>> dr. uche blackstone, the

title of your book is legacy. you happen to be a legacy at harvard. what is the story? dr. blackstone: thank you for ha me on. the story is that my twin sister and i and my mother are the first black mother and daughter legacy graduates from harvard. i graduated in 2005, my mother in 1976, so we made history. host: you write that your mother was one of the lucky ones who made it through. dr. blackstone: it is important when i talk about that legacy, since i graduated, there has only been one mother and

daughter legacy graduate, so we are talking about first and second in the 2000's. that is to say my mother grew up in different circumstances, essentially on public assistance, a challenging childhood, but was lucky to have men touring. she was the first person in her family who went to college and her professor encouraged her to go to medical school. she was a brilliant woman and deserved everything, but there were other young children who could have ended up at harvard if it were not for poverty and

racism, because that decreases access to opportunities. it is important when i tell my story and my mother's story that we talked about the other people that could have been there, physicians or health professionals that are not because of the legacy of racism. host: what kind of medicine did she practice? dr. blackstone: she was the original dr. blackstock. internal medicine, study of the kidneys and geriatrics, a specialty in medicine where you care for older people. after hartford -- harvard she trained at a hospital and worked in the same neighborhood she grew up in, central brooklyn,

taking care of family, friends and neighbors. host: you say she chose it for a reason, what was that? dr. blackstone: she chose neurology because it is one of the most challenging specialties, the kidney is a challenging organ. the other is because within black communities there is a high burden of chronic kidney disease and that is the results of systemic racism. diabetes, high blood pressure leads to kidney disease and what we see is lack of access to health care and healthy food, lack of access to culturally responsive care and other determinants are the reason we see higher kidney disease within our community and my mother worked at a hospital in a neighborhood with the highest

kidney disease rates in the countr host: you write and legacy quote i believe our mother practiced structurly competent and culturally responsive care, meaning that the complex nature of the patient's background in the social context in which they live is considered during evaluation. why are those important? dr. blackstone: they are important because the biomedical model that we are taught in our training and education is individuals are the most responsible for their health. individual choices make them healthy or not. it's about what you eat, not drinking alcohol and exercising,

but 70 to 80% they have no control over related to systemic factors like the neighborhoods that they've lived in, the workplaces that they spend a lot of time in determining how healthy they are. when i think about the care my mother delivered to her patients, she was recognizing when she was in the room with patients, it was family members, fellow colleagues, employees. really taking into consideration the factors that we know today determine how healthy someone is and very much so it is less dependent on the choices people make and more so determined by environment, a model that not enough medical schools and

programs focus on and that we know from the data has the largest impact on how healthy communities are. host: you mentioned your mother's mentors and i want to call them out. junot mulvaney and milford clark , who were they? dr. blackstone: dr. june was my pediatrician, a black woman and i talk about how growing up my mother would take us -- she was in leadership roles in black organizations and she would take my sister and me to the meetings so i was exposed to what it means to be a black physician at an early age. dr. mulvaney was well known and respected, someone who had been

caring for me and my sister since we were babies. mildred clark is an ob/gyn on our block in crown heights, the only neighborhood we lived in. what i did not realize was i had a rare experience being surrounded by black women physicians to the point where i thought most physicians were black women until i got to college and recognized most students did not look like me. these women were role models to me just like my mother and that representation was important in giving me the confidence to recognize that being a physician was possible. host: you describe your mother at harvard as a fish out of water. dr. blackstone: yes, i talk about how when she got to

harvard her classmates had parents who had written the textbook, another classmate was a relative of jackie onassis in another had a parent who had won a nobel prize in immunology. at that point my mother could say her own mother worked full-time, managed to get off of public assistance, became a licensed practical nurse and she was proud of her mother. but it was a culture shock for her to be at harvard surrounded by people who had tremendous resources and opportunities, family members who were physicians and she was the first to go to college, medical school. she was fortunate to find friends.

