of internalized shame. Then you didn’t even want to share it with your own family. You didn’t want to tell your sister, and your mom, and your dad. And that piece of how we construct things that intentionally set things up so that certain people are advantaged based on the color of their skin, and other people are disadvantaged based on the color of their skin– and then design it in such a way that you feel ashamed if you don’t have as much. Design the messaging to be that there’s something must be wrong with me, then
When it’s exactly the opposite of that. And so, I think that’s so heartbreaking in that story is that it got held in your heart when it absolutely was about everyone else with white skin who had constructed a world that was creating redlining– and people that look a lot like me– that designed an environment that kept you out. And so, what that does to a young child is exactly the reason why the work that you’re doing is so important, and that others are doing, to change the way we’ve set things up. You shared a beautiful story in the book that I thought would be a good one. It is during the early days of COVID, and it’s kind of a unique story because it was that moment when there was the full protective equipment– you were totally wearing all of the gear– and as a result, the patients could barely see you because you were essentially covered from head to toe.

Because we were still trying to figure out: What is this outbreak, and how do we protect against it? So, you write in the book that you went to meet with a patient and introduced yourself, and I want to just share an excerpt. I think it’s a really powerful one. So this is what you wrote: “I introduced myself to this patient and then asked the young woman to tell me about why she had come in. But before I got the chance to continue, she stopped me and she said, ‘Can I ask you something?’ I told her, ‘Yes, of course,’ nodding vigorously in case my voice was muffled through the double mask and shield. And she said, ‘Are you Black?’ I realized she couldn’t see my skin color under all the layers of PPE. ‘Yes, I’m Black,’ I replied, hoping she could see the smile in my eyes. I could sense the tension leaving her body. ‘Thank you, doctor,’ she sighed. ‘At least I know you’ll listen to me.’

And I think it’s like– there’s so much in that, right? So much that’s revealed around safety, trust, what allows us to feel like we can actually be heard. And there’s so much for medicine to learn in that story of what’s actually needed. And so, I think part of what I’m wanting to understand– because I see how much stories like this have inspired your work and now what you’re doing through your consulting firm, Advancing Health Equity, where you’re doing education, where you’re doing training, where you’re doing different things to really assess the environment and what can we do to make it better and different. And so, I’m curious how stories like that are informing the work that you’re doing today.

Uché Yeah, I mean, that story– that experience for me– was unforgettable. And it’s one of those moments that I think back on that, like you said, drives the work that I do. Because in that interaction, like you mentioned– the trust issue– the fact that it seemed like this person, this patient, had not been listened to before and then had to carry that burden going into this encounter. It’s one thing being sick, but it’s one thing being sick and being worried: Are people going to listen to me? Are they going to recognize my humanity? And so, like you mentioned, some of the work that I do through my consulting firm, Advancing Health Equity really is about training clinicians to really reflect on their biases, to form trustworthy relationships with their patients, to recognize that they should have some humility in their interactions with patients– that they may not know everything. And that our patients are the experts in their bodies. And so, I will say health professionals are the most challenging group of people to work with, because I feel like especially physicians feel like they know everything. And so, that interaction and many others like that drive the work that we do in terms of working with health and health-related organizations around these issues.

Shay And talk about some of the responses you’ve gotten– one of the physicians who said, “Well, I’m nice to all my patients. Why do I need to do this?” And it’s like, well, it’s so much more than that, which you spell out very out in a very articulate way in the book. As an example, you share some of the data– that Black babies who are cared for by Black neonatologists and pediatricians in their first year of life are more likely to survive, more likely to survive than those treated by white neonatologists and pediatricians. Like, that right there tells you so much.

Uché And it’s like really? Babies? Babies?

Shay Babies. Yeah. So, it shows how deep this runs, and you have a chapter in your book– it’s called, “A Tale of Two ERs”– that shows these really clear disparities between a public and a private hospital. And I’m interested, when you think about hospital systems, right, because worked in both kind of the more privileged institutions and you’ve worked in public hospitals, where it’s a very different set of rules. And I’m interested, as you look at these structures that we have in place, what do you see as some of the highest priorities for how we are going to create change systemically?

