For anyone interested in making our world more equitable and just, Uché Blackstock's new memoir, Legacy, is required reading.
The book is foremost a love letter to Blackstock's mother Dale, who navigated the societal and economic barriers she faced as a Black woman in the 1980s to become a Harvard-educated physician. Growing up playing with their mother's leather medical bag at the public hospital where she worked, Blackstock and her sister Oni developed an appreciation for the medical field and a desire to care for their community as she had. When the girls reached college, they faced a tragic loss: their mother died of leukemia at age 47 at a pivotal stage in her life and work.
As Blackstock embarked on her own medical career, she began to experience many of the challenges her mother faced—and health inequities at every turn. The memoir grounds Blackstock's personal narrative in historical injustices and their ugly legacy. Racist housing measures, including redlining and the GI Bill, created lasting poverty in Black communities, and mistreatment of Black Americans such as Henrietta Lacks and those subject to the Tuskegee Syphilis study sowed a deep mistrust of the medical system. Coupled with historical barriers to stable housing, education and resources, "exposure to racism," Blackstock writes, "has a measurable, deleterious effect on health." As a result, Black women are the most likely to die in childbirth of any demographic group, and Black men live an average of seven years fewer than white men.
Exposure to racism has a measurable, deleterious effect on health
Dr. Uché Blackstock
The structural inequities Blackstock explores in her memoir ran deep among the patients she served. In addition to witnessing racism against Black patients, she saw racist legacies directly affect health. Due to an outdated test, for example, kidney function was often underestimated in Black patients, leading them to be excluded from transplant lists. During her residency at Kings County, the same hospital where her mother had worked, Blackstock experienced the chaos of a historically underresourced hospital serving mostly patients of color. Her anger and grief—spurred by inadequate staffing, exhaustion, and challenges obtaining simple tests such as CT scans—are palpable in Legacy. When Blackstock later worked with wealthy, mostly white populations at New York University (NYU) Langone's Tisch Hospital, the disparity in funding was jarring.
When it came time to specialize, Blackstock chose emergency medicine. She was drawn to the field's mission to serve all patients regardless of their ability to pay. In urban areas, Blackstock cites, nearly 60% of patients identifying as African American used emergency rooms rather than seeking a health-care professional because they had no insurance. Long-standing mistrust of the health system and white doctors plays a large role as well. Although being treated by Black physicians has been shown to improve health outcomes for Black patients, only 5.7% of physicians identify as Black, relative to the 63.9% who identify as white. That figure shows no signs of increasing. According to a recent study in JAMA, significantly fewer people identifying as Black or female are pursuing careers in health care since the pandemic.
Blackstock was the first Black woman faculty member at the NYU School of Medicine. Despite being a Harvard-educated physician like her mother, patients and fellow doctors alike doubted her decision-making. In addition to having to deal with the racism she experienced at work, Blackstock was tapped to spearhead diversity and inclusion efforts after the police killings of Eric Garner and Michael Brown sparked outrage at NYU in 2014. Blackstock dove into anti-racism work in her new role but quickly discovered that her ideas were not valued or supported and that funding was scarce. Rather than being able to affect real change, she felt more like a figurehead.
In whichever community you belong, however you can, you must act against systemic racism and white supremacy
In 2019, Blackstock decided to lean into her advocacy work on her own terms, founding an independent consultancy called Advancing Health Equity with the goal of "partnering with health-care organizations to dismantle racism in health care and to close the gap in racial health inequities." At the pivotal junction of the COVID-19 pandemic and Black Lives Matter movement, Blackstock developed a powerful voice as an advocate. In front of the House Select Subcommittee on the Coronavirus Crisis hearing on racial inequities, she issued a compelling call to action:
This country desperately needs a truth and reconciliation process around the racist policies, economic systems, and institutions that have left Black lives devalued.
This is an opportunity to explicitly acknowledge unjustified past and ongoing wrongs, engage with Black communities, and rebuild them equitably.
Blackstock ends her memoir by urging the same of her readers. In whichever community you belong, however you can, you must act against systemic racism and white supremacy.
As a writer, advocate and compassionate physician, Dr. Blackstock carries her mother's legacy with grace. As she writes, her memoir is "an urgent reminder of the work we have to do." And it's on all of us—particularly those of us working in health care—to do it.
