Trust is an essential element in healthcare as it increases efficiency and makes patients less vulnerable. It is not only a fundamental element of therapeutic patient-physician relationship but also a vital factor in the patient’s decision to seek help when sick. However, Distrust in the healthcare system is relatively high in the United States with African Americans being the most affected population. In no segment of the US population is distrust more persistent than in the African American community with studies showing that blacks are more likely than whites not to trust their doctors ( Kennedy, Mathis & Woods, 2007) . They have a high degree of distrust in the American healthcare system to act in their best interests, and one of the reasons for healthcare disparity. It is difficult to engage patients when they don’t trust in the healthcare system as they will not reveal the full extent of their medically relevant history without trust. Patient’s distrust towards healthcare reduces patient-physician interactions that can lead to reduced medical compliance and low utilization of healthcare services. As such, it is essential to understand the suspicion of the US health system and explore its historical roots.
The US healthcare ranks poorly globally due to the disparity in access to care for the minority groups, especially African Americans. There is strong empirical evidence of healthcare disparities involving African Americans, where blacks are less likely than Whites to get access to healthcare or receive needed services such as routine preventive care ( Kennedy, Mathis & Woods, 2007) . The medicine’s dark history explains why African Americans have poor quality healthcare including high rates of maternal mortality. One of the broadest racial disparities in medicine today entails alarming rates of maternal mortality where black mothers giving birth are three times more likely to die than white mothers giving birth. This is because of the discriminative nature of white physicians when dealing with black patients. These factors contribute to distrust in the healthcare system that often leads to poor health outcomes. Most African Americans fear that white physicians may not provide adequate health services that would benefit their health conditions.
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Several reasons can explain this distrust in black populations including their experiences with racism, the knowledge of history with racism in the healthcare and the cultural distance between black patients and white physicians. The US health sector has a long legacy of discrimination towards black Americans, a memory that remains deeply embedded in the collective consciousness of the African American community ( Whetten et al., 2006) . African Americans suffered physical, social and mental brutalization during slavery period affecting their ability to associate with healthcare. Medicines have been used on blacks without consent including forcing them to participate in dissections and medical examinations.
During slavery, african Americans were used on various non-consensual medical experiments to develop medicines as well as gynecological surgical techniques. For example, they could be used to determine the viability of the experimental vaccine or discover whether there was an effective treatment for typhoid pneumonia. Perhaps the most common non-consensual experiment is the infamous Tuskegee experiment that in the US which saw many African American men suffer and die from syphilis in an experiment where researchers neither treated them nor informed them of their sickness ( Gamble, 1997) . This study was meant to discover how syphilis affected blacks as opposed to whites in America but ended up killing more African Americans and impacting the lives of many others but ended killing most of them. Since then, they have been questioning healthcare practices involving other illnesses.
Another element of distrust among African Americans entails the history of discrimination where they were confronted with overt racism in the healthcare sector. The marginalization of blacks takes place at all levels of the contemporary medical system in America. Physicians engage in differential treatment of patients based on their race and skin color, which occurs in the form of different prescription patterns or increased restraints in using the hospital ( Whetten et al., 2006) . For example, black patients are less likely to receive certain medications for mental health compared to whites in the same condition. They may also receive lower triage scores for the same complaints as white patients translating to longer wait for lines. This discrimination dates back to Jim Crow Laws that created segregation against African Americans in terms of access to healthcare, where blacks could receive inferior services and not mingle with the whites in obtaining healthcare. They were treated as inferior beings by getting poor medical facilities and attention, with this legacy of discrimination in medical research and the healthcare system linked to the low levels of trust ( Whetten et al., 2006) .
At the same time, Blacks also have significantly less trust in their physicians due to the lack of enough physicians of color in the health sector. The gap between diversity among doctors and physicians compared to the overall population has been widening, where African Americans do not get enough opportunities to serve as nurses. This lack of inclusion affects the provision of quality care as black patients feel like white physicians do not provide culturally competent care, changing their trust issues ( Kennedy, Mathis & Woods, 2007) . The physicians tend to perceive African Americans negatively than they see white patients, affecting their care provision. The discrimination in many black physicians also contributes to the distrust, where the healthcare sector is described by having more white physicians compared to nurses. Thee physicians tend to discriminate black patients by offering poor quality medications as compared to the white patients,
In conclusion, there seem to be a more significant cultural memory of abuse among African Americans that makes them unwilling to trust white physicians. Black Americans regardless of their social status or educational achievement tend to display behaviors of mistrust and reluctance in seeking medical care in the United States. This fear prevents them from complying to medication or seeking treatment, thus affecting their quality of care. The mistrust that blacks have for physicians is the most difficult to change due to the dark history with the medical system ( Whetten et al., 2006) . They tend to have negative attitudes towards the nation’s health institutions grounded in the circumstances and experiences that have failed to eliminate racial disparities. However, the country can reduce this distrust by increasing the ration of black physicians in the health sector, as well as training all nurses to be culturally competent.
References
Gamble, V. N. (1997). Under the shadow of Tuskegee: African Americans and health care. American journal of public health , 87 (11), 1773-1778.
Kennedy, B. R., Mathis, C. C., & Woods, A. K. (2007). African Americans and their distrust of the health care system: healthcare for diverse populations. Journal of cultural diversity , 14 (2).
Whetten, K., Leserman, J., Whetten, R., Ostermann, J., Thielman, N., Swartz, M., & Stangl, D. (2006). Exploring lack of trust in care providers and the government as a barrier to health service use. American journal of public health , 96 (4), 716-721.