Uché I think what I would like to see more of from hospitals and health systems is accountability. And what accountability looks like is having standardized processes and procedures in place that are keeping track in real time of any disparities in terms of care and decision-making. So, for example, we know that over the last few years, there has been– especially, it’s been documented– there are discrepancies in how pain is treated in Black patients and in white patients. And a lot of that we were able to find because we’re looking at the prescribing habits of clinicians. We were actually able to disaggregate that data and say, oh, it looks like physicians are actually over-prescribing for white patients in pain and under prescribing. And that’s because the data was being captured. And so, I think it’s incredibly important that we are tracking, for example, how long patients are waiting in the emergency department.

One of our clients– they shall remain nameless– but they found that their Black patients are waiting 80 minutes longer in the ER to be admitted to the hospital than other patients. And so we thought about what can we do? Let’s have reminders in electronic medical record system after a certain amount of time saying, “Hey, patient so-and-so is still waiting to be dispositioned.” We developed internal dashboards for each clinician to say, “Hey, this is what your waiting time looks like, and this is your colleagues. This is the ideal benchmark,” just so that they have some self-accountability. But we realized that we have to really have multi-pronged strategies. But I think most importantly is for health systems to have metrics in place, ways to capture data, to recognize these disparities, and then to act in real time to intervene in real time to say, “What is our plan for addressing this?”

Shay Yeah, absolutely. And I think what’s so cool is there’s a capacity to make change through the identification of those disparities using data that you can see in such a simple factual way. And then it’s harder for people to deny and say, “Oh yeah, it’s all equal,” when you can easily show that it’s not. And I think another thing in “Legacy” that you do quite beautifully, and I felt like you wove this narrative throughout the book in multiple ways, is linking a lot of the disparities in medicine actually to slavery. And so, things that people had to believe in order to enslave people, like, “Oh, they don’t experience as much pain. Oh, their body is different in a number of ways.” And there became this whole– I mean, very well developed narrative around how a certain group of people were very different from another group of people, like physiologically different.

And that you actually can still see all the vestiges of that in things that even you learned when you went to medical school that, at the time, because you were a young person and didn’t yet think necessarily that, “Is what they’re telling me wrong?” But that now, as someone who has more life experience, you realized that was totally wrong. But it was just the same thing– it was errors passed down through generations that were deeply harmful. And what’s so sad with that information around neonatologists and pediatricians, that actually affects survival, and we see that in a number of areas. You talk about also childbirth and how deep the disparities are.

Uché Because people, I think, will question, “Why in 2025, why are we seeing these disparities despite advances in innovation, technology and research?” And a lot of it is because these deeply rooted beliefs, these myths, still show up in different ways. So, I talk about kidney function in the book and how, since the 1990s, there was this myth perpetuated that Black people have higher muscle mass and that muscle breakdown product creatinine, it corresponds to how kidneys function. And so, for a very long time, there was a different set of normal values for kidney functions for Black patients and non-Black patients that was in the electronic medical record system of hospitals and still is. I think, about as of last year, about a third of hospitals had gotten rid of that race correction factor. But what we found from that race correction factor was that it actually delayed referral for kidney care to Black patients. The assumption was their kidneys were functioning fine because this different set of normal values, and they were not placed on the kidney transplant list. So, the National Kidney Foundation actually, last year, had to go back and reprioritize 14,000 Black patients on the list. So, that’s why I made this connection between these myths actually end up creating significant harm.

Shay And that was your mom’s area of expertise, was working with the kidneys. And you talk about why you think that might’ve been, and it’s a few different reasons, but also because there’s a lot of impact in the community in which she grew up for kidney issues. And you also, I thought, another good example of this was around pulse oximeters. So that might be just another one to share. I thought that was really interesting too.

