the health disparities podcast

Reckoning with Racism in Medicine: A Conversation with Dr. Uché Blackstock on Health Equity and Systemic Change

Systemic racism continues to shape medical education, clinical practice and patient outcomes. It’s a topic near and dear to Dr. Uché Blackstock—physician, health equity advocate, and New York Times bestselling author of Legacy: A Black Physician Reckons with Racism in Medicine.

In this episode, Dr. Blackstock reflects on her own experiences as a Black woman in medicine, including a misdiagnosis during medical school that left her hospitalized. She also examines how historical policies, such as the Flexner Report and redlining, continue to impact today’s health inequities.

The episode also touches on bias in clinical decision-making and the urgent need to reframe medical training around social determinants of health. This conversation with Movement Is Life’s Dr. Mary O’Connor and Dr. Hadiya Green is a call to action for everyone working to advance health equity.

Registration is now open for the upcoming Movement Is Life Annual Summit on Friday, November 14, 2025, in Washington, DC. This year’s theme is “Combating Health Disparities: The Power of Movement in Community.” Visit movementislifecommunity.org for more information.

Never miss an episode – subscribe to The Health Disparities podcast from Movement Is Life on Apple Podcasts, YouTube, or wherever you get your podcasts

This transcript has been lightly edited for clarity

Dr. Uche Blackstock: In medical school, there’s like, there’s, there’s a lot of emphasis on the diad, right? You and the patient, right? And that decisions that you make are critical, and it’s true, they are critical for your patient, but they also can reinforce, like, systemic inequities. If you’re not aware of what your patient is experiencing, like in their everyday lives, right? What is happening in their communities? And so I always say that, you know, clinicians, a lot of times, I think of, when we’re in the room with our patients, it’s just the two of us, but I always think it’s, there all these other people in the room there, there’s like, there’s the family, the community, your employers, right? So there’s, there’s all these other people in the room that actually impact the quality of life that your patient is having.

Dr. Mary O’Connor: You’re listening to the Health Disparities podcast from Movement Is Life. I’m Dr. Mary O’Connor, Chair of the Board of movements life and Co Founder and Chief Medical Officer of Vori Health.

Dr. Hadiya Green: And I’m Dr. Hadiya Green, steering committee member, founder of healthy healing community. We’re excited to introduce our guest for today’s episode. Dr. Uche Blackstock is an author, sought after speaker on racism in medicine, and founder and CEO of Advancing Health Equity. She’s a former associate professor in the Department of Emergency Medicine and the former faculty director for recruitment, retention and inclusion at NYU School of Medicine.

O’Connor: Dr. Blackstock is also the author of the book “Legacy: A Black physician reckons with racism in medicine.” Dr. Blackstock, welcome to the Health Disparities podcast, where we’re just so excited to have you here.

Blackstock: Thank you so much for having me excited to be here.

O’Connor: So before we dive into the conversation with Dr. Blackstock, I just want to put a plug in for our upcoming movement is life annual summit. The theme of our summit this year is combating health disparities, the power of movement in community. The conference will be in Washington, DC, on Friday, November 14, and it’s really an incredible event, bringing together stakeholders from diverse backgrounds to discuss the challenges that we’re facing with health disparities and to drive to actionable solutions. So we hope you can join us for the summit. You can visit our website Movementislifecommunity.org, for all the details. Okay. Dr Blackstock, I’d love for you to introduce yourself to our audience, because they may not know a lot about you.

Blackstock: So I’m an emergency medicine physician by training, I was in academic medicine for about 10 years, and then, you know, had several experiences, you know as a Black woman physician, also you know as as someone who’s who’s cared for a diverse patient population, where I recognized this was like in 2019 I realized that I wanted to really help organizations think about how to operationalize equity and what that looked like in leadership, operations, care and strategy, and I wanted to help them move from aspiration to action with in terms of closing the gap in racial health inequity. So I founded Advancing Health Equity, which is my strategic consulting firm, and that’s where I do a lot of my work. I no longer practice clinically, but just as I left my job in 2019 you know, we know what happened in 2020 and I was working in Brooklyn, New York. I was still working clinically then, and we were the epicenter. And, you know, I I was obviously in shock about what happened, but within the first few days, I said, I have to ring the alarm. I really have to write about what I’m seeing and that I think that really it’s going to be black, brown and marginalized communities that are going to be most disproportionately impacted by this virus. I became one of the first voices in the pandemic to really talk about racial health inequities and to bring attention to it.

