♪ ♪ ♪ ♪ ♪ ♪ (camera shutter) KERN REESE: The Zulu Social Aid and Pleasure Club is an intricate part of the fabric of New Orleans.

♪ ♪ And it also became a focal point for social gatherings and for revelry.

♪ ♪ NARRATOR: For the Zulu Club, Mardi Gras 2020 was supposed to be what Mardis Gras had been for generations; a time to let go, forget about hard times, and party.

♪ ♪ Happy Mardi Gras, planet Earth!

Come on down!

It's a party!

REESE: That Mardi Gras was pretty much like any other Mardi Gras season.

There was a chance to have fun and a chance to fellowship and a chance to enjoy the Mardi Gras season.

NARRATOR: But Mardis Gras 2020 would come to mark tragedy for the city of New Orleans, and soon, the rest of the country.

♪ ♪ REESE: There was an apprehension about COVID, but not substantially.

When you were 10,000 people and you're in close proximity and you're dancing, and all the things that go on, it possibly could have been a super spread event that we were not cognizant of.

(sirens blaring) REPORTER: State officials confirmed the first Louisiana death due to the coronavirus.

♪ ♪ JAY MARKS: When COVID hit the city, it hit the Zulu organization extremely hard.

Everyone in the organization is talking about health, be it diabetes or hypertension, or high blood pressure.

COVID put that to the forefront for us.

REPORTER: The impact of the coronavirus, uh, outbreak on members of the famed Zulu Club in New Orleans after they performed at Mardi Gras is really sort of, um, helping us focus on the impact of this virus on the African American community in this country as a whole.

♪ ♪ ♪ ♪ MARKS: We lost 15 to 20 Zulu brothers within a span of three to four months, and a lot of those deaths were related to underlining illnesses.

Some of our brothers just going into the hospital with pneumonia and not coming out.

So the, the organization was rocked extremely hard in a short period of time.

♪ ♪ REPORTER: The breaking news: stay at home, that is the order tonight.

From four state governors as the Coronavirus pandemic spreads.

REPORTER: On Capitol Hill, the nation's top infectious disease experts told lawmakers coronavirus is ten times deadlier than the flu, and that the outbreak will only get worse.

REPORTER: Across Louisiana, the numbers are simply staggering.

The state has seen the fastest growth rates in the world.

On Thursday, the numbers soared to more than 2,300 coronavirus cases and 83 deaths.

THOMAS LAVEIST: Early in the pandemic, it was New York and New Orleans were the two places that were the hotspots.

We had bodies in refrigerated trucks, and all of the, the horror stories that we saw in the media was here.

Louisiana was one of the first states to release the mortality data by race, and it showed huge disparities in, um, in COVID death rates.

NARRATOR: The story was the same everywhere: Black Americans were hit harder by the virus in part because of all the underlying conditions that made them more vulnerable to COVID-19.

But the numbers also revealed a broader reality: in America, we don't all have the same life chances.

What is it about the conditions in which we allow people to live that would actually contribute to and exacerbate this pandemic in the most vulnerable communities; the ones that are least able to respond to it?

DAVID WILLIAMS: African Americans had death rates from COVID-19 that were at least twice as high to 2.6 times higher than that of whites.

All Americans were in the same storm.

We were not in the same boats.

And the boats of people of color were just not able to weather the storm.

NARRATOR: People of color across the board in the U.S. have been negatively impacted by health disparities that leave them vulnerable to chronic illness and disease.

Black American communities are among the hardest hit.

EBONY HILTON: African Americans in particular have higher death rates for cancer.

We have higher death rates at, at younger ages for heart attacks, for strokes.

These are statistics that have been generational, and yet we haven't moved the needle to figure out why is it that these disparities exist.

CAMARA PHYLLIS JONES: We have documented these race associated differences year after year, decade after decade, century after century.

And then we put the results on a shelf.

And we don't ask a deeper question.

NARRATOR: The deeper question is why?

Why do we see these vast differences in health outcomes between Black and white Americans?

♪ ♪ Part of the answer lies deep in the nation's past.

WILLIAMS: As we look back historically, what were the American beliefs about race?

That Blacks were actually a distinctive species different to whites, that a given disease would manifest itself differently in Blacks than it did in whites.

It is very important that we recognize that scientists are part of the larger society in which they were raised.

They have drank the same Kool-Aid, that is all of the negative stereotypes and beliefs about groups in society.

And so the larger societies' beliefs about race and about Blacks and about their inferiority then shaped the questions that scientists asked.

It shaped the assumptions that they made as they went about their work.

DONALD YACOVONE: One of the essential elements in the creation of knowledge for white Americans was the expertise of scientists and medical leaders.

Louis Agassiz, who was a Swiss physician and a scientist came to America in the 1840s and was hired by Harvard and the School of Science was created just for him.

He became so important, he became so dominant, that Ralph Waldo Emerson thought he would turn Harvard University into a school of science.

His work was respected throughout the world, not just the United States, and he said African Americans represented a separate species of human.

If someone of the stature of Louis Agassiz said that African Americans represented a separate species of human, who's going to challenge that?

"Harvard says so, it must be true."

EVELYNN HAMMONDS: They create a scale that emphasize these differences.

You go from the whitest-- Caucasians, the Europeans, all the way down to the darkest, who were considered to be closer to apes.

So Europeans come out on top.

When they observe Black peoples, they might say they have smaller veins.

They might say that we see that Black people experience pain differently than white people.

They may be able to stand more pain than white people could.

They connect the physical differences to other kinds of differences about intelligence, about behavior, about character.

♪ ♪ By the early 19th century, um, physicians and these observers who are trying to understand how Black bodies, white bodies, Indigenous people's bodies are different, focus on the skull.

YACOVONE: Samuel Morton in Philadelphia collected over a hundred skulls of white Americans, of Native Americans and of African Americans, or so he said.

Measured their content, and because of the volume that he measured, proved, according to him, that people of European descent deserved to be at the top of the hierarchy because their brains were bigger.

Therefore, they were smarter.

And people of African descent had smaller craniums.

Therefore, they were less intelligent.

Science proved, according to Morton, that African Americans were grossly inferior, designed by God and nature to do the work of the white man.

Well, that's simply his own creation.

The idea of a race is fictional.

It's a social category which has, in fact, no scientific basis.

Nothing that modern Americans would recognize as science was behind what he was doing and all the other so-called physicians and scientists, whether it's Agassiz, Morton or anyone else.

JOSEPH WRIGHT: The institution of slavery was justified by many of the policies, the approaches to medical care of the time.

The assessment of lung function is, is probably a, a very clear example where Thomas Jefferson posited in a 1781 treatise based on no science, that the enslaved had lesser lung capacity than the enslavers.

NARRATOR: In the 1840s, Dr. Samuel Cartwright, a Louisiana physician, set out to prove Jefferson's theory by experimenting on enslaved men and women using a device called a spirometer to measure and compare Black and white people's lung functions.

WRIGHT: He then published in the peer review literature of the day, his supposedly scientifically proven premise that Blacks not only had lesser lung capacity, but that the way to correct it was forced labor.

♪ ♪ VANESSA NORTHINGTON GAMBLE: When you look at the history of race in American medicine, you see Black people fighting back against this theory about Black bodies are different.

FORD: So one way that Black people have fought back is by confronting racist research very directly.

Prior generations were clear that they needed to show that the high rates of disease that Black people experience were not due to something about their bodies.

It was not due to their race.

It was not due to being Black.

It was due to being subjected to unfair treatment.