Uché Yeah, and, you know, pulse oximeters, people listening may know that they’re the little instruments that we put on our fingertips that measure the blood oxygen levels. And more people found out about them during the early parts of the pandemic because COVID would impact your oxygen levels. And what’s interesting is that it’s actually been known for about three decades that pulse oximeters are inaccurate in people with darker skin, because they were never really assessed or tested initially in people with darker skin. Clinicians were never told this. And so what happened was, out of the pandemic, because of COVID, that several studies were done that showed that patients with darker skin were actually denied COVID treatments, because what some of the criteria is based on your blood oxygen level, and their blood oxygen level came back normal, even though they were probably symptomatic. And we saw the harm in that. And so the FDA actually now is working on ways to address this, because they can’t pull all of those pulse oximeters off the market. But what I think is really important is to make sure that our clinicians are educated about this deficiency in the technology, so that we can really assess the whole person. If a patient’s telling you, “I feel short of breath,” and you’re like, “No, but you’re fine, your blood oxygen level is normal,” you need to listen to your patient.

Shay And you give a few examples of the research deficiencies. Even in your mom’s story, you say the cancer drugs that she was given to treat her were not necessarily tested on anyone that looked like her.

Uché Right, yeah. And that’s why we talk about the importance of diversity in clinical trials, which, unfortunately, is an ongoing issue and deserves a lot of attention. And I want to talk about that because it’s not that Black people are biologically different, but we do know that the impact of racism, the stress from racism on the body, does cause biological changes. And we often see that in how people may respond to different medications. And so that’s why we do need to make sure that, even just with the pulse oximeters, that we have a diverse clinical study group, so that we know how this technology or different medications are behaving in people from different racial and ethnic backgrounds.

Shay And I guess this really ties to the whole epigenetic side, that you have two people that have obviously very similar genetic composition, but that very different life experiences. And it’s the behavior and lifestyle that can make radical changes in terms of health outcomes. And that’s the kind of piece that you’re talking about. If you’re dealing with racism and a variety of different factors related to that that are aggressive and harmful, then that’s shifting your body’s resilience to any kind of illness or virus, like with COVID, that you’re exposed to. And I think too, there’s fortunately more happening in medicine currently to understand the stacking effects that, for example, a lot of the people who are getting long COVID starting to see, it was because their body, in part, was already stressed to the max. And that can be for a variety of reasons, including structural racism. So if you already have a number of sort of hits that you’ve taken, then your body, at a certain point, just says, enough, my immune system can’t tolerate the load; that it’s too much of a load. And so I think we’re starting, in medicine, to understand a little bit more how those factors all then can contribute to also the manifestation of longer-term illness or chronic disease.

Uché Yes, absolutely. And I appreciate you mentioning this– epigenetics. I feel like it’s an area that a lot of people don’t really know about, but this idea that stress from your environment can turn genes on and off. And there is suggestion that, especially for Black Americans, that the reason why we see higher rates of autoimmune diseases, cancers, atherosclerosis or heart disease– I think I may have said diabetes– but it’s because of that stress that is actually turning genes on and off. And the other phenomenon I wrote about in the book is weathering, that the public health researcher, Arlene Geronimus writes about, the fact that this stress causes a chronic wear and tear on your body that prematurely ages you and makes you susceptible to chronic diseases and dying earlier.

Shay And we certainly see this in the ACEs data, so the adverse childhood experiences data, which it’s shocking when you first see the data connected to that. For me, when I first saw it several years ago, it’s heartbreaking, honestly, to think that a child who experiences traumas, essentially very early in life, 20, 30, 40, 50 years out later, has significant differences in terms of health outcomes. Statistically, does that mean everybody has that? Of course not. So I always remind people too, and that there are a number of things we can do. So it’s not like that should provide an experience of powerlessness. Because I am one of those kids too, who has an extremely high ACEs score. So I understand it from the inside side. And so I don’t think it has to, in a sense, take away your power. For me, in a sense, it’s actually done the opposite. I’ve become more committed to, given that that there’s a history of something there, what are all the things that I can do that can help to improve health outcomes? And I think for anyone, that’s always a possibility for whatever disparities you’re facing, and there’s a variety of different possibilities. You’ve got that’s the hand that’s dealt, but then what do you do about it? And obviously, make systemic changes wherever possible. But then, on the individual and interpersonal level, there’s also still things that we can do.

