How the story of Remus Robinson relates to current racial disparities in healthcare
Dr. Remus Robinson was born in Birmingham, Alabama, in 1904. He first came to Detroit as a teen before getting his medical degree from the University of Michigan in 1930.
At the time, Detroit had about 120,000 Black residents, but the overwhelming majority of people who lived in the city were white. Many institutions in the city, including the biggest and most well-funded hospitals, were still segregated and openly discriminated against Black people. Black patients who did go to the city’s major hospitals were kept in separate wards and died from treatable diseases more often than white patients.
Black hospitals — operated, funded and managed by Black people — offered training opportunities for Black doctors and cared for patients who were refused treatment at other facilities.
Coming out of med school, Robinson wanted to get an internship at the city-owned Receiving Hospital, and had graduated in the top 10 percent of his class, according to his daughter, Ilene Robinson. His University of Michigan class rank should have guaranteed his position, however, he was ineligible because he was Black.
Robinson’s daughter said the discrimination he dealt with early in his career fueled him for the rest of his life, but it also was something he didn’t like to discuss.
“I grew up during the Civil Rights era, so I knew about racism, but my dad kept me shielded from a lot of the things he had faced and things that were going on. I could tell it made him upset to think about,” she said.
She also said she believes this is why he was “civically” focused on increasing opportunity for “the next generation in Detroit.”
Robinson interned in St. Louis before coming back to Detroit in 1934, where he worked as chief surgeon at Parkside Hospital. He worked there for many years before helping to integrate Grace Hospital, which is now part of the Detroit Medical Center.
One of the biggest barriers that Black doctors were up against was the inability to get admitting privileges at white hospitals — meaning their patients often couldn’t receive care at segregated hospitals. Robinson was one of the first Black doctors in the city to be able to admit patients.
Robinson also worked to integrate hospitals along with medical and nursing schools. He hoped to improve both the quality of health care and provide career opportunities for Black people.
Robinson died in 1970 after spending the last 15 years of his life serving as the first Black person elected to the Detroit Board of Education. Even with the racial barriers he broke, his daughter questions how much things have changed in the 50 years since his death.
“As we look at the events of today, it is obvious that change may only have occurred on the surface. ... (There are) more steps that need to be done. What they are and who will help us make them, I don't know,” she said.
Today, the medical field still lacks Black doctors. As of 2018, Black physicians account for just 5 percent of working physicians in the country, according to the Association of American Medical Colleges, even though Black people are about 13 percent of the country’s population. Not only are there fewer Black doctors, health outcomes for Black Americans are worse on average than other racial groups.
COVID-19 has further exposed Michigan’s racial health disparities. In the first three months of the pandemic, 40 percent of Michigan residents who died of COVID were Black, and that number now stands at about 21 percent. Yet Black people make up only about 14 percent of the state’s population.
Detroiters make up about a quarter of the state’s COVID-19 deaths. Concentrated poverty, access to technology, the need for a comprehensive health system and affordable clean drinking water have been barriers for Black Detroiters long before the state saw its first confirmed COVID-19 cases.
Detroiters have also been hit harder by the economic fallout of the pandemic than their suburban counterparts. According to a survey conducted by the University of Michigan, 43 percent of Detroiters have lost their jobs because of the pandemic.
Dr. Asha Shajahan, the medical director of Community Health and director of Health Equity and Health Disparities at Beaumont Hospital, specializes in understanding the links between a person’s community, lifestyle and overall health. She saw the disparities in COVID-19 health outcomes and “wasn’t surprised.”
“We know that racism in medicine is not something new. It has been since the history of our country. We also know that the social determinants affecting health is not anything new either. And so the history of some of the injustices done to the Black American population has kind of set the tone for the outcomes itself,” Shajahan said.
Some of those social determinants include unequal education, unequal job opportunities, housing discrimination, lacking access to healthy affordable food, and inconsistent access to clean drinking water. Shajahan said those ever-present inequities exist alongside a past of health care professionals and scientists abusing Black people for “the sake of research.”
Harmful experiments, such as the Tuskegee Experiment, in which nearly 400 Black men with syphilis were intentionally not given treatment for the disease, have been well documented. The experiments also come up as a common refrain on social media in the wake of the COVID-19 vaccine rollout. The Tuskegee Experiment went from 1932 to 1972, but there are more recent examples of studies that were harmful to Black people.
From 1992 to 1996, a New York study looked at violent behavior in Black and Latino boys. In the study, these boys, who ranged from six to 10 years old, were given fenfluramine — a temporarily banned drug that is known to cause heart valve disease. Critics of the study claimed that the drug had no health benefits for the boys in the study, but posed great risk to their lifelong health. Shajahan said this long history of unethical practices have had negative consequences for Black people.
Black people “distrust” the health care system and are less likely to get colonoscopies or preventative screenings, Shajahan said. Many Black Detroiters have also said that they are hesitant about taking the COVID-19 vaccine.
Dr. Herbert Smitherman, general internist at the Detroit Medical Center and vice dean of Diversity and Community Affairs at the Wayne State University School of Medicine, has been a practicing physician in Detroit for 33 years. Smitherman said he has met with several Black patients who don’t trust the COVID-19 vaccine or the health care system itself. He believes that can change if there are more Black doctors.
“The race of the provider and having people that look like you, understand you, understand your concerns and your culture are very important to helping you receive needed care,” Smitherman said.
A 2018 study done in Oakland, California, found that increasing the number of Black doctors could reduce the Black-white male gap in cardiovascular mortality by 19 percent. A 2016 study found that Black men and women in the U.S. have a life expectancy that was, respectively, 4.4 and 2.8 years shorter than white men and women.
Robinson spent so much of his professional career trying to increase the number of Black doctors, in part, for this reason. But Smitherman cautions that efforts to increase the number of Black doctors cannot be the only solution.
“The mistrust was not created by Black physicians. It was structural racism and systemic racism within a health care system that created that mistrust, not Black physicians, but by non-Black physicians,” he said.
Smitherman pointed out that issues such as where the vaccine is distributed, the times of day it’s offered, and the method for scheduling a vaccine appointment are all potential complications for the average Detroiter. He said figuring out solutions is all about having a diverse group of decision-makers at the table.
“If you aren't having people of color represented in your real strategy setting and planning for vaccine distribution, we're not going to get where we need to get,” he said.
This story was done in partnership with Bridge Detroit. How do you feel about racial disparities in healthcare? Let us know your thoughts on Twitter @BridgeDet313, and don’t forget to subscribe for FREE to get more content about your city.