In the United States, Black citizens experience drastically shorter lifespans and higher infant and maternal mortality rates compared to white citizens. Rates of diabetes, cancer, and heart disease are also highest in Black communities. Understanding the causes and effects of these statistics is intrinsically connected to the long history of medical experimentation on Black Americans. Journalist and medical ethicist Harriet A. Washington described this phenomenon as “medical apartheid” in her 2006 book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, and it has lasting effects on the contemporary medical system. The damage is far-reaching; cultural bias has formed on both sides, including from medical professionals. Over half of medical students still adhere to medical myths about Black patients’ pain tolerance, including false beliefs that Black patients have thicker skin, fewer nerve endings, or a tendency to exaggerate their pain levels. Over time, Black Americans' deeply traumatic experiences with doctors have become so widespread that it earned a name: the “Tuskegee Effect." Named after a decades-long study that included denying medical treatment to hundreds of Black men, the Tuskegee Effect refers to the feelings of suspicion and mistrust of the government and medical community experienced by some Black Americans. This collection explores solutions that leverage interpersonal connections between healthcare providers and patients to address the racial justice gap.

1. Why is personal testimony such an influential factor in Black families' end-of-life care choices?
2.  What factors contribute to the disproportionately high maternal mortality rate for Black mothers?
3. Anna Gorman's article clearly outlines why Black communities have difficulty trusting scientific research. Using the Solutions Story Tracker, find 3-5 stories describing times when research led to a direct benefit for Black communities or individuals.
4. Building trust emerges as a crucial component of the work described in this collection to reduce the racial inequality in healthcare. The power and influence of relationships are another SJN Success Factor; summarize the lessons provided within these articles on how to build trusting relationships and suggest other social issues that could benefit from similar efforts.
5. Journalism is a collaborative practice: reporters are writing for their community, but they also depend on community members as sources for information. Indeed, the very purpose of journalism, according to the American Press Institute, is to provide citizens with the information they need to make the best possible decisions about their lives, their communities, their societies, and their governments. With that in mind, SJN wants to help connect news readers and journalists. Beside the name of the journalist on any of our story pages or the results page of the Solutions Story Tracker, you’ll find a Twitter icon that will link you directly to the journalists profile. Tweet at them with questions or compliments about their piece - you might be surprised by how much writers want to engage with their audiences! Don’t forget to tag us too (@soljourno) and use the hashtag #journalistintheclassroom if you are reading as part of an academic assignment.

1.  Personal testimony is an influential factor in Black families' decisions regarding end-of-life care because their trust in the medical community has been eliminated by centuries of unethical medical experimentation and dishonesty. Many Black patients have observed additional subpar treatment throughout their own lives, and believe that they will be denied appropriate life-saving measures due to discrimination. Finances are also a concern, as wealthy communities have access to greater resources and social assistance programs like Medicaid have complicated relationships to hospice care. Hearing positive stories about end-of-life care from family, friends, and religious leaders encourages Black families to explore their options when the reality of discrimination might otherwise overwhelm all motivation.
2. Many Black mothers are isolated in rural communities where the nearest OB-GYN is an hour away by car (in regions where public transportation is nonexistent). While midwives traditionally filled medical needs in such communities, legal restrictions and lack of insurance coverage pushed mothers to only use hospitals for their births beginning in the 1970s, resulting in less prenatal care and more deaths in emergency cases where the mother lacked easy access to the hospital.
3. Answers will vary. Some great articles to spark discussion include this one on the Operation Peacemaker Fellowship or this one about culturally sensitive coronavirus outreach.
4. All four articles emphasize the importance of listening closely to the needs of individuals; honoring patients' pre-existing support systems; acknowledging history's impact on current practices; and admitting that diverse communities have unique needs and there are no one-size-fits-all solutions. The same attitudes can be applied toward efforts to find solutions for many other contemporary social justice problems: income inequality, education disparity, police violence...