And, you know, I would say that that was like, that was the beginning of really, you know, sort of like using my platform as a health equity advocate. I became an MSNBC medical contributor, and I honestly use that role in order to communicate all of this, like dynamically changing information. So a lot of information to our communities in a way that they could understand it and be informed and make and make informed decisions about their care. And then I had the opportunity to write my book “Legacy: A Black physician reckons with racism in medicine,” which came out last year, last January, 2024 became was an instant New York Times bestseller. But I think that speaks to really how much people really care about, you know, about health equity, about health disparities, and really wanting to find ways that. In 2024 and 2025 where we have so much wonderful technology, research and innovation, like to think about why some of these disparities are even worsening, right? So I really wanted to use that book to bring people in.

Green: Thank you so much Dr. Blackstock, and we talked about your accolades and the immense amount of work that you’ve done and put into this area, which is only enriched by your personal background. I understand that growing up, you and your twin sister oni, were surrounded by black women, physicians, your mother being one of them, but your mother, when she was a child, had the opposite experience. So you write that she rarely saw a physician as a child, let alone a black one. So tell us about your childhood and how your life growing up ultimately led you to pursue medicine as a career for yourself.

Blackstock: Yeah, thank you for that question. Yeah. I always talk about, you know, being a physician is very, very personal, right? Because it’s a generational theme in my family, and blessed to be able to say that, right? But you know, my mother’s upbringing, as you allude to, is very, very different than mine. My mom was born, actually, here in Brooklyn, where I live, about 15 minutes from where I am right now, but born into poverty and raised on public assistance to a single mom, she had five other siblings, and really had a very, very difficult life, very, very challenging. And I think she just had, like, a curiosity about her, and she loved science, and she had a very strong work ethic. And there was, there was luck and fortune and all of that. And she ended up at Brooklyn College, the first person in her family to finish college. And there she actually had a chemistry professor, Dr Dillard, who saw her potential, and who’s a Black man, and said, I think you should apply to medical school. You know, I see that potential in you to become a physician, encouraged her to apply to medical school.

She went to all her med schools and then ended up at Harvard Medical School. And of course, there, she felt like a fish out of water, because there were so many of her fellow students whose parents had written the textbooks they were using, who had won Nobel Prizes. But she knew that she was there for a reason. She was there because she wanted to come back to her community and practice and work in service to her community. And so that’s what she did. After she graduated, she returned to Brooklyn and really worked with a community of black physicians that actually lived in the same areas where they practice, right? So I think that was also very, very special. But growing up because I had this, this exposure, you know, I tell people, when I was a little girl, I thought that most physicians were Black women. I didn’t realize that, you know, they only present 3% of all physicians in the United States. But I had this very, you know, interesting, unique perspective that I’m very, very grateful for, because it enabled me to see that, you know, this was something I could be but also, these women were just such wonderful role models, because they were doing community based work, you know, around health equity at a time when we weren’t even talking about health equities, the 80s, right? So they were really thinking about, what are the services, what are the approaches we need to keep communities healthy? And so that’s that that’s the exposure that I had that really informs a lot of the work and advocacy I do now.

O’Connor: You mentioned the number of Black women physicians, and we know that even today, the number of black physicians in the United States remains stubbornly low. Only about 5% of all US physicians identify as black, although black people make up about 13% of the population. In your book, you dive into some of the reasons for this, so share with our audience your thoughts about the Flexner Report, which was that landmark report in US medical history that had such an impact on the need for greater diversity in the medical workforce.