she started medical school around the time of diversity initiatives, so her class was 10% black in the wake of mlk junior's assassination. higher education implemented diversity initiatives. host: one detail you put in about your mother was she had a scar on her forehead. dr. blackstone: yes, it is interesting because as an adult holding multiple roles i see my mother in the fullness that she was in addition to be a mother. but reflecting on experiences she had, the fact that she lived in poverty and that scar was from a rat bite. those are the conditions my

mother was living in that i cannot imagine because she and our father were able to give us more security and safe housing then she had growing up. so now when i reflect on all that she had gone through to end up at harvard medical school i mean as an adult now reflecting on that privacy the challenges that she had to encounter to come from a setting where you are living in a rat infested apartment to graduating from harvard medical school is something not many people can say. host: what did she mean when she said i had to get my bearings together? dr. blackstone: that was one of my mother's favorite phrases. i did not recognize as a child

how much my mother was struggling. struggling being a first, struggling being one of the only black women physicians at her institution and a career in academic medicine, being a parent to a set of twins. when she came home she was overwhelmed and needed some time to settle down before we jump all over her and ask where is dinner. i think it means that heavy load she was carrying at that time in the 80's and 90's, i did not recognize how much she was carrying a burden until now as the founder of my own firm and

author, recognizing all that she had to carry and that was a tremendous amount of stress on her read she had to get her bearings together, the things that she had to have two herself to rest and restore. host: july 5, 1997, what happened? dr. blackstone: so to put it in context, it was in the fall of 1996 that she was diagnosed with leukemia. my mother was a runner and she ran several marathons in her life. in her 40's she was faster than my sister and me as teenagers. we would run the races together as part of a runners club and i remember the summer she such how tired she was after a race.

that never happened and within a few months she was diagnosed with acute kenya and given a few months to live. her brother even though he was a bone marrow match, we were not able to get into remission to get the transplant. so those eight or nine months were very difficult for her and us as a family. then surely she developed a long goal infection as a result of being immuno compromised. the chemotherapy suppressed her immune system's and she developed pneumonia due to a fungus. and she ended up passing away on july 5, 1997. that day i thought for a long time i would not be able to experience that day without dealing tremendous pain and

grief. so many years later it comes and goes. i think about her every day. that was the saddest day of my sister and my lives, so at the age of 47. i'm 46 now, she was 47 when she died and she was too young. host: is leukemia hereditary? dr. blackstone: what is interesting is the kind of leukemia lima mother developed was a result of a syndrome which is a type of leukemia that develops in older white men. very rare for my mother, a young black woman in her prime, to develop that.

in reflecting on conversations my mother and i had, when she went for a second opinion for her leukemia in boston, one oncologist said it looks like you were exposed to radiation early on in life and in doing the research for my book and looking where my mother grew up, she grew up where there was toxic dumping so it is reasonable to think my mother could have been exposed to radiation at an early age as a result of where she lived. we know in communities of color there will be sites with toxic dumping and radioactive materials so that could have contributed to the facts that my

mother developed a kind of leukemia which is rare for a black woman. host: dr., you and your twin sister grew up in crown heights during the cracked arrow. what was that like? dr. blackstone: that was hard and i don't think i realized until i got older, but we would find crack vials in our front yard. i witnessed several people being shot on our block, but my parents kept us as protected as possible. they were overprotective this bite that, we witnessed the devastation in our community. one of our neighbors was someone who was a very kind woman who

became addicted to crack cocaine. we saw what it did to her body and mind. she became very thin, agitated, having a lot of arguments and we heard that through the walls of our home which were adjacent to her home. i did not understand why this was happening in my neighborhood. i did not understand why we didn't have a supermarket that had an abundance of fresh fruits and vegetables. why did my parents feel comfortable sending us to go school old. they were concerned about the quality of education. why wasn't there a park? there were so many things i was seeing that only as an adult was i able to understand why that was happening. that there was not something inherently wrong with the people