NARRATOR: Dr. James McCune Smith, the first Black physician in the United States, used his medical degree to speak out against using racial difference in medicine.

JAMES MCCUNE SMITH (dramatized): The illogical conclusion has been adduced that there is a permanent difference between these two races.

This argument is about as conclusive as if we were to select all the white men in this city who have gray eyes, and to argue that because the color of their eyes differs from that of the remainder, therefore the two classes belong to different races.

NARRATOR: As early as the 1850s, Black doctors pushed back against racial medical theories.

Dr. John S. Rock, a physician educated at the American Medical College in Philadelphia, pointed to the real reason for the poor health of enslaved Black people.

The horrible living conditions of the plantations on which they were forced to live.

♪ ♪ Besides measuring the lung capacities of enslaved people, Cartwright invented a disease to maintain slavery.

HAMMONDS: One of the things-- he noticed a problem that plantation owners had indicated to him is sometimes that slaves try to run away.

(dogs barking) (distant hollering, barking) ♪ ♪ He coined the term drapetomania and he says, "That's running away disease."

Slavery is their natural condition so if they want to run away from their natural condition, then we have to think about that as a mental condition.

FORD: It essentially was a made up disease, but it naturally reflected the ways that racism operated within the medical community and broader society at the time.

They sincerely believed that Drapetomania really does characterize something peculiar about those Black people who would venture off the plantation and try to live a life of freedom.

HAMMONDS: Now that he's claimed it as a disease, how do you treat it?

Well, you enforce your labor practices on them even more.

You whip them more, you make them more submissive.

You make them more accustomed to their state, their natural state.

So it is a justification for increasing discipline and physical beatings on the slave, the enslaved peoples.

NARRATOR: After Emancipation, pseudo-scientific racial theories continued to grow.

One theory was that Black Americans would become extinct.

Freedom was not "natural" for Black people.

Now that they were no longer enslaved, they would simply die out.

GAMBLE: One of the major proponents of this was a man by the name of Frederick Hoffman.

Hoffman worked for Prudential Life Insurance, and for many years, Prudential Life Insurance did not insure Black people, because the company believed that Black people were going to die out.

Frederick Hoffman wrote a book, and what Hoffman said was that Black people were going to be extinguished.

FREDERICK HOFFMAN (dramatized): Previous to emancipation, the Negro enjoyed health equal, if not superior to that of the white race.

A higher death rate must be considered an evidence of race deterioration, tending toward a condition in which gradual extinction of the race take place.

NARRATOR: In a scathing book review, scholar and activist, W.E.B.

Du Bois challenged Hoffman's ideas in a prominent scientific journal.

W.E.B.

DU BOIS (dramatized): The question, therefore, first arises, where did Mr. Hoffman find material sufficient in quantity and quality to form the basis of so momentous deductions?

One cannot, however, agree with the author that this excessive death rate threatens the extinction of the race.

Compared with death rates elsewhere, it is not remarkable.

FORD: Though they may seem absurd to us today, these determinations became embedded in scientific theory and methods.

Every prescription, every course of treatment is based on evidence that has these assumptions woven throughout them.

NARRATOR: Among those who embraced these false medical theories was Dr. J. Marion Sims, a 19th century doctor who would become known as "the father of modern gynecology."

RADIO ANNOUNCER: The DuPont Company of Wilmington, Delaware makers of better things for better living through chemistry presents the Cavalcade of America... NARRATOR: Sims' reputation extended far beyond the medical profession.

Nearly 70 years after his death, he was celebrated in a radio program featuring one of Hollywood's biggest stars.

RADIO ANNOUNCER: Tonight's "DuPont Cavalcade" stars Ray Milland as a pioneer surgeon of the 19th century: Dr. J Marion Sims.

It mostly focused on his establishment of a woman's hospital in 1855, and his encounter with an Irish woman by the name of Tilly.

J. MARION SIMS (dramatized): The woman's hospital was opened at last, and as I began my story with my housemaid Tilly, so I'll bring it to a close with her.

Only now, as I fondly hoped, Tilly has become my nurse.

GAMBLE: Talk about a whitewash.

There was nothing about the enslaved women who suffered at Sims's hands.

Nothing at all about the, the surgeries on the enslaved women.

SIMS (dramatized): Oh, you're going to be a fine nurse, I know, Tilly.

TILLY: (sighs) A knight in shining armor.

That's what he is, a regular Sir Galahad.

(birds twittering) WANDA BATTLE: James Marion Sims was born in 1813 and he died in 1883 at age 70.

So here this marker calls him the "Father of Modern Gynecology."

The marker says, "he cured the considerate hopeless malady gaining him fame as a benefactor of women."

NARRATOR: Monuments like this one in Montgomery, Alabama, were erected in Sims' honor across the nation.

HAMMONDS: Sims is trying to understand how to give a treatment to women who have prolonged labors and they end up with these tears that are called fistulas.

What he decides to do is to take some slave women and began to try to figure out how to fix these tears, which meant that he was, uh, on a regular basis doing extensive operations on these women, surgeries on these women.

The health of Black women was not important to him.

What was important to him that he could use them to answer the questions that he was trying to answer.

HARRIET WASHINGTON: Vaginal fistula, a horrible complication of childbirth; horrible, painful infection.

A Black woman with that vesicovaginal fistula couldn't work.

She was of no use to her master.

People had tried to cure vesicovaginal fistula, and he knew that there were white women with it who would pay to be cured, and there were slave owners who would pay to get these women back into productive labor.

HILTON: Dr. Sims, he performed surgeries on them without any use of any type of pain medicine.

During that time, we knew ether was an ability to anesthetize the body to allow for surgeries to be done.

NARRATOR: An enslaved teenager named Anarcha was operated on 30 times.

She and two other enslaved teenagers named Betsey and Lucy endured torturous and humiliating operations.

WASHINGTON: We're talking about years of these women having their genitalia sliced by scalpels and sewn together, then falling apart again.

Sims would allow other doctors to come and watch these surgeries transpire.

NARRATOR: Sims himself documented an operation on Lucy.

She endured an hour under his knife, crying and screaming out in pain.

SIMS (dramatized): Lucy's agony was extreme, and I thought that she was gonna die.

The poor girl on her knees bore the operation with great heroism and bravery.

WASHINGTON: To say that it was courage implies heavily that it was voluntary, but it was not.

If you are a slave that refuse to do your master's will, you could be beaten, you could be injured, you could sometimes even be killed.

So saying no was simply not an option.

NARRATOR: The man who came to be revered as the "Father of Modern Gynecology" was influenced by what was by then a long tradition of racist pseudo-science.

What made that possible is that deep belief that Black women didn't experience pain the same way as white women did.

The slave women are different.

Their bodies are different.

(distant cheers and applause) Does this sound like a man we want to celebrate?

CROWD: No!

MACK: Does this sound like a man we want to commemorate?

Mr. De Blasio, tear down this statue!

MAN: Take it down!

(cheers and applause) NARRATOR: After a decade of organizing, local activists have fought back to dismantle the relics of Sims' controversial legacy.

Some of the monuments have begun to come down, but his beliefs are still alive in the medical profession today.

HILTON: It would be one thing if that was a, kind of notion that died along with Dr. Sims, but unfortunately, we see studies that show that medical students and residents were still reporting there was some innate difference in the way that we were born between Black and white people.

NARRATOR: In 2016, a study of medical residents' and students' beliefs found that many thought Black people felt less pain than whites.

This false belief can significantly impact the treatment that Black patients receive.

