Examining the Role of Family History of US Enslavement in Health Care System Distrust Today

Objective: Black/African American people have long reported high, albeit warranted, distrust of the US health care system (HCS); however, Blacks/African Americans are not a homogenous racial/ethnic group. Little in­formation is available on how the subgroup of Black Americans whose families suffered under US chattel slavery, here called De­scendants of Africans Enslaved in the United States (DAEUS), view health care institu­tions. We compared knowledge of unethical treatment and HCS distrust among DAEUS and non-DAEUS.Design and Setting: A cross-sectional random-digit dialing survey was adminis­tered in 2005 to Blacks/African Americans, aged 21-75 years, from the University of Pennsylvania Clinical Practices in Philadel­phia, Penn.Participants: Blacks/African Americans self-reported a family history of persons enslaved in the US (DAEUS) or no family history of persons enslaved in the US (non- DAEUS).Main Outcome Measures: HCS distrust was measured by a validated scale assessing perceptions of unethical experimentation and active or passive discrimination.Methods: We compared responses to the HCS distrust scale using Fisher’s exact and t-tests.Results: Of 89 respondents, 57% self-re­ported being DAEUS. A greater percentage of DAEUS reported knowledge of unethical treatment than non-DAEUS (56% vs 21%; P<.001), were significantly more likely to express distrust, and to endorse the pres­ence of covert (eg, insurance-based) than overt forms (eg, race-based) of discrimina­tion by the HCS.Conclusions: DAEUS express greater HCS distrust than non-DAEUS, patterned by awareness of unethical treatment and passive discrimination. Understanding how long-term exposure to US institutions influ­ences health is critical to resolving dispari­ties for all Black/African American groups. Rectifying past injustices through repara­tive institutional measures may improve DAEUS’ trust and engagement with the US HCS.Ethn Dis. 2021:31(3):417-424; doi:10.18865/ed.31.3.417