Uché Absolutely. And thank you for bringing that up because I think when we think about how do we approach these huge issues, I love looking at it from the individual, interpersonal, institutional, systemic, because we realize that all of those approaches are necessary.

Shay Yeah, it’s definitely multifactorial. So, you got to approach it in all the different facets. You start book “Legacy” with a quote from Martin Luther King Jr. that I think is such a wonderful one, and maybe one that not as many people or as many of our listeners have heard. So he said, “Of all forms of discrimination and inequalities, injustice in health is the most shocking and inhuman.” And I’m interested, I mean, you obviously chose to lead with this quote. What do you see as the significance of what he was saying and how it’s tied into the work that you’ve committed yourself to in the world?

Uché Yeah, absolutely. And that quote is from the 1960s at a rally in Chicago around universal healthcare. But when I hear that quote– and it’s interesting because that quote often gets misquoted, “inhuman” gets called “inhumane”– but I think, and I have been reading on it, MLK Jr. really meant “inhuman” because the difference between “inhumane” and “inhuman” is: “inhumane” is not to have sympathy for someone, not to have compassion, but “inhuman” means not to have any human qualities. But I really feel like he meant that not having- or having- inequalities in health was something that was “inhuman”, that was incompatible with life. Because how can you live fully if you’re not healthy, if you don’t have good health? And it strikes me that these were issues he was thinking about in the 1960s that are still relevant today.

Shay And you talk about, in your book, universal access to healthcare and some of the things that you think, if put in place, would help to have an equalizing effect– at least to some degree. I’m not saying it…

Uché Yeah, exactly. But I think when you compare the United States to other high-income countries, it’s very, very clear that there are certain policies that other high-income countries have in place that do improve the health of their people. Universal healthcare is one of them. We’re one of the only high-income countries that we do not have universal healthcare. We also don’t have paid family leave and sick leave, and that’s something that we know improves the health of people. We also know, in terms of maternity, that we don’t support birthing people in the postpartum period. Most people will have one visit with their doctor six weeks after they get birth, and that’s it. And we know that most of the maternal deaths actually occur in the postpartum period. And we know in other countries that their care is more midwifery-centered– so centered around midwives, not necessarily in hospital with obstetrics-gynecologists. We know that they have more support after they give birth to their baby– that there are people that come to their house, that make sure that they’re okay, they’re checking their blood pressure. So there’s more support. We don’t support people in our country in the way that other countries do, especially around just overall wellbeing.

Shay And you even give examples of women like Serena Williams or Beyoncé, who had very challenging narratives around childbirth– even at that level of fame and prominence and wealth– but that’s still where their race was determining a lot of how things played out in those cases.

Uché Yeah, I think it’s really important to emphasize that socioeconomic status is not as protective for black women as it is for other groups of people.

Shay For other groups.

Uché Yeah, so that even if you do have a higher education and you are more wealthy, that we often still see these disparities. I always say that even with my Harvard College and Harvard Medical School degree, I still am five times more likely to die of pregnancy-related complications than a white woman with an eighth-grade education. People would say, why is that? And why is that? It’s because of the everyday racism that we internalize, and that causes our body to wear in tear and increases the risk of maternal complications. So what’s happens on an interpersonal level between clinicians and patients, where often our concerns are minimized, ignored, or dismissed. So it’s a really brutal combination of things.

Shay And I do think too– and I’m very interested to hear your thoughts on this– kind of what James Baldwin talked about in relationship to tribalism, and then carrying that forward, the deep otherizing, right, of how we otherize people. Obviously, slavery takes such an incredible capacity, and we do all sorts of other variants on this currently and actively, where we otherize someone enough to allow them to suffer in a way that we wouldn’t tolerate amongst another group. And so there’s something fundamental to when we make that shift towards othering someone, that now their suffering is somehow different from my own, that then that gives us this great capacity to treat them so differently, on ways we’re just not even consciously tuned into. And so I feel like a lot of the medical errors that are happening systemically with white physicians, a lot of it’s happening from a deep cultural legacy of otherizing that’s just so blind to– no, it’s like that suffering is the same as my suffering, but I’m not even aware that I’m making a harmful decision because, on some core level that I learned very young, I’m treating you as different from me.