Some of the false beliefs about biological differences that we explore are things that are Black people's blood coagulates more quickly.

Their nerve endings are less sensitive.

They age more slowly.

That they have thicker skin than white people.

Um, even things, like, they're able to detect movement more easily.

What we found is first that half of the medical students and residents endorsed at least one of these false beliefs.

So among white medical students and residents who endorsed more of these false beliefs, they thought that the Black patient would feel less pain than the white patient and they were less accurate in their treatment recommendations for the Black compared to the white patient.

FORD: That actually is surprising to a lot of people, to know that, here's proof that racism still exists among those who altruistically, at least let's presume that, go into medicine.

They still nevertheless carry these racist, uh, beliefs.

In part because those beliefs are in the literature, in the evidence space, and in the way that the field practices.

♪ ♪ NARRATOR: False beliefs about racial differences have been so widespread, that in 2017, Pearson Education, a leading educational publisher, was forced to apologize for publishing a nursing textbook with false and biased information about how to treat patients of different races.

I'm Tim Bozik and I lead global product development at Pearson, and I want to apologize.

In an attempt to help nursing students think through the many facets of caring for the patients, we reinforced a number of stereotypes about ethnic and religious groups.

It was wrong.

NARRATOR: The book made stereotypical claims about a number of groups.

"Blacks," it read, "often report higher pain intensity than other cultures," and "they believe suffering and pain are inevitable."

We've removed the offensive information from the eText versions of the book, the most recent printing of the book, and any future print editions of the book.

NARRATOR: But the damage had already been done.

The textbook had been in distribution across the U.S. for three years.

That disparity in thought process leads to a disparity in health outcomes and treatment and protocols that are for Black Americans, and we see it on a day-to-day basis.

(sonogram thrumming) NURSE: Look at here.

Look at those lips.

(sonogram thrumming) NARRATOR: One area in which racial disparities are especially stark is maternal health.

Black American women face some of the worst health outcomes in the U.S. during pregnancy and childbirth, in part because of racial bias in medical treatment.

VERONICA GILLISPIE-BELL: History has affected how we deliver care.

And so, we don't believe Black women when they say they're having pain, when they say they're having headaches, when they say they're having different symptoms.

It's really ironic that the very bodies that have been experimented on-- um, Black women-- that we would suffer today, not benefiting from... presumably, the knowledge that will come from that, that pain, that suffering.

NARRATOR: 80% of pregnancy-related deaths in the U.S. are considered preventable, and Black women are three times more likely than white women to die during pregnancy or childbirth.

Black women also experience pregnancy-related complications at disproportionately high rates.

MELODY SEGUE: Going into the second trimester, I started to notice swelling in my hands and my feet.

And at the beginning of the third trimester, I started to experience shortness of breath.

My blood pressure was taken and it was elevated.

I had no idea there was anything to be concerned about.

Those are all signs of preeclampsia and any individual coming into the healthcare system should be evaluated for preeclampsia with those symptoms.

When the blood vessels get tighter, that's what causes our blood pressure to be elevated.

And with preeclampsia, particularly in pregnancy, when those blood pressures get elevated and those blood vessels get smaller, then we, one: don't have as much blood flow going to the baby, but then for moms, we don't have as much blood flow going to other areas like the kidney, the liver, the brain.

If we don't evaluate it and treat it at that point, it can go on to be eclampsia, which is elevated blood pressures that then leads to seizures.

♪ ♪ SEGUE: The day that my son was born, the doctor did an ultrasound, and then she looked kind of concerned and she said, "We're having this baby today."

She says, "Well, there's no amniotic fluid "around the baby except right at the umbilical cord, "and he's a breach, so, "we're going to the O.R.

"You're going to have a cesarean," and, you know, "we need to get the baby."

I was in the O.R.

within an hour, my husband was there with me.

I heard the baby cry, which is so beautiful.

(chuckles) I found out after delivery that I had preeclampsia, the symptoms of preeclampsia, which... which are swelling in your hands and feet, you can have shortness of breath, and high blood pressure.

I had all three.

♪ ♪ All of the diagnoses were not on the table, and if they were, they weren't explained to me.

I was not a partner in my own care.

♪ ♪ GILLISPIE-BELL: I had some shock in realizing that this had happened to me as well.

I was about 25, 26 weeks pregnant.

I went to the hospital and I told them, you know, "I'm having pain.

It's coming and going.

I think I'm maybe contracting."

And they said okay.

So they put me on the monitor, and in that space, I did not feel comfortable saying "I think something may be going on."

It doesn't matter what your title is, it doesn't matter what your socioeconomic status is.

I am Dr. Gillispie.

I'm a Black woman, and so while it is sad, it's not shocking, it's... unfortunately it happens way too often.

EXPECTANT MOTHER: I can see him.

NURSE: You can see him?

He has his hand right up there... NARRATOR: The single greatest factor determining the quality of the maternal care Black women receive is race-- despite education, wealth, or even fame.

REPORTER: Tennis star Serena Williams and her husband, Reddit co-founder Alexis Ohanian, recently welcomed into the world their daughter.

Williams recently told "Vogue" magazine how she self-diagnosed a life-threatening emergency after giving birth.

NARRATOR: Williams recognized the signs of blood clots that she had suffered before, so she guided her doctors on how to save her life.

GERONIMUS: Even though she's this wealthy famous woman, and has allegedly the best healthcare in the world, they finally listened because she was Serena Williams.

Most women they wouldn't listen to, most Black women.

World champion sprinter Tori Bowie was a force of nature on the track field, but at the age of only 32 and while she was eight months pregnant, she apparently went into childbirth at home and died alone.

Bowie's death was ruled natural, and the report stated that there had been possible complications, including respiratory distress and eclampsia.

Sadly, her story is not unique.

SKANES: The fact that we see women of color dying despite socioeconomic status lets us know that there is a level of bias somewhere in our system.

HILTON: What is it that lets our voice not carry the same weight when we say something is wrong?

Education is not protective for us.

Income level is not protective for us.

As a double Board-certified anesthesiologist, I spent 13 years after high school to earn this degree, and at the same time, my child is twice as likely to die than a white woman with a third grade education.

KAI FRAZIER: Do you want to hand me stuff out of here and we can start going through that.

I can start... Let's see.

We can put... You can probably put this in there.

FRAZIER (voiceover): This is my first baby, and looking forward to it.

I wasn't sure if I was going to have kids.

I was, you know, kind of indifferent.

I found a great partner, we decided we would have kids.

Either the 20th or... FRAZIER (voiceover): I was well aware by moving to Alabama, I was in the region that statistically, has a higher Black mortality rate in labor and delivery.

NARRATOR: Maternal mortality in the state of Alabama is among the highest in the nation.

Dr. Heather Skanes decided to do something about it-- opening the first freestanding birthing center in the state.

Good afternoon, Ms. Bailey.

(voiceover): A lot of people ask me, why would you start a birth center as an OB-GYN?

I think sometimes you have to create the culture that you want to see.

I started my private practice first in 2021, and my goal was to create a space in which women of color were the center of the narrative.

Girl down.

IFAFOLAWE STACEY FLUKER: Kai and Burgess.

How are you all doing?

We're ready to see you.

FRAZIER: Good, good.

BURGESS: All right.

How are y'all doing today?

FRAZIER: Doing good, doing good.

Y'all look fabulous.

Oh, thank you so much.

FRAZIER (voiceover): I didn't wanna go into a hospital for my healthcare visit, so, being able to go to a small office full of Black women has been fantastic.