in my neighborhood. it was a result of policies. host: tell us about earl. dr. blackstone: earl is my father and he came from jamaica to the u.s.. his mother had come years before him he was raised by a great aunts. so he was an immigrant from jamaica and when he came to new york city, he was a young man who worked lots of odd jobs until he went to college later in life, his late 20's. that is where he met our mother. as an immigrant, there were things that were important to him. academics were important and that was a focus. also owning our own home. my father was the one who pushed

our family and my mom to purchase our beautiful home in crown heights in 1977 before my sister and i were born. how to be successful was home ownership. and he spent many years fixing up our home, turning it into the beautiful place that it is today. host: you talk about internalized shame. to the daughter of a physician and a successful father. you would have a white friend drop you off blocks from the house. dr. blackstone: i know, i know. when i wrote about that in the book, it was something i had thought about a lot since i was a freshman in high school. it was because of these observations i made about my

neighborhood and why there were so many abandoned buildings and shootings. why did our neighborhood looks so different even though it was a community and we could hear each other neighborhoods in brooklyn, i always said i wish we could live in a white, affluent area. and so, i think up to a certain point my parents instilled pride in who we are as young black children. we had to write essays about what it meant to be gifted and black and read about well-known and lesser-known black americans. it's difficult at times not to internalize cultural messaging that there is something wrong

with black people. so it was on that cold winter day when i went over to my white friends house in park slope and her mother offered to drive me home. i had her drop me off blocks from my house because i was ashamed of where i lived. that was internalized racism and anti-blackness that i was experiencing and looking back now as an adult on that time, it makes me so sad that i felt that way, but i think it is unavoidable because without knowing in a conscious way, we internalize the messaging that we are not good enough and that there is something wrong with us. host: was that tough to write about? dr. blackstone: i definitely got

emotional because it is something i thought about often. i run into my friends with our kids and i feel like if i could do it again, i would've said drop me off at home because it was a cold day and i remember walking home feeling ashamed. and feeling guilty that i felt ashamed of my neighborhood and what it looked like. host: what is the origin story of your names? dr. blackstone: my parents wanted to make sure that my sister and i had names that connected us to our ancestors. my father is an immigrant from

jamaica, my mother is a descendant of enslaved black americans. we do not know a lot about our history. i would love to look at the genealogy and do some research into my background. but we do not exactly know who our ancestors are. i do know because of testing that they are from west africa and that is where many enslaved black americans came from, so my parents felt it was important to give us names from africa and so those are nigerian names. uche man's wisdom or will as part of a longer name. it means god's will.

a lot to live up to. oni means good chief or leader of the kingdom, so they are powerful names that my parents were intentional about choosing for us. they put so much love, energy and effort into raising us and wanted us to do something positive with our lives as adults. host: why did you choose harvard ? dr. blackstone: it's interesting because my sister and i went to a specialized high school in new york city, considered one of the most competitive schools to get into and being in that environment, the messaging i was getting at harvard, the number

one school in the rankings, having such history that that was the place to go. when we got in there was no doubt, and so we had taken resources that it had to offer. in retrospect, i should've considered an hbcu like howard. at that time i was caught up in what is success traditionally. it is easy to say that now as a graduate in a privileged position. but i think going to harvard college and medical school opened doors for me in ways that if i had gone to another school,

it would not have. host: you talk about the history of hbcus. dr. blackstone: yes, what i love about "legacy" as i shine a light on systemic issues. the history is important to include because i wanted to connect the dots for a broad audience as to why in 2024 we are seeing such a low racial equity today. one report that i write about is commissioned in 1910, the american medical association which has its own history of

discrimination against black physicians, they and the carnegie foundation commissioned abraham fleshner to assess american and canadian schools and hold them against the criteria of western schools and in the u.s., johns hopkins. what that report did was compared hbcus -- at the time there were seven in existence which i trained 1500 students. mind you, they did not have the same endowments. it compared them against white institutions in terms of admissions criteria. in terms of what laboratory facilities look like. so it was looking at predominantly white medical schools as well. what happened was they left

behind at howard, it's estimated that that school remained open. when i heard that number in 2020, it was an article and i thought about all of the patients who could have been cared for. all of the students who could have been meant toward and the potential lost as a result of the schools closing. they were comparing them against predominantly white institutions. but i wonder what would've happened if they had endowments.