Uché Yeah, yeah, yeah, absolutely. It’s interesting because I often ask myself, I say, can you develop empathy for other people? It’s like either you have it or you don’t. There is the really hopeful side of me that likes to think that, yes, you can develop empathy after living in a society where you are absorbing all of this cultural messaging that does otherwise other people. I mean, the fact is that once you enter the healthcare system, even as a clinician, you still are coming in with those beliefs. But we’re expecting people, because you’re caring for patients, to treat them with compassion. I do think that’s why it’s so important that we have these very candid and honest conversations about these issues and that we acknowledge, yes, you can do a lot of trainings, you can do self-reflection, but we also are going to need for there to be standardized processes and procedures within our systems to mitigate that bias. We need that too, because it’s so deeply embedded.

Shay It’s so deeply embedded, you can’t even see it. It’s like the fish swimming in the water that you don’t even know you’re in water. And so I think that is such a powerful reason for– exactly, I’m just reinforcing– I love what you said earlier about just wait room times, things that are very concrete, very tangible, very measurable, that can show you those disparities in ways that we’re going to consciously miss. And so I think it does show the importance of that, of measuring certain things in medicine that can help to eek out the disparities, that if you ask all those people, they’re going to be like, “Well, I wasn’t doing that. I had no intention of doing that. I wasn’t trying to do that.” And it’s like, no, I’m sure you weren’t actively trying to do that, but you’ve inherited a whole legacy of thinking from prior generations that now you’ve absorbed and are carrying into everything you do in your day-to-day life, right?

Uché Exactly. And I think it’s so important when we do trainings, we tell people, look, this is not to make you feel bad. This is not to make you feel guilty. Our goal is the same: we want our patients– all patients– to receive the best care possible. But we have to recognize that we are coming into these interactions holding certain beliefs that are influencing the way that we care for patients. We have to accept that at the minimum.

Shay And you talk about that with patients who have sickle cell anemia– this underlying assumption of there’s a drug-seeking behavior with this patient population– which is not accurate, but it’s deeply embedded in the culture of medicine. And so then people are treated differently. They’re not given necessarily as much pain medication as they need, that there’s these embedded assumptions and understandings that have a cultural legacy behind them, but that again, aren’t actually a reflection of that patient, their needs, and what’s actually going on.

Uché And I think, especially for patients with sickle cell, there is that multi-tier system that is inequitable. So yes, they have these interactions with clinicians who think that they are drug-seeking and are suspicious of them. But one of the reasons why they have to come to the ER so often is because, in the United States, sickle cell is known as a Black disease, even though it’s a disease where people from all over the world develop it. It’s a genetic disease based on geographical ancestry. It’s actually a response to being in areas where there are, it’s a lot of malaria.

Shay Malaria, yeah.

Uché But because it’s been racialized as a Black disease– because most people in the U.S. who have sickle cell disease are Black– it hasn’t received the funding for research. We don’t have centers of excellence. And so, as a result, people have to use the ER. They don’t have their disease well controlled because of the lack of infrastructure to care for them, and so they end up in the ER. And because they’re in the ER with all sorts of complications, they become “persona non grata”. They become the person that clinicians are suspicious of– that, oh, they’re just here for pain medications– when it’s really like they are victims of a system that hasn’t properly cared for them as outpatients. So they wind up having to utilize the ER, and it’s so unfair.

Shay The double whammy, right? I’m interested in– this is obviously a conversation on healing, and it’s healing in multiple dimensions and domains. And I feel like, from your story, you have, over the course of your body of work, approached healing directly with direct patient interactions. You’ve worked in a lot of different ERs, because that’s been your area of specialization, with a lot of different patient populations– from public institutions with much more limited funding, higher-end private institutions with much more funding, and variety of different populations in all of those. And there’s then this whole other side of your work that you’ve embraced more recently in your life, around systems-level equity change. What does health equity actually look like, and what are the ways that we’re really going to address this? And that’s the kind of systems-level healing that you’re doing now. And I’m curious, from both of those vantage points, how you’ve come to understand what healing is. What is healing on both that interpersonal level and on the systems level?