Blackstock: Yeah, I thought it was so important to be able to tell this, this part of the story in legacy. Because I think people know, they look at the numbers and say, Oh, really, less than 6% of all physicians in the US are Black. Like, is there something wrong with black people? Like, what? Why aren’t they? Why are they getting the job done? Come on, you know, just study. And I think it’s really important to understand that, you know, when we see the numbers that we see, especially in this country, we really have to look back historically at practices and policies that have impacted the number of, you know, the diversity of our of our healthcare workforce and so the Flexner Report, really important report that you know, I didn’t even learn about until. I was a practicing physician, but the impact has had a domino effect for decades. So in 1910 American Medical Association and Carnegie Foundation, they commissioned Abraham Flexner, a white education specialist, to go around to all 155 US medical and Canadian Medical Canadian schools, medical schools, to really assess them against the gold standard of Western European schools, and in the US Johns Hopkins, which was the gold standard. And so they were looking at what kind of admissions criteria were they using? What were the laboratories like and what was the percentage of physician scientists on faculty?

And based on that report, he made recommendations about whether or not a school should remain open or closed. And so that report led to closure of actually predominantly white institutions as well. But the issue was also that at the time in 1910 there were only seven historically black medical schools, and at that time, they were the ones educating most of the black doctors, because black doctors were not allowed to be admitted into predominantly white schools. And so, you know that report closed five out of seven of the medical schools, leaving behind Howard and Meharry, and so it’s estimated. And I also just wanted to say that, you know, you know, these schools, these historically Black medical schools, they were probably operating with a fraction of the endowment and a fraction of the resources that predominately white schools were because of the legacy of slavery, right? But who’s to say, you know, objectively, that they, that they were graduating, you know, physicians that were, you know, delivering a lesser quality of care, right? But the, but the impact that it’s had is that, you know, there was a report in 2020 in the Journal of American Medical Association, interestingly, that estimated that if those five medical Black medical schools that were closed in 1910 had remained open, they would have educated between 25,030 5000 black physicians. And that number is so incredibly staggering, because you think about 10s of 1000s of physicians, the impact they could have made on patient care, the impact they could have made on research, and that we really are seeing in the numbers today, in 2025 the impact of that report.

Green: So I want to shift a little bit and get into the policies that contribute to some of these differences that you eloquently outlined in the flexor Flexner reports. So let’s get into some of the ways that racist policies have contributed, not only to the under representation of black physicians, but the rampant racial health disparities we see in these conversations around disparities and inequities, we often hear about redlining and the lasting impact on communities that it has had. You actually grew up in the Crown Heights area of Brooklyn, New York, so that clearly was also affected by redlining policies. How did redlining personally affect your family and your community?

Blackstock: Yeah, you know, what’s so interesting is that I didn’t even, I didn’t recognize how much redlining had impacted my community again, until I was a practicing physician, you know, but growing up, I always, first of all, I loved my neighborhood. I loved my neighborhood, I loved my neighbors. We looked out for each other, but I also appreciated how my neighborhood was very different from neighborhoods only, like a five minute drive away, right? I noticed that we didn’t have a grocery store. I noticed that we didn’t have a lot of green space, right? I noticed I knew that my parents did not feel comfortable with the quality of education of the public schools in our neighborhood, right? And it wasn’t until I was a practicing physician, really learning about how, how do health disparities evolve? Right, learning about the impact of policies from the 1930s right, where neighborhoods were assigned grades, A, B, C or D based on who lived in those neighborhoods, and most of that determination was based on the racial and ethnic composition of people who live in those neighborhoods. So if they were minoritized populations or immigrant communities purely based on that, they were not if they applied for a mortgage or mortgage backed insurance, they were very unlikely to qualify just because of where they lived, not because of anything else.

And so when I talk to students about this, I say to them, what happens to a neighborhood where people are not able to own property? Right? What happens to that neighborhood so people are renting? We know that they’re not able to accumulate generational wealth. We know that property taxes go towards funding schools, so there’s a low tax base, right? And that impacts the quality of education. We know that if people don’t have disposable income, businesses aren’t going to come to establish themselves in that neighborhood, and if businesses don’t come, then jobs don’t come. And so it’s all interconnected. And I tell them, It’s interesting when you look at the maps of redlined areas from the 1930s and if a neighborhood hasn’t been gentrified, those are the same neighborhoods today where we see that some of the worst health outcomes, and that’s one of the reasons why there could be like, a 20 year age gap right in terms of life expectancy between two neighborhoods that are really like adjacent to each other, but the quality of life in that neighborhood, when we talk about the social determinants of health, are vastly different, and that impacts how long people live, for how healthy they are. And so for me, it’s really important that health professionals understand this like not when they’re practicing. They understand it during their education and training, because it really does influence how you care for your patients and the perspective that you have.