host: black americans makeup 13% of the u.s. population. 5.4% of physicians are black and you report that that is less than 1940. dr. blackstone: yes, exactly. so that is why i thought it was important to talk about the percentage is and why they are so low. that is one of the reasons and it shows how a policy from the early 1900s can have repercussions that echo today in 2024. in terms of medical schools,

they rely on gpas and it is often socioeconomic status. a disproportionate students belong to the highest income. we know there is an intersection between race and socioeconomic status. schools are still using traditional indicators of success to determine who comes in and who comes out and when you look at communities of color and black communities especially because of the legacy of redlining and discrimination, that impacts the schools because property taxes go toward funding schools and that impacts the polity of education. what we need to think about is

how to support students, how do we support them with sponsorship and have a diverse workforce in health care. host: we talked about your legacy at harvard medical school. it has a double meaning and i want to quote -- i do not remember anyone talking about racial health inequities and outcomes between black and right -- white and how to competently care for patients of different backgrounds. dr. blackstone: that was my experience and that is why talk

about a process of learning, on learning, relearning and recognizing the gap in training and a lot of the work and commentary, those were awakenings as a practicing physician that i did not get into medical school. a number are working toward a curriculum that can prepare physicians to care. the history, the idea of a public social determinants of health, the decisions you make about your own health.

it was my experience after medical school where i started seeing my patients recognizing the illness in my patients was not choices they were making, it was communities they were living in where the lack of access, the kind of jobs more responsible for their outcomes than anything else. host: you had an experience where you were a patient? dr. blackstone: i did, i did. and at the time i did not understand that i was a first year medical student. i developed a bad pain and i

ended up going to the er three times. and they were personal questions , i was questioned about my sexual history and i was told i did not seem to be in much pain. i was sent home the first two times for appendicitis. by the time i went to the er the third time, i had serious educations -- symptoms and when i reflected on that experience, my sister was with me in medical school.

so you can imagine how the average layperson would feel in a similar situation. with that, it taught me the importance for health professionals to truly listen to than -- listen to them. that was a true learning experience. when people felt ignored and their concerns were minimized by health professionals, what that leads to lead to complications and death for some pple. host: from your book, are you

black? i realized she could not see my skin color under all the layers. yes, am black, i replied. i could sense the tension leaving her body. thank you, doctor, she sighed. at least i know you will listen to me. dr. blackstone: yes, yes. that is such a powerful experience. a young woman came in, diagnosed with covid, coming in with persistent shortness of breath. and i had complex feelings. i was proud to be the doctors she needed but also saddened that she had bad experiences where she did not feel listen to. i was wearing so much personal protective equipment and i was

covered health -- head to toe. it was important that whoever she saw would listen to her. i was proud in that moment but it also saddened me that she did not have interactions where she felt listened to. host: talk about the double meaning of legacy. could this be institutional distrust? dr. blackstone: yes, there is a double meaning, being a second-generation black woman physician, second is the deeply rooted history of medical racism that rears its ugly head today and accounts for why we still see appalling statistics like the black maternal mortality rate. still seeing these statistics despite advances in innovation,

research and technology, that is the other piece that felt important to talk about. not only is it in the report, but this issue of henrietta black who was a young woman from baltimore who went to johns hopkins in the early 1900s with uterine cancer without her consent and has been used by companies and they made millions of dollars. it was not recent until she received compensation. the fact is that health care and related institutions has proven itself untrustworthy.

