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Date Submitted

Spring 4-21-2013

Research Mentor and Department

Bradley P. Stoner

Restricted/Unrestricted

Dissertation/Thesis

Abstract

African-American distrust of health care is often cited in studies as a possible source of health disparities. However, there has been no in-depth research of this issue. Distrust is an incredibly powerful deterrent to seeking health care. Utilizing ethnographic fieldwork – interviews with African-Americans and personal experiences as a community health worker in St. Louis over two years – I was able to begin exploring the complexities of distrust. Distrust of medical practitioners and hospitals in the African-American community is shaped by personal experiences and understanding of the history of one’s family and community. Specifically, the fieldwork points to sources of distrust as lack of insurance and thus feeling you are not entitled to good healthcare, life-saving medical interventions, urban legends, belief in Western biomedicine versus in alternative medicines, amount of contact with physicians and hospitals, the era in which you grew up and how prevalent outright discrimination was, one’s understanding of the family’s past experience with healthcare, personal current experiences of racism, and whether or not the individual felt the doctor understood him or her. Urban legends have long been the weapons of the marginalized as a way to conceptualize the world as they experience it. There were three urban legends in St. Louis that were particularly interesting symptoms of this distrust of healthcare. They were the ideas that the government had a contract with hospitals to kill off the black elderly, that black cancer patients had unnecessary surgery done to them, and that the St. Louis County sent their expired food to the City to be sold. Possible ways to address distrust must focus on how physicians can make patients feel valued and respected as individuals. Part of this method should be to teach physicians how to create culturally safe environments.