O’Connor: So Uche, let me follow up on that, because you you talk about in the book, in your book, stunning omissions and flaws in the education that you received, and that the information that was imparted to you and other students in the classrooms, and you know, through the hospital, was presented as factual data and research driven, but it didn’t lack kind of a broader context in terms of, you know, socio economic or socio political. So, so can you, can you tell us a little bit more about that and how the direction that you think we need to move so that our clinicians, our healthcare professionals, can be better educated and better equipped to care for people that aren’t necessarily just don’t look like them, right?

Blackstock: It’s so interesting. There’s this pyramid that I use a lot in my in my in my slide presentations. It’s from the CDC, but it’s a pyramid that kind of breaks down the impact, impact on health of different interactions and that patients have like either with systems or with health professionals. And at the very top of the pyramid, which is like, the least impact on health is actually, you know, the clinical interventions that we do, and what’s at the base of the pyramid is systems. So it was like housing, right, education or systems, you know, of racism, right? That you know that has an impact. And so what we know is that about 80% of what determines, over 80% of what determines how someone, how healthy someone is really systemic is really beyond, is beyond their control. And I think what’s interesting is that in medical school, there’s like, there’s, there’s a lot of emphasis on the dyad, right, you and the patient, right? And that decisions that you make are critical, and it’s true, they are critical for your patient, but they also can reinforce, like systemic inequities.

If you’re not aware of what your patient is experiencing like in their everyday lives, right? What is happening in their communities. And so I always say that, you know, clinicians, a lot of times you think of, you know, when we’re in the room with our patients, it’s just the two of us, but I always think it’s there all these other people in the room. There, there’s, like, there’s the family, the community, your employers, right? So there’s, there’s all these other people in the room that actually impact the quality of life that your patient is having. So I was even thinking about, for example, like, you know, like, even, like smoking, like someone can not be a smoker, right? But if they live, I’m sorry if they are working in an environment where they’re surrounded by secondhand smoke, right? They have very, and that’s the only job that they can have. They have very little sort of autonomy to decide, you know, whether or not, you know, I want to be exposed to this. So these are things that we have to think about, you know, obviously about, you know, air pollution and, you know, environmental racism being occurring more often in communities of color or marginalized communities. So I think we need to have a, you know, of course, we can tell our patients, yes, you know, be careful about smoking, try not to drink so much. All of that, you know, sure makes a difference, but what makes it a bigger difference is really to understand what’s happening in our patients’ communities.

Green: I really appreciate that you brought up the social determinants of health, and you and Mary touched on the political determinants of health, as Daniel Dawes refers to them, because I think that there is a growing awareness that you mentioned when your book did so well so quickly off the shelf and interest and efforts on the part of health care providers to start to sew in where there are these holes in the net. And I think one of the holes in the net are the health and well being of actual black health care providers. And as a black health care provider, myself and one who understands that you are under immense this, you’re under the same influences and impacts that your patients are undergoing, and there’s this undercurrent of silent suffering among many of us that starts from when we are in school. As you mentioned, like that, it’s not okay to wait till you’re practicing to get this information, but when you’re in school, so may you tell us about more of the subtle and sometimes not so subtle, ways that racism permeates, or even upholds the medical school education as we currently know it.