there institutional trustworthiness. it is the obligation of institutions to engender trust in the community so that when people are sick they feel comfortable seeking care. host: what about grave robbers? dr. blackstone: even well-known schools like my own medical school digging up the bodies of formerly enslaved people and using them for experimentation or using them in learning and teaching within medical school, medical schools have a history of doing this. and again, it is something that i did not know until i was a practicing physician. so when you think about what kind of -- the symbolism of that, the dehumanization of digging up the bodies of

formerly enslaved people and use that for teaching purposes, i feel like what that does is dehumanization of black people as well as racial and biological centralism where we are different, we can be experimented on and we've seen that again and again over the last several centuries. host: you spent time talking about diagnoses. dr. blackstone: so can you give me a little bit more detail? host: you're talking about lungs, kidney pain, readings, things like that. some of those things i did not even know about. dr. blackstone: one example i talked about his kidney function, how there has been a race correction factor in kidney function.

it is how i was educated. up until recently when you would go into electronic medical records, you would see we were looking at lab values. there was a normal value for black people and one for nonblack people. and i have to say i never gave it a second thought. and i think a lot of my colleagues never gave it a second thought. but it turns out that difference in kidney values is based on a myth that black people had more muscle mass and that there is a correlation between muscle mass and kidney function. so that has led to black americans being delayed from being referred for kidney care because what that did was it made their kidney function appeared normal when it was not.

so they were not referred for specialty care when they needed it and not placed on transplant lists when they needed to. so the national kidney registry has been going back several years to try to find people who should have been placed on the list. there is a correction factor for the tests. it is this idea based on false notions of differences of people with different races. whether explicitly or implicitly, it sends a message that there is something biologically different, when race is a social construct. this results in worse health outcomes. the polls oximeter people may be

familiar with a small gadget when you see a doctor. during the last few years of the pandemic, it was recommended people purchase one. essentially it reads blood oxygen, something that was not known to many including myself was for the last 30 plus years, the fda has known that those do not accurately read oxygen levels in the blood in people with darker skin because they were only tested on people with lighter skin. the implications are that during the pandemic when oxygen levels were being used to determine who qualified for covid medicine, people with darker skin did not get what they needed because there oxygen levels were seen as normal.

and so we saw people did not get the treatment they needed and some people died. that emphasizes the importance of making sure we have diverse patient populations and also it is important to communicate using accuracy. as health professionals we look at the whole patient. if the patient was saying i still do not feel good but there oxygen level was normal, if we had known this, we would have acted on that. host: emergency rooms have become medical safety nets for social problems come to roost. dr. blackstone: yes, you know, i was naive in that medical school. i chose emergency medicine

because i thought it was a place of equity, we take care of all different backgrounds. but i did not realize until i was in residency that what we see in the emergency department is a failure of our system to care for patients. the ideal is a public health system that prevents people from developing disease. we do not want people to have diabetes or high blood pressure. we want to take care of them in a way where they do not get to that point. so what we see is the end result of disease, but also people who are either uninsured or underinsured and who do not have primary care.

they are coming in with uncontrolled diabetes. that is what i thought -- what i saw in my residency and in academic medicine. what we are seeing is a failure of our system to care for patients, especially the most vulnerable. they end up using the emergency department for primary care. host: nyu, tisch center, are you practicing medicine today? dr. blackstone: i am still licensed, but i am focusing on my consulting firm, advancing health equity, which i founded five years ago this month. it was to do work i felt like i could not do within academic medicine. we worked with health care

institutions to create diverse workplaces and we also worked on external work in terms of how they cared for patients in communities of color. host: you wrote an article when you were about to leave nyu entitled's why black doctors are leaving faculty positions in academic medical centers. dr. blackstone: yes, ridding that piece, i was in tears because i had not even imagined that i would continue my career in academic medicine. i was in medicine for 10 years. in new york city in one of the prestigious medical schools and despite being in the middle of

that i was one of two black faculty. there was not an awareness of diversity in the institution. later on in my tenure, i was appointed to a role in the office of diversity affairs and i was so excited, but it ended up being a figurehead role and i was unable to do the work that i wanted to do authentically and i was silenced, i could not speak up. i began to fear being retaliated against in the context of being one of the on the black faculty. people mentor people who look like them and that determines how successful you are in your career. i did not get the mentor ship or sponsorship that i needed and i felt largely unsupported,

