History of Racism in Healthcare: From Medical Mistrust to Black African-American Dentists as Moral Exemplar and Organizational Ethics-a Bioethical Synergy Awaits.

Racism as a contributing factor to health disparities and inequities has long been understood and established. Recently, scholars, professional organizations and even the public at large have made a clarion call that racism is, in and of itself, an actual public health issue (Wright et al. 2020). In fact, scholars have named racism itself as a social determinant of health (Yearby 2020). In uncovering the many aspects of the history of racism in healthcare, one does not have to look far to encounter one of the remaining vestiges of such years gone by. The issue of medical mistrust, particularly amongst our most vulnerable populations, remains a current bioethical issue today. In fact, mistrust of academic and research institutions and investigators is the most significant attitudinal barrier to research participation reported by African Americans (Scharff et al. 2010). The intersection of healthcare professionals’ ethics, or the lack thereof, along with the continued modern zeal for interprofessionalism among varying clinical providers is most powerfully witnessed at the doorstep of a seemingly most unlikely of places: America’s Black dentists. Roughly accounting for a mere 3.8% of America’s dentists (Wright, Vujicic, and Frazier-Bowers 2021), Black dentists treat more underserved and vulnerable patients, carry more educational debt load, and experience a detrimental amount of discrimination in pursuit of their dental education and careers, with more than 86% of Black dentists reporting discriminatory experiences (Wright, Vujicic, and Frazier-Bowers 2021; Mertz et al. 2017; Fleming et al. 2022). Yet the fact remains, Black dentists lay claim to a lineage of one of the most significant breakthroughs throughout America’s centuries enduring battle of access to equitable and just healthcare. In 1962, George Simkins Jr., a Greensboro dentist, and other black dentists, physicians, and patients filed a lawsuit claiming federal support for the Moses H. Cone Memorial Hospital and Wesley Long Hospital, local institutions that served only white patients, was unconstitutional (Reynolds 1997, Oral History Interview with George Simkins 1997). (One of Simkins’ patients had an abscessed tooth and needed surgery; Greensboro’s black hospital didn’t have space for him and the whites-only hospitals refused to treat him.) While the plaintiffs initially lost, they appealed, resulting in the Supreme Court decision, Simkins v. Moses H. Cone Hospital, that set in motion the desegregation of hospitals throughout the South. Despite decades and centuries long discriminatory treatment, somehow Black dentists have been a living emobidiment of altruism and entrenching a legacy as moral exemplars in a world and professional environment oft designed to instill just the opposite. The history of racism in healthcare has often, and rightly so, centered the experiences of patient exploitation, abuse and, at times, downright disregard for the humanity of those from historically minortized, oppressed and vulnerable communities. From the initial colonial period of conquest, where racialized persons who were enslaved quite literally had no agency over their own health and bodies, with legally sanctioned sexual and reproductive violence, through to