Health-services researcher Kim Rhoads, MD, MPH, founded Umoja Health Partners to unite about 30 community organizations combating COVID-19 in Black communities in the Bay Area. She shares why the Umoja approach (the organization’s name comes from the Swahili word for “unity” or “oneness”) is working.
What’s behind Umoja’s community-driven approach?
Something one of our community leaders said really captures it: “You can’t teach what you don’t know, and you can’t lead where you won’t go.”
You point to sources for Black distrust of the medical establishment beyond the often-cited Tuskegee experiment – for example, the so-called “chest pain while Black” 2010 study documenting disparate cardiology interventions and your own research exposing differential cancer treatments.
Yes. Also, pulse oximeters, which measure oxygen levels, were recently found to give unreliable readings for people with darker skin.
How are these issues connected?
They seem disparate, but they all come under one umbrella, which is that our agenda – as health care institutions, as academic institutions, as public health organizations – does not align with the agenda of Black people, and it never really has. That underpins why Tuskegee was allowed to go on and on: because that agenda is the preservation of the health of white people.
That agenda sort of includes Black people: “Whatever we build, it’s generic, it’s for you.” It’s not, though, because it doesn’t take into account the history of Black people in this country, the ways in which we’ve been dispersed and displaced and othered.
We need to go further and understand that the Centers for Disease Control was formed in 1946, as a new branch of the U.S. Public Health Service, to manage three diseases, and syphilis was one of them. So the problem with the Tuskegee experiment goes beyond the fact that a government study tricked Black people and allowed them to remain sick; it’s actually that our federal-level public health institution is founded, in part, on that study. That part of the Tuskegee story doesn’t get told. That’s in the soil from which everything else grows in public health.
So lack of trust should be thought of as an expected response to historically untrustworthy behavior.
How does Umoja address this deep history?
We’re very intentional about going to places where our partners say Black people will come. Everything is for us, by us – our materials are created by community members; our mobilizers are local or from partner churches. Our tents are red, green, and black. We are signaling so loudly: This is for Black people. Yes, other people can come, but, Black people, this was actually created for you.
We also emphasize an ongoing relationship. Every week we share our data in real time, and we give the community an opportunity to comment on it. We post the data publicly – we don’t embargo it while waiting for publication. Our agenda isn’t necessarily the academic agenda; it’s the public health agenda – for the African American community.