This is an example of your uterus.

This whole entity of the balloon.

SKANES: Right now, we're the only birth center that's operating.

We're the first licensed birth center in the state of Alabama's history.

JO CRAWFORD: Jayla, are you ready?

SKANES: You have to be a low-risk candidate, meaning you don't have any specific chronic conditions like high blood pressure, diabetes, anything like that.

And you have to get to full term.

So you have these muscles on the side of your uterus that contract... SKANES: Most of what we know about obstetrics has come from the art of midwifery.

And what the actual contraction is.

♪ ♪ (crying) SKANES: When I look at my data from before I had midwives to after, you'll see increase in the vaginal birth rates, decrease in the epidural usage, decrease in interventions.

That's been shown in many ways in randomly controlled trials that you have better chance at a good birth outcome if you have a doula or midwife when you're Black.

NARRATOR: From the 19th to the early 20th century, Black midwives played a large role in providing care to Black and poor white women who had no access to hospitals.

(baby whimpering) Then, things began to change.

SKANES: There is this shift in the narrative about midwifery.

One of the ways that people chose to do that was to say that it was dangerous for people to be at home, and a lot of it was steeped in racism, that they, midwives, were Black, they were uneducated, that they were dirty, that they were causing deaths, and that just wasn't the truth.

It's documented that there were midwives who had caught thousands of babies and who had less than one death in their whole careers.

NARRATOR: Despite midwives' effectiveness, Alabama banned midwifery in 1976.

But after a decades-long grassroots effort, the state began licensing midwives again in 2017.

But now, only a handful of them are Black.

Always find where the back is first, which we know because we feel feet here, and she says the back is over here.

Okay.

Kicking has been over here.

FLUKER (voiceover): Currently, I'm a doula, a birth companion, and with the birth center, I get to get my hands a little bit closer to my ultimate dream, which is midwifery.

(indistinct talking) ♪ ♪ When I envisioned my delivery, I never envisioned it in a hospital.

I wanted to give birth in a birthing center because I wanted to make sure that we had the least amount of medical intervention as possible.

(water shifting) Kai means ocean and water.

I wanted to have a water birth.

♪ ♪ (indistinct talking) (low groans) One thing that I love about Oasis is that it's small enough to where women really have the opportunity to develop a relationship with her birth team.

♪ ♪ SKANES: People are down here fighting for their lives, and the birth center is a part of this larger grassroots effort to create a new culture in Alabama.

I would say that we are at a critical junction as far as maternal health in this country.

Of all the developed nations, the U.S. is at the bottom.

♪ ♪ GILLISPIE-BELL: This is supposed to be a time of joy, where your outcome is supposed to be a healthy mom and a healthy baby, and we're seeing Black mothers die at a rate higher than that of their white counterparts.

And so I think as providers in the healthcare system, we have to be aware of all of these things and make sure that we're creating a safe space for our patients to speak up, and that we're also creating a space where they are heard.

NARRATOR: In maternal health and other disciplines, doctors rely on new technologies to help them care for patients-- using massive data sets of symptoms, medical histories, and test results.

All of this data is analyzed using algorithms-- computer-based formulas that guide how physicians diagnose and treat their patients.

WRIGHT: The use of the algorithms is to really standardize or systematize the way that we process and use a wide array of information.

And I would say that the-- this is part and parcel of the practice of medicine.

This is not... these are not some esoteric tools.

♪ ♪ Algorithms are used every day in every setting by practitioners to make decisions.

NARRATOR: Reliance on mathematical algorithms and artificial intelligence is exploding, but America's history of racial bias is sometimes baked in.

CAMERON WEBB: Over the last few years, we've started to identify that any time these tools incorporate race, then we have to ask the question, what is actually the role of race?

And is it the appropriate proxy or measure to include in this algorithm?

NARRATOR: One example of how race-based algorithms put Black patients at a disadvantage in receiving life-saving treatment is pulmonary function tests.

The spirometer, utilized by Dr. Samuel Cartwright in the 19th century, is still being used to diagnose lung disease today.

(inhaling) HILTON: This test measures what is the lung volumes of a person, right?

And we see that there was an adjustment made again for race.

Historically, they said that we had a lower lung function than white people.

WRIGHT: The roots of that work live on to current day in the way that we assess lung function in spirometry.

Anyone who's blown into that... tool, that machine, to assess lung capacity, has had their race baked into the actual machine.

NARRATOR: What this means is that Black and white patients with exactly the same test results are diagnosed differently by the algorithm, to the disadvantage of Black patients.

(taking deep breaths) HILTON: A white person hit that same mark, they would be considered to have lung disease, and you will be considered to be normal.

So those interventions to try to better your lung function or identify what it is that's causing your lungs not to work, were not made.

And so when we're thinking about lung transplants, and we're thinking about how to get you on medications to help improve your lung function, that was denied for Black people, delayed for Black people, and given to white people.

WRIGHT: It's only until just recently that the American Thoracic Society made their recommendation that race should be removed in spirometry testing.

NARRATOR: While algorithms are indispensable diagnostic tools, the racial biases programmed into them, coupled with documented medical mistreatment of Black people have led to an overall distrust of the medical system.

During COVID-19, this distrust became a national public health issue.

REPORTER: Health officials around the country are working to reverse declining vaccination rates.

Recent data shows that roughly a quarter of Americans are not inclined to get a COVID vaccine.

That number is believed to be higher in the African American community.

NARRATOR: By the end of April 2021, when all adults in the U.S. were eligible to receive the COVID-19 vaccine, about 41% of white Americans were not vaccinated against COVID, compared to 54% of Black Americans.

Some of this vaccine hesitancy was cited by researchers as stemming from historical experiences of discrimination and injustice.

REESE: I know of people who didn't trust the vaccine.

They thought if you take the vaccine, it'll make you sick, it'll give you COVID.

Or it'll give you something else, and as a result, they wouldn't do it.

We have been subject to all kinds of experiments.

That history obviously gave people apprehension.

NARRATOR: Discussions of distrust often cite an infamous study conducted on Black men in Tuskegee, Alabama beginning in 1932.

These images were produced as part of a U.S. Public Health Service campaign to raise awareness about syphilis and its prevention in southern communities like Tuskegee.

WASHINGTON: U.S. Public Health Service put out a call saying anybody who's sick and needs a doctor, come to see us.

And people flocked.

Hundreds of people came.

But they didn't come up with things to ameliorate Black health.

Instead, they wanted to research syphilis.

What did they want to find in particular?

They wanted to prove something that 19th century doctors had said, that syphilis would affect Black people differently than white people.

♪ ♪ GAMBLE: There was a belief that with the last stage of syphilis, that white people got more neurosyphilis because they used their brains more.

And, you know, Black people didn't use their brains, the theories went, and that they had more cardiac complications.

And in order for there to be scientific evidence for these theories, there had to be experimentation.

♪ ♪ DAVID HODGE: These men thought they were being treated for what was called at that time bad blood.

Bad blood was a kind of grab bag term for all blood diseases, like diabetes and hypertension.

NARRATOR: In fact, they were not to receive any kind of treatment.

Instead, the government doctors withheld treatment so they could study the long-term effects of untreated syphilis on Black patients.

HILTON: They all had wives, they also had girlfriends-- they were young men.

And so we had the infection of women as well.

And we allowed for children to be born with congenital syphilis, all because the U.S. government wanted to see what happens when we don't treat this illness.