Uché Yeah, I think that’s such a great question. And I think it’s similar to what I said before– this recognition of what care should look like for our patients, that we have this Western biomedical model that focuses on the way the decisions that individuals make about their lives and what foods to eat. And yes, all that makes a huge difference, but what we know what has the biggest impact on how healthy people are is those systemic factors like poverty, housing, education. And so I just love this idea of making sure that everyone knows, whether it’s the clinicians or the hospital leaders, understand that when we’re thinking about health, we’re thinking about it on multiple levels.

We’re thinking about, yes, how our clinicians are interacting with our patients and honoring them and respecting their dignity, and having some cultural humility, and recognizing that I don’t know everything about what’s happening with my patients, so I’m really going to listen to them.

But also this other idea of how do we create systems where people feel trust, where people feel like when they need to seek care, they feel comfortable seeking care, a system that is going to make sure that not only does your patient have great cholesterol level, but also making sure that your patient has somewhere safe to stay. That is what I see kind of joining the work that I do– that making sure that, on all these levels, we understand that care needs to be holistic, and that’s the perspective we should have in taking care of a single patient, but also taking care of communities.

Shay And how do you see that we do this in an asset-based way rather than a shame-based way? And I’ll give you just a simple example: So we know how important your zip code is, but in medicine, if we started sorting patients by zip code and said, “Okay, so based on this zip code, this body of patients is going to need a lot more potential support in a variety of areas,” but then you’re starting to create disparities that can feel awful and ugly. So, at the same time, how are you approaching some of those hard questions of, like, “Okay, those disparities exist. We don’t want to deepen them, but we also need to see and acknowledge them”?. So how do you work with that?

Uché Yeah, it’s interesting. I mean I think that too, I often, I talk about the difference between equity and equality. Often, we use those two terms interchangeably, but equality is giving everyone the same thing and not recognizing maybe the personal or systemic barriers they may be encountering, whereas equity is giving each person or community what they need so that everyone is on the same playing field. And I think what is important is this recognition of that where we are today is a result– and this is why I made sure to include all this a lot as much as I could in “Legacy”– but really about the history, the history of how we got to where we are, which I think more than justifies what we need to move forward in the best way possible. So, thinking about discriminatory housing policies in the 1930s, like redlining, that have led to the worst outcomes today. Like the neighborhoods with the highest maternal mortality rates, highest chronic disease rates, are the ones that were redlined. So thinking about, yes, this is about giving resources– the appropriate resources– to those communities so that we can really think about how do we make these people healthier, how do we make communities healthier? Because there’s some communities that already have this, that have not been devastated chronically by this legacy, and there are others that have been so. And I think the history justifies it.

Shay Yeah. Well, I want to give you an opportunity, just as we start to conclude our time together, if there’s any other aspect of your work or your book that you feel like we didn’t get a chance to discuss that you’d like to share with our listeners.

Uché Oh, I think just sometimes people may feel like these problems feel very big and overwhelming, and I always suggest to people to look locally or hyper-locally at community-based organizations near you that are really doing wonderful health equity work. So, in the book, I write about a birthing center in Minneapolis, Minnesota, which has some of the very worst racial health inequities, but a black midwife founded the Roots Birthing Center with the mission of providing dignified and respectful birthing care, to especially people of color. And they’ve been able to see a reduction in maternal complications and preterm births. And so, these really are the type of solutions that improve community’s health and that we should be supporting. So, thinking about how you can amplify that work, whether it’s donating, volunteering, sharing with other people that you know. So again, the problem seems so big, but whether it’s in your neighborhood or an adjacent neighborhood, look and see what are the organizations that need your support.

Shay That’s great. Well, I hope that people that are tuning in will read “Legacy”. It’s a wonderful read because it is such a mix of beautiful personal narrative and storytelling, but then so magnificently interwoven with history, science, and medicine. It’s like this very interesting intersection of the personal, and the social, and the political, and medical, and how all these come together. So, it’s a wonderful book. So, thank you so much for joining me today and having this conversation.

Uché Yeah, thanks so much for having me. I really enjoyed it.

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