Blackstock: Yeah, and it’s so interesting, because, you know, I think at the end of my book, I talk about whether or not I would want my my I have two boys, two sons, eight and 10, if I want them to go into medicine, and I have really serious concerns about that. Because, you know, as eventually, two black men, you know, I have concerns about the experiences that they would have, as students, as residents, as practicing physicians, because, based on what what I’ve seen, and obviously, as a mama, I want to keep them safe, and I don’t, I don’t know if that environment is safe enough for my children, just based on what I’ve experienced and and what I’ve seen and so, you know, I always say that, you know, medicine healthcare, it’s just like a microcosm of the rest of society. It’s not like, you know, yes, there may be people within medicine and healthcare. Who are you know, are more altruistic or want to help people? But the fact is, is that if you’ve been socialized like in this society, right, whether it’s intentional or unintentional, you have absorbed a lot of this, the cultural messaging that is around us, that is based in stereotypes, that’s based in myths, right? And, you know, we see that even coming up in medical education, where certain things like kidney function, right? Like we were for kidney function, I thought, because, based on what was on the electronic medical record and what I was taught in school, that there were actual differences between how black people’s kidneys function, and non Black people’s kidneys function, right? And here we are, like years later, finding out that that distinction actually caused people their lives. They caused people to be deprioritized on the kidney transplant list, like National Kidney Foundation literally had to go back, reprioritize 14,000 Black patients because of this race correction factor that’s used for kidney function, that’s based on this myth that black people have higher muscle mass and that’s related to creatinine and that’s related to GFR.

So it’s so dangerous how a lot of these stereotypes and myths get promoted and then they get internalized by clinicians, and we’re just saying, Okay, we’re just doing our thing and or even, like, the pulse oximeters. You know, the pulse oximeter issue with people with melanated skin, so black, Hispanic, Asian, how? Actually, FDA has known for over 30 years, but it wasn’t until during the early parts of the pandemic, where people were doing studies that showed that there are patients that were not getting the medications that they needed because the pulse oximeter was giving a different value, was saying, actually, no, your oxygen is fine. Even the patient may have been saying, I’m not feeling fine. And so there are all these ways I think that our system has really betrayed black patients and other patients of color, and so that’s why, like, when we talk about medical mistrust, I get really it’s a cringe to me, because it’s almost like you’re asking people like, why would you feel this way? It’s almost surprising. It’s like, no, why wouldn’t you feel this way? And what do institutions and systems have to do to engender that trust in the first place?

O’Connor: I’m going to follow along that theme. Because, you know, I think a lot of the times we we think of physicians as being very objective. You know, we’re trained to follow the evidence, right? We’re supposed to be scientists and not be biased, right? But, we know that we all have blind spots. I mean, it’s part of the human condition to have bias. Just, you know, that’s part, that’s part of who we are, and of course, recognizing those biases, especially in medicine, that we bring into the patient conversation or encounter, and how we can control them or work to mitigate those biases, I think, is really important. So do you feel that there’s a growing awareness about implicit bias. Now, at least you do think we’re moving in the right direction, and do we need to acknowledge more of that?

Blackstock: When I hear unconscious bias, I always want to make sure I make the point to people that you know, even though it’s something that’s unconscious or involuntary, we know that it still is incredibly harmful, right? And so just because it may not be explicit, it may be implicit, does it when we know that it has no very negative impacts on patients? And I think that, you know, we saw, we saw in 2020, 2021, a lot of work being done around unconscious bias in health and health care settings. You know, obviously, what’s happening right now politically? In this moment, we’re actually seeing a lawsuit against California Medical Board for requiring implicit bias training for California physicians, right? So we’re seeing a movement that is almost like erasing or negating that this actually impacts patient care. So this is something that, like, you know, we definitely still have to talk about. I’m also not one to believe that, like one or two trainings, it’s going to get rid of someone’s unconscious bias. I actually personally think that we need checks and balances like in our systems.

So for example, you know, we saw with the opioid epidemic that white patients were actually being over prescribed pain medications and black patients were being under prescribed. So we need, we need the systems to keep track of that. We need to see how our how our health systems going to hold those themselves accountable if they see these disparities, like, what are they going to do in real time? I once worked with an emergency department who they found that their black patients were waiting 80 minutes longer to get admitted to the hospital, right? And so, of course, you know, all the providers are like, Oh no, I don’t I don’t know why that would happen. Okay, fine. You don’t know why that would happen, but we’re going to make sure that we actually have a dashboard. You have an internal dashboard that shows how you’re doing compared to what the standard should be, right? We’re going to have, you know, reminders and electronic medical record, you know, every 20 minutes to say, Hey, you got to disposition this patient, right? What’s your disposition? Are they staying or are they going? So I do think that you know these, these internal biases that people hold because it’s everywhere, because they get it from their parents, they get it from school, they get it from television. Really what we need? We Yes, self reflection is great, but we also need to have processes in place that can mitigate these biases that are not dependent on individuals that are dependent on systems.