NARRATOR: These Black patients were denied treatment for 40 years, even after it became known in 1943 that penicillin cures syphilis.

♪ ♪ It is morally wrong to have a drug that works and refusing it to a particular population for no other reason than because they were Black.

NEWS REPORTER: It's decades late, but finally a president apologizes for experiments that used Black men as guinea pigs.

What the United States government did was shameful, and I am sorry.

HODGE: During COVID, each and every day, we saw multiple times where the name Tuskegee was mentioned associated with vaccine hesitancy, vaccine reluctance.

Many Black and Brown people, all they know is that something took place and it wasn't good.

WRIGHT: When the COVID vaccines became available, I had a front row seat to hearing from patients about their hesitancy.

The justifications were well beyond the Tuskegee experiment.

That is what... the lightning rod is, but I found the roots to be in a broader inherent mistrust of the system.

♪ ♪ NARRATOR: Centuries in the making, bias in the treatment of Black Americans inside the medical system is still being felt today, contributing to the wide and persistent racial disparities in health outcomes in the U.S. At the same time, researchers increasingly point to the impact of social and environmental factors that undermine Black people's health before they reach the doctor's door.

♪ ♪ LAVEIST: Certain communities have an infrastructure that can facilitate a more healthy lifestyle: good restaurants, good quality housing, good schools.

Other communities have an infrastructure that facilitates ill health: less availability of quality foods, more pollutants in the community that they live in, less availability of healthcare.

NARRATOR: This kind of residential segregation, steeped in racism, has detrimental health effects.

Residential segregation refers to policies of the late 19th and 20th century that determined where people could live based on their race.

FABER: These policies largely excluded Black people and Black neighborhoods from home ownership opportunity, and also encouraged white Americans to leave those neighborhoods.

♪ ♪ NARRATOR: These policies help deepen the unequal and poor conditions that exist in many segregated Black American communities to this day.

MARTIN LUTHER KING JR.: We found not only slums, which is a real problem, but ghettoized conditions.

Chicago really is one of the most segregated cities in the United States in housing.

♪ ♪ We sent Negroes in large numbers to the real estate offices in Gage Park.

Every time Negroes went in, the real estate agent said, "Oh, I'm sorry.

"We don't have anything listed.

(children playing) Now you can find something somewhere else."

And it was always back in the ghetto, but they didn't have anything.

And then soon after that, we send some of our fine white staff members into those same real estate offices, and the minute the white persons got in, they opened the book-- "Oh, yes.

Well, we have several things, Now, what exactly do you want?"

(applause) ANSELL: Those neighborhoods became the Black and Brown neighborhoods that we see today, of concentrated poverty and segregation.

♪ ♪ Those conditions were driving the poor health I was seeing.

♪ ♪ (rumbling) NARRATOR: More than 8 million Black Americans live in food deserts-- areas where people have limited access to affordable, healthy food.

For them, like residents of Chicago's segregated West Side, the consequences are not only unhealthy, but can take years off of a person's life.

♪ ♪ (indistinct talking) HAYES: The neighborhood, they are on limited income, so you got to be able to keep the prices down, but if you can't buy a product in bulk, it's hard to keep the prices down.

So it's definitely a challenge.

And a lot of times, we just end up with lower quality goods or no goods at all.

LARDE (voiceover): Are those the only frozen meats that you have, that are in that one back there?

Yeah.

Right now, yes ma'am.

Okay.

WEBB: What we have is these really high-calorie, low-quality foods people with lower incomes are forced to consume, and that actively accelerate the process of them being sick.

Uh, her insulin, Lantus.

WEBB: You see more diabetes, higher cholesterol, higher blood pressures.

The combination of those three, you see more heart disease, and then you see the bad outcomes that come with that.

HAYES: You forced to make decisions of what you need the most.

And a lot of times, you go for the cheaper products, which are usually the lower quality products.

I can't get the same price Whole Foods gets for the product.

So if they're charging seven bucks, I'm going to have to charge nine.

There's definitely a need for fresh goods and fresh groceries in these neighborhoods.

So, we try the best we can, and that's all we can do.

PAYEL GUPTA: We know that all of these processed foods are the reason this country is suffering from this obesity epidemic.

♪ ♪ When you have obesity, you have more inflammation in your body, and any of that extra weight can cause not only inflammation, but it can inhibit the way that you take a breath, even.

Your diaphragm is not able to expand as much.

There's a clear link between asthma and obesity and other chronic lung conditions.

CARL LAMBERT: Patients, they will go towards what's closest to them.

They're eating things like fast food because there isn't a fresh food market that's nearby.

And we have to be really careful not to put blame on patients for making the choices that they're almost forced to make.

ANSELL: Let's give a hug.

(voiceover): How do you begin to, as a doctor or as an institution, address those neighborhood conditions?

What we did was to lay out life in Chicago along the L tracks, because it resonated that if you lived in the Loop, you're more likely to be white, more likely to be wealthy.

You could live to be 85.

But if you go down the Blue Line, right past Rush, two or three stops, you land in one of the lowest life expectancy neighborhoods in the city.

And then when people say, well, what are the reasons for that premature mortality?

Is a lot of people thought was gun violence and homicide... ...but it was cardiovascular disease and cancer and diabetes accounted for more than 50% of that.

We needed people to think about it differently, the root cause of this was structural violence, structural racism, and economic deprivation.

LAMBERT: So you're gonna feel some pressure.

(voiceover): Food is medicine, but you have to have the lens of the patient that's in front of me.

What sort of access to healthy food do they have?

ANSELL: We've gotta start focusing on the structural conditions in the neighborhood around food.

And we thought, what could we do to improve the conditions?

And then one day, one of the only food stores left Garfield Park.

It's been almost one month since the boards went up and the doors to the Aldi's in West Garfield Park closed for the final time, seemingly without any warning.

NARRATOR: Aldi cited "poor sales performance and increased expenses" for the store closure.

PROTESTORS (chanting): Food is a human right!

We won't leave without a fight!

NARRATOR: Rush University Medical Center joined forces with residents to protest the closing that had made access to healthy foods even more scarce.

Come get your free food!

NARRATOR: The action led to a community grocer initiative.

ELIZABETH ABUNAW: There's over a half a million Chicagoans that live in neighborhoods and communities where affordable, fresh, healthy food is not a given.

I don't call them food deserts.

I call it what it is, it's food apartheid, um, access to affordable fresh food is wholly unequal and it breaks down along racial lines.

♪ ♪ What I wanted to do was give people a shopping experience that would delight them.

Delight them with all of the wonder that is food.

Forty Acres Fresh Market is an independent, Black woman-owned grocery business that operates in the city of Chicago and close western suburbs.

You are what you eat.

All of those sayings are absolutely true.

Food drives your health, and all we're saying is that we deserve the options to have more control of that where we live.

NARRATOR: Community grocers in Chicago and other cities are trying to reverse the effects of food deserts.

But other factors, also linked to America's history of racial segregation, can have just as big of an impact.

WILLIAMS: One of the things that has happened historically in the United States is that when neighborhoods were demarcated as places where Blacks should live, they became places where you could build a freeway, places where you could set up trash dumps and other undesirable neighborhood characteristics.

And that has happened across the United States, that the places where Blacks live are places where there's a higher level of exposure today to physical and chemical toxic substances.

NARRATOR: The communities of West Oakland, Hunters Point and Richmond, California make up what's known as the Toxic Triangle.

The area is bound by shipyards, oil refineries, and a matrix of freeways spewing diesel, truck exhaust and other pollutants into the air.