undervalued and underappreciated. toward the end of my tenure, i felt like i was the only one going through that and i felt isolated. many people reached out to me in health care and other industries saying i have felt the same way and it was incredibly validating. and i was able to speak publicly about the experiences that i had and received the response that i did which was affirming. host: greg mom's he is a republican and a neurologist. he had an all ed, band ddi in medical schools. accrediting institutions are pushing america's 1 eht medical schools to train future physicians in political

activism, wasting precious time and resources that could be spent on medical practice. results will likely be physicians less qualified to meet patient needs. what is your response? dr. blackstone: i saw today he put forth a bill to rid of ddi in medicine and my response is im appalled. when we look at the statistics. myself as a black woman with a degree in medical school, i'm still five times more likely to die in pregnancy than white counterparts. why would that have been? why is it happening in 2024? our health care system and professionals are not trained to care for diverse patient populations. patients are dying and i feel

like this is politicizing a crisis. we have statistics and numbers that show we could be caring for patients, especially black patients, in a more competent way and that is a matter of life and death. i feel aware of this movement not just within health care but outside of health care to silence ddi programs. we could not be doing it at a worse time. they said statistics are only hitting worse and when we look at life expectancy for americans, it has been going down since before the pandemic and it continues to go down. for all americans. especially americans call her. all americans are not doing well compared to other high income

countries because of income inequality and racism. so these anti-de i efforts are scary to me, it seems like there is a big disconnect in people understanding where we are today. host: you write health outcome have gotten worse. black men have the shortest life expectancy, navies have the highest infant mortality rate. what is your sister doing? dr. blackstone: she has her own consulting firm, so we're doing work from the outside. she works with health care organizations, nonprofits around health and racial equity doing training and organizational assessments. we are both doing our own piece

to address the inequities that we see today that are worsening in our own ways. it's a frustrating moment but we are trying to do our peace. host: do you see yourself going back to seeing patients? dr. blackstone: while i miss seeing patients and i felt privileged to have that interaction with people, patients tell physicians things that they do not even tell family members. i feel like the work i'm doing now advancing health equity and writing this book is bringing issues to a broader audience. even policymakers. that is how we will make people healthier is changes in policy. i have a bigger impact doing that the end political work. host: you close your book with a letter to different groups, to

medical schools and white physicians and health care professionals and this is what you wrote. your black colleagues are exhausted, black patients are dying. the first step towardixing racial health inequities is to acknowledge systemic racism. you must recoizyour own biases no matter how ultra mystic you think you are. make sure that you are treating all of your patients are t same, that you're colorblind, giving everyone the best possle care or you may be reinforcing systemic inequalities in your interactions with black patients by ignoring how systemic racism impacts their health. dr. blackstone: yes, yes. i feel privileged to have the opportunity to write the book. i feel clear about the messages i'm trying to deliver and that

call to action at the end was important to me because these are conversations that we don't have in person or within institutions and it is clear to me that if we are going to address in equity, we need everyone. all health professionals would say they want to be the best to their patients, but the fact is that is not happening. people need to acknowledge that there biases influence how they make decisions and you have that in the data. we need to step up to do the work so that we can ensure every american has the opportunity to live a full and healthy life like they deserve. host: dr. blackstock, what does the word legacy mean to you? dr. blackstone: acknowledging

that the road is difficult for black americans, whether healthwise, careerwise and recognizing that i'm going to continue my mother's legacy in our communities which is called health equity work. she started that in the 80's in the 90's. continuing to bring attention to that, but also making the road easier so that they are not experiencing the same challenges and barriers to access medicine or receive culturally competent care. so it has a lot of meanings but it is to bring attention to the issues in today's discussion. to make sure people can celebrate birthdays and graduations in the way that they deserve to.

>> part of the first mother and daughter black americans to graduate, dr. blackstock is the author of this book. legacy, a black racism reckons with racism and medicine. we appreciate you spending an hour without us. >> thank you so much. ♪ >> all q and a programs are available on our website or as a podcast on c-span now cap.