 

O’Connor: I’ll point out one other example, because I think sometimes we think of unconscious bias as only being related to race and that, and you and we know, all of us know that’s completely untrue, right? And sometimes, if I’m at a meeting and I’m giving a presentation to, you know, 500 orthopedic surgeons, and I say, Okay, I want everyone to raise their hand that in that wants to operate and do a knee replacement or a hip replacement on the patient who’s morbidly obese, okay? Like, be honest, raise your hand, right? And of course, no one raises their hand. Why? Because it is physically much harder. It’s, it’s, physically much more taxing for the surgeon to do that surgery on somebody who’s that large, the post operative risks are higher. You know, they’re likely going to need to stay in the hospital. I mean, there’s just all these factors that come into play that I think bias the surgeons, consciously or unconsciously. When that patient comes into the exam room, you are more likely. Likely to say, No, I don’t think surgery is the right next step for you. Yeah, and then we also know that, of course, obesity prevalence is different depending on sex, population, race, ethnicity, so yes, it’s a huge issue.

Green: Looks like we are wrapping up our time, so this will be the last question or two. We understand that you yourself have gone through experiences that could contribute to medical mistrust, even to you as a now physician, you have a personal experience that you talk about, um, and where you were misdiagnosed and left, yeah, understanding what it feels like to be that patient at the mercy of the white medical establishment, so to speak.

Blackstock: Yes, as a medical student. First year medical student, I went, I had to go to the ER three times to be properly diagnosed with appendicitis over the course of a week. And I was presented with nausea, vomiting, belly pain. And during a few of those visits, I was really, I mean, of course, I’m a young woman of childbearing age, definitely gonna ask about my sexual, history, but I was really, like, prodded and interrogated about that. I was told also, I didn’t seem to be in that much pain. So I was sent home twice from the ER, and by the third time I came back, my appendix had perforated, yeah, and I had to have an open appendectomy because there was so much pus. You know, typically, it’s done laparoscopically with the cameras. Instead, I and then I developed an intra abdominal abscess, so I could be out of school for four weeks. So, you know, we talk about, like, you know, these sort of biases, we know that the ultimate impact they have on patients could be misdiagnoses, could be delayed, delayed diagnoses, it could be harm, and then sometimes even death to people, right? Just like, it can be bad.

 

So, you know, I think definitely, being a young black woman, there were things, there were things that happened in those interactions that I like reflected back on I didn’t know. I didn’t realize in the moment, but later on, I look back and I’m like, huh, that was not that. That was not how. That was not appropriate, yeah. But I learned that lesson that was such a huge lesson for me. And really one of the biggest lessons from that was really, just listen to your patients. Like, listen to your patients. Like, listen to your patients. Doesn’t seem like rocket science, but if you truly listened, you know, they tell you, I mean, they, like, 99% of what’s happening, right? They can, you know, you have the diagnosis there, and you can treat them properly.

O’Connor: I think that is absolutely the most critical thing. If we listen to our patients, it’s going to engender trust. Yeah, trust is essential. Essentially, Essential. Essential. Essential to have a positive relationship where the healthcare professional can actually partner with that individual to help them on a journey towards better health. So okay, we’re wrapping up. Dr. Uche Blackstock is author of the book “Legacy: A Black physician reckons with racism in medicine.” She’s also a sought after speaker on racism in medicine, and founder and CEO of Advancing Health Equity. Dr. Blackstock, thank you so much for joining us today on the health disparities podcast.

Blackstock: Thank you so much for having me.

O’Connor: That brings us to the end of another episode of the Health Disparities podcast from Movement Is Life. I’m Dr Mary O’Connor.

Green: And I’m Dr Hadiya green, until next time, be safe and be well.