I had no idea the magnitude of pollution from the Port of Oakland and the three freeways and the industrial businesses in West Oakland.

I live on a thoroughfare of 7th Street and I'm two blocks from the entrance to the Port of Oakland, so trucks run through 7th Street 24/7.

NARRATOR: Margaret Gordon moved to West Oakland in 1992 and has seen the impact of the air quality on the people of Oakland.

The exhaust makes its way into her home, and she says it's made her sick.

GORDON (voiceover): You open up your windows, it, it can start collecting, and it collects the higher the ceiling is.

That's where it collects at.

On your Venetian blinds... on your car, people think it's dirt.

It's from the tailpipe of trucks, trains, ships as a cumulative impact.

(ship horn blares) I use an inhaler.

I use an inhaler daily or sometimes twice daily.

NARRATOR: Gordon suffers from chronic asthma, but that only motivated her to fight for cleaner air in her community.

She co-founded the West Oakland Environmental Indicators Project.

GORDON (voiceover): I started getting involved real heavily in community activities around environmental justice, that's when the clock started ticking for me to understand asthma and relationship to pollution.

♪ ♪ NARRATOR: She's worked with local environmental organizations, to monitor the air and map pollution "hot spots" in her neighborhood, using new technologies.

Studies have documented high concentrations of nitrogen dioxide, nitric oxide, and black carbon-- pollutants linked to increased cardiovascular and respiratory diseases.

GUPTA: Diesel fumes and fumes from cars, produces something called particulate matter.

The smaller the particle, the more easily it can get into your airways.

NARRATOR: In West Oakland, emergency room visits for asthma are 76% higher than the county average.

GUPTA: Black individuals are two to four times more likely to die from their asthma compared to white counterparts.

NARRATOR: A Black child born in West Oakland has a life expectancy of 73 years, while a white child born in Oakland Hills, a community just six miles away, will be expected to live 15 years longer.

GORDON: We have this unequitable situation of who breathes what in the city of Oakland.

That's always been a major thing.

How to reduce these emissions from the port and from the freeway.

(seagulls squawking) NARRATOR: Across the bay from West Oakland is a community living in the shadow of the Hunters Point Naval Shipyard.

(explosion) Just after World War II, ships that survived atomic bomb testing in the Marshall Islands were brought to Hunters Point.

Where they were sandblasted to rid them of radioactive material.

That sand was then left to seep into the ground, contaminating the entire area.

SUMCHAI: We are looking at a staging area for soils that are likely to be radioactive.

There's nothing, you know, that stops a wind gust from disseminating this soil.

They're supposed to be covered and they're supposed to be contained.

DEREK TOLIVER: As residents that live here, do we get worried about being exposed to it?

Absolutely, because it becomes airborne.

You know, once anything becomes airborne, it's spreading.

NARRATOR: The shipyard was designated a toxic superfund site in 1989.

But in the decades since, the cleanup has been plagued with delays and faulty test results, and as recently as 2021, the navy found radioactive objects, and admitted that toxic groundwater posed a threat to the longstanding African American community that settled in Hunters Point to work at the shipyards.

SUMCHAI (chuckling): I have a love-hate, you know, relationship with it.

My dad used to bring photos home of the ships that he worked on, and, uh, you know, so I've been exposed to it since I was a little girl, and, uh, you know, it's just a tug of war of emotions.

Our findings show that people who are living with the half-mile perimeter of this superfund system are endangered.

You know, they have body burdens, they are nutritionally deficient.

They have secondary diseases.

Many of them have more than one disease, you know, that's associated with toxic exposures, you know and this is just a very, very serious situation.

It's a situation that can't be ignored.

NARRATOR: More than 11 million Black Americans live in close proximity to pollution-emitting facilities or one of the nation's 1,800 toxic superfund sites.

These places have been linked to higher rates of infant mortality, cancer, and lung and heart disease.

Monitoring to detect and document exposure to toxins in these communities is critical.

SUMCHAI: Anything in, uh, green is radiation contaminated.

NARRATOR: Dr. Ahimsa Porter Sumchai has been conducting tests in the Hunters Point community since 2019.

We have screened people who have ten to 12 toxins in their body, in concentrations above, you know, what is allowable.

HARRISON (voiceover):: I took the test with Dr. Sumchai and it was, um, I was kind of blown away.

What was found in my body was lead, rubidium, cesium, cobalt, which is a metal, mercury, platinum and plutonium.

The way it was explained to me is that through my urinalysis, that, that it's in my bones.

♪ ♪ ICILMA FERGUS: If people live in certain environments where there's a high level of pollutants and toxins, you're gonna have more adverse outcomes and you're gonna have that lower life expectancy.

NARRATOR: Health risks to Black American communities don't end with toxic sites and food deserts.

The very same communities have fewer primary health facilities and a dangerous shortage of doctors.

ELAINE BATCHLOR: We have a separate and unequal healthcare system in this country.

If you live in an, in an affluent community like Santa Monica or Beverly Hills or Hollywood, you have ample access to physicians.

If you look up the number of licensed primary care physicians in Compton, there are only 22 listed.

♪ ♪ NARRATOR: In these communities, hospital emergency rooms often become the primary source of care.

Blow out a little harder.

(exhales) Good, one more time.

BATCHLOR: Our hospital is located in an area of Los Angeles that has over a million residents who are primarily people of color, Black and Brown and low income.

The community is missing almost 1,500 physicians.

NARRATOR: The acute shortage of healthcare professionals in Black and Brown communities is due in part to the economics of healthcare in the U.S. Say, "Ah."

Ah.

BATCHLOR: We know that there are providers who want to serve poor people, but physicians can't sustain a practice in South L.A. You're just gonna head on down to those red chairs on the left and the right and they'll call you from there, okay, all right.

BATCHLOR: Most of the residents who live in the community are covered by public insurance.

Medicaid pays very low rates for physician services compared to commercial insurance that many people get through their employers, and as a result, there aren't enough doctors and not enough access to primary care.

OSCAR CASILLAS: Because there's a lack of urgent or same day appointment care or next day appointment care, or same-week appointment care, the emergency department becomes the de facto form of care that people in this community are left seeking out.

These are the type of things that lead to higher amputation rates, higher rates of uncontrolled diabetes and hypertension, dialysis, kidney failure, heart failure, strokes, and all the things that we see at higher rates in this community.

NURSE: Oh, you got it.

You're strong.

Yeah.

Okay.

NURSE: You want me to scoot your back up?

Are you okay?

Are you comfortable?

You're okay?

Just like this.

All right.

Seeing Dr. Hall for a lot of months and we're saving this toe.

BATCHLOR: Diabetic amputations are the number one surgical procedure we do in our hospital.

The diabetes mortality rate is 72% higher in South L.A. than in the rest of California.

Are you having any pain?

Not today.

MYRON HALL: When things become more chronic in terms of wounds, especially diabetic foot wounds, we find that 50% of the people that have a below knee amputation will die in five years.

Your sensation is still pretty good and your circulation is good, 'cause I can feel your pulse.

All right.

Yeah.

I didn't know that would ever stay wounded as long as it's been wounded.

And how it started is... a nightmare.

BATCHLOR: If you live in one of those affluent communities, you have good insurance, you have good access to high quality prevention, treatment.

Even if you advance to the point where you have a wound, you also have access to comprehensive wound care, which can prevent an amputation.

MAITA KUVHENGUHWA: Hello, sir.

How you doing?

Okay, so... (voiceover): I think that a lot of hospitals in underserved areas are dealing with the same things that we are.

Um, and I can tell you that things are not equal.

Is it okay if I listen to your heart and your lungs?

(voiceover): My patients tell me stories about how they've been discriminated against how they've been to other hospitals, and people didn't take them seriously.

BATCHLOR: Studies have shown that the language that providers use to describe Black patients in medical records is different from the language they use to describe other patients, and that it is more derogatory and it tends to describe the patients as being less compliant and more problematic.

Those obviously shape not only how that provider interacts with the patient, but how others tied to that network of care are going to interact with that patient.

And one cannot help but wonder how that affects the interactions.

Just, you know, the kind of dignity.

Sometimes it feels like we're asking certain patients to exchange their dignity for the care that they get.

KUVHENGUHWA: I have had um, an experience with systemic racism, actually, when my dad had his stroke and he was airlifted to a tertiary care center.

They thought that he was just some guy off the street.

They didn't realize that he was a doctor, and so they were treating him in one way until the family showed up and we said, "No, he was a surgeon.

He was operating yesterday before he had this stroke," and then suddenly everything changed.

So it actually made me really sad because I'm, I was thinking if my dad weren't a doctor, he would get substandard care.

If we weren't advocating for him, he might get substandard care.

So it opened my eyes a lot.

Good afternoon, ma'am.

Good afternoon.

KUVHENGUHWA: How are you?

I'm okay, Dr. K, how are you?

KUVHENGUHWA: I'm excellent.

So I wanted to introduce you to Dr. Shibata.

Hi, Dr. Shibata.

SHIBATA: Nice to meet you.

So he is one of our internal medicine residents.

So when she first arrived, her entire left lower leg from the knee down was severely swollen.

Her white blood cell count...

I would say that the goal of the residency program here is multiple-fold.

Um, first we need to fill a physician shortage of over 1,000 primary care and specialists here in South L.A. (voiceover): So we're trying to train people who will hopefully be willing and able to serve the community when they graduate.

We need to train a more diverse healthcare workforce.

We need to have more physicians of color.

And two weeks ago I got this cold... GILLISPIE-BELL: So the data shows that when there's concordance of race between the patient and the physician, meaning the same race, that there is a level of trust that is immediately established because we know we have shared experiences.

Um, there is data also that shows that there are improved health outcomes for Black individuals that have a Black primary care provider.

They have better health outcomes.

LAMBERT: There's plenty of physicians who are not Black or Brown who do the best job that they can, who do a solid job of caring for people that do not look like them.

But at the same time, we have to be honest that there is a lack of representation in our workforce.

I, I couldn't have no better other doctor.

Thank you Dr. K. You're very welcome.

Sorry.

I know you've come a long way and you're almost at the finish line.

Almost ready to go home.

Yes.

So, we just gotta get you there.

(voiceover): I feel like the patients here really deserve high quality care.

Um, and that's what I strive to provide.

(voiceover): We're not short changing people here.

We aim to provide the best.

(on camera): Hello, hi ma'am.

PATIENT: Hey!

How are you?

♪ ♪ ♪ ♪ (laughter, excited chatter) NARRATOR: Only 5.7% of medical doctors in the U.S. are Black.

Many of those doctors graduated from a historically Black medical school, such as Charles R. Drew University of Medicine and Science in Los Angeles.

(cheers) (applause) MITCHELL: It's my absolute deep personal honor to participate in your official white coat ceremony today.

(cheers and applause) GUPTA: Your white coat ceremony is kind of your initiation into this really important part of your journey in your life, into what you're gonna do for the rest of your life.

MITCHELL: And I look forward with all that I have to be at your graduation ceremonies when we all officially address you as doctor-- thank you.

(cheers and applause) ROBERTO VARGAS: This model emphasizes person-centered, team care, integrated long-term treatment approaches to diabetes and comorbidities and ongoing collaborative communication and goal setting between all team members.

NARRATOR: A new generation of doctors is being educated in a new way to understand the connections between social conditions and health outcomes, and to confront bias head on.

SABRINA MONTGOMERY: We're learning a lot about implicit bias and medical racism, even as Black and Brown people.

You know when they first brought it up, I was just like, "We don't have implicit bias," but you know they had us take certain, like, tests to just see.

And everyone has some level of implicit bias and it's our responsibility to really, like, work on those things.

♪ ♪ VARGAS: You guys talked to your standardized patient.

He had diabetes, and you know, he was a little bit reluctant, but the goal was not only for you to interview that person and to find out what were his barriers and why he, you know, what was going on with his diet, but to also think about those contextual issues that are gonna potentially inhibit his likelihood of having a good outcome.

MONTGOMERY (voiceover): We're taught how to actually interview patients and really learning how to sit, how to lean in, because the more you're able to connect with the patients, the more that they're able to open up to you, the more they're able to tell you.

WEBB: You wanna create the best doctor you can create.

It's so critical that we are introducing doctors into our society who don't have those same flaws that prior generations had.

There are so many studies that have shown that when medical schools introduce this idea of inequity, of discrimination, of disparity early on in the curriculum, they create doctors who are more likely to try to address those dynamics.

♪ ♪ LAMBERT: There's a lot of beliefs, racist beliefs about Black people and Black bodies, and certainly you don't want that in the medical healthcare realm because lives are at stake.

You literally will kill people.

NARRATOR: Training new doctors to counteract bias is an important step forward.

Even as clear scientific evidence has been building for decades against the old false racial theories especially thanks to a groundbreaking research project begun in the 1990s.

REPORTER: Pure human DNA, the building block of life.

And in this, the greatest human science project ever, they grow the DNA and separate its parts so a computer can read its chemical sequence.

BILL CLINTON: Today, the world is joining us here in the East Room.

We are here to celebrate the completion of the first survey of the entire human genome.

Without a doubt, this is the most important, most wondrous map ever produced by humankind.

NARRATOR: The Human Genome Project sequenced three billion base pairs of our DNA.

The genetic material that makes us human beings.

Continued genetic research provides definitive evidence that there are no meaningful biological differences among what we call races.

HAMMONDS: It became clear that we are one people and there are certain kinds of differences between us even at the genetic level, but they do not represent the kind of differences that we associate the old term of race.

So all human beings have genes for skin color, and those genes are expressed in different ways among different groups of people and individuals, depending on their ancestry, depending on the geography, depending on a number of things.

But there is no gene for race.

We knew even in advance of the Human Genome Project, of the unity of humanity.

But because of prevailing social, political and economic forces, we kept insisting on differences and significant differences.

GERONIMUS: The Genome Project helped to debunk the idea that there's anything genetically biological about being Black that would cause these poor health outcomes across the board.

There's just nothing to suggest, if you really look at the science or the genome, that while individuals may have predisposing genes to specific diseases that they, they don't correlate with skin color genes.

LAMBERT: So why are Black people suffering from more disease?

We've talked about, about there's systems where you're not getting access to healthy foods, healthy air, proper access to healthcare professionals.

Another thing that I would say is there is such a thing as being Black in America.

GERONIMUS: Black Americans face what I might call the neon lights of systemic racism.

These are the things like greater rates of poverty, discrimination in jobs, working longer hours, having physically more demanding jobs, medical underservice, having educational underservice, living in disinvested areas that now subject you to environmental racism, to just a whole range of stressors that are due to the disinvestment in your communities.

♪ ♪ FORD: It comes at so many different levels.

We experience it interpersonally in the treatment we receive when we're in the store, walking while Black, driving while Black, living while Black.

Many of us carry the sense that we have to be twice as good to get half as far.

That also is a form of chronic stress for us, a burden that we're constantly carrying.

It's that we are being hypervigilant in response to the racism that pervades every facet of our society.

It's racism through multiple pathways, but it's also racism due to the stress of being Black.

(indistinct shouting) GEORGE WALLACE: I draw the line in the dust and force the gauntlet before the feet of tyranny, and I say segregation now, segregation tomorrow and segregation forever.

(cheers and applause) GAMBLE: I went to medical school at the University of Pennsylvania.

There were times where people thought I was the maid.

(indistinct shouting) On your face!

This is a no (bleep) zone.

CAMERAMAN: Mm, not really.

Oh, is it?

Stop recording.

CAMERAMAN: Please don't come close to me.

Please take your phone...

Please don't come close to me.

I'm calling the cops.

Please, please, call the cops.

Do you have a receipt for this sir?

I got you on-- yes, sir.

Show me.

You got it in your hand, sir In Chicago, now, a woman claims a CVS drug store manager called police on her when she tried to redeem a coupon at his store.

REPORTER: The incident, just the latest in a string of episodes caught on camera of white people calling the cops on Black people for everyday activities like these two Black men arrested at Starbucks shortly after one of them tried to use the bathroom.

I'm gonna tell them there's an African American man threatening my life.

CAMERAMAN: Please tell them whatever you like.

GILLISPIE-BELL: When I was pregnant and I saw that it was a boy, I immediately freaked out.

I was like, how am I gonna protect this Black boy in the United States of America?

That is a level of stress in discussing with my friends that are not Black, that they never even thought of.

(sirens blaring) WILLIAMS: I am a professor at Yale University.

I'm leaving work at the end of the day, and then there are bright lights in my face, and I turned down my window and I said, "Why am I being harassed?"

And he is upset that I'm using the word harassed, because he's just doing his job.

One of the scales I developed is called the Everyday Discrimination Scale.

It asks people, in your day-to-day life, how often you are treated with less courtesy than others, treated with less respect than others.

That people-- you receive poorer service than others in restaurants or stores, that people act as if they're afraid of you.

Just these little day-to-day indignities.

Today, there are more than 450 published peer-reviewed papers from around the world in the medical literature documenting that everyday discrimination leads to worse health.

Pregnant women who report everyday discrimination, Black women give birth to lower birth weight infants.

Persons who report high levels of everyday discrimination, more likely to develop diabetes, breast cancer, hypertension.

The science is now overwhelming that discrimination is one type of stressful life experience that is pathogenic.

And what we mean by that, that is causing disease and death on a large scale in the United States.

GERONIMUS: When you're chronically being challenged by your environment, by societal explications, by danger of various kinds, whether it's literal danger or a possible threat, there's a degree of vigilance that if you're Black in America, you need to have all the time.

Every part of your body is affected down to the cellular level.

LAMBERT: There are hormones in that cortisol that's released in your body, that's like your stress hormone.

If there's consistent racial stress and strife and such, that hormone stays elevated and that leads to chronic conditions.

♪ ♪ JACKSON: There is a concept called biological age.

So you have your chronological age, which is your actual age, and then you have your biological or physiological age, which is the age of your organs, the age of your vascular system, for example, the age of your kidneys.

And they don't always coincide, the chronological age and the biological age.

And what we're seeing is that in places where there is high stress and great unpredictability, it tends to increase the aging rate on different parts of the body.

And at the ends of chromosomes, we have something called the telomere.

GERONIMUS: Our chromosomes keep safe our genetic material, and part of how they keep them safe is they have these sort of caps on them that are certain length.

They are there to protect your cells and your DNA in particular.

And so as more and more damage happens to your body, you lose some of that telomere length until a point where the telomeres are too small to protect your coding DNA.

JACKSON: That means that that chromosome is aging, and the older the chromosome, the more frayed the ends are.

NARRATOR: Telomere shortening is a normal cellular process involved in aging that occurs in all individuals.

But the phenomenon is accelerated when people face high stress and difficult life situations.

GERONIMUS: At some point when the telomere lengths get very short, either the cells die, or even worse, they become what I call zombie cells.

They no longer can replicate.

They just sort of roam around your tissues and organs, and your bloodstream letting out what are called cytokines that can lead to cancers, can lead to autoimmune diseases, and in their own way, damage you across a variety of body systems.

♪ ♪ This human biological process that is a result of being oppressed in a society and living with chronic stressors of all kinds, I named weathering.

The term "weathering" was meant to suggest that you're both weathered by the storm that you're exposed to and you weather that storm.

It's that active, effortful coping.

♪ ♪ WILLIAMS: Imagine a drop of water falling from the rooftop of this building to the concrete sidewalk below.

And if water drip today, there's no big deal.

But if day in day out, week in, week out, month in, month out, there's a steady drip, drip, drip of water, the concrete sidewalk will become weathered.

It becomes eroded by the constant exposure to adversity.

WEBB: There is a physiological toll of being Black in America.

And when you have that aggregate stress over the life course, we absolutely know there's an increase in high blood pressure, heart disease, shorter lifespan.

And for individuals who identify this this, uh, experience with discrimination or racism, they have higher systolic blood pressures at the end of the day.

So folks who say, "I am being discriminated against", and it's their perception of discrimination.

So I don't care what somebody think, if somebody says, "I wasn't discriminating against you," it doesn't matter, right?

Somebody's perception of that discrimination leads to higher blood pressures at the end of the day.

WILLIAMS: When you're Black in America, there is a ceiling on how much health you can achieve.

If you are high in income and education, you have better health than Blacks who are worse off, but you don't do as well as whites.

And I'll give you one other dramatic example.

A study of physicians who graduated from medical school, all Black, from Meharry Medical School, all white from Johns Hopkins, about the same time in late 1950s and 1960s.

25 years later, they're all medical doctors working in the United States.

But those Black doctors have more health problems.

And if they get sick, they're more likely to die.

HILTON: We look at African immigrants.

Their health outcomes are actually better than white Americans.

It's not until their children and their children's children are living here for an extended period of time that their health outcomes then become of what Black Americans health outcomes are now.

And that leads you to think, then what's the difference?

It's not genetics.

♪ ♪ HAMMONDS: At the end of the story, it's racism.

It's not race.

Racism is a systemic way of ignoring the lived experiences of various people in this country.

And for many of us, for Black and Brown people, it's racism that this is really harming our lives, and our health.

WEBB: If you look at all these systems, all these structures, all these social drivers, the tie that binds so many of them is the pathological existence of racism in our society and our fundamental inability as a nation to name it, to call it out, and to make it public enemy number one.

♪ ♪ WILLIAMS: What can we do as a society to raise awareness levels of everyone?

That the way we treat people on a day-to-day basis, failure to treat others with dignity and respect that each person deserves, has consequences for their health.

FABER: Looking at this history, we very much know what we did to create an unequal society.

And acknowledging that and dealing with that is the only path forward.

WRIGHT: It will require those who are training now to have a different mindset that does include the history of how we got here.

We're having conversations today that have not been had in 400 years, if you think about the history of this country.

♪ ♪ We are peeling back the way that healthcare should be practiced going forward.

We're not going to fix this tomorrow, but it's cliché that a journey of a thousand miles begins with, but a single step.

We're taking those early steps.

FORD: There's so many preventable deaths.

There's so much preventable suffering.

But we often choose to look away.

So, um, the only way I think we can begin to address it is to begin to address it, and we have to do that right away.

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