By Alan Dow, M.D., M.S.H.A.
Recently, I joined a couple hundred health care practitioners, faculty, and students from VCU who gathered as part of White Coats for Black Lives. This event was one of many nationwide during which health care practitioners advocated for addressing the impact of systemic racism on our patients.
For eight minutes and forty-six seconds, we knelt in honor of George Floyd in the courtyard of the Egyptian building on the VCU Health Science campus. As I knelt, I thought about this place that has been the center of medicine in Richmond for over two hundred years. This ground has borne witness to our deeply embedded history of racial injustice.
Near this spot in the 1800s, medical students dissected bodies stolen from graves. Fifty-three of these bodies were dumped in a well until they were rediscovered in 1994 during the construction of a new building. Through DNA testing, we know most of these individuals were Black. Nine were children.
During their lives, most of these people were undoubtedly treated as property. After their deaths, their bodies were desecrated without consent. Though we will never know their names or specific life stories, this history must have shaped the perspectives of their descendants. My institution has worked with community members to memorialize this story through the East Marshall Street Well Project, but I am not sure we can fully atone for this injustice.
In the 1920s on the same spot, the Medical College of Virginia opened St. Philip Hospital and St. Philip School of Nursing. These “separate but equal” institutions cared for the Black community and trained Black nurses. Neighboring buildings, connected by underground tunnels, served the White community.
But, of course, these institutions were not equal. MCV School of Nursing was integrated, and Black students began choosing MCV instead of St. Philip School of Nursing. The school closed in 1962 because of declining enrollment. During the same period, MCV integrated its hospitals and, in 1957, allowed Black physicians to have admitting privileges. St. Philip Hospital became MCV East Hospital before closing several years later.
This history is recent enough that I have seen its impact. Sometimes, when I ask older Black patients where they are, they answer St. Philip. A number of these patients seem puzzled to have a White doctor caring for them. Although the only physical remnant of St. Philip is a preserved entranceway, the story of this institution is still inscribed in my patients.
We see this history demonstrated in health outcomes, too. Black individuals have a life expectancy four years shorter than White individuals. This difference is not explained by biology but rather by factors like the neighborhood where you live. In a span of five miles in our city, a child born in a low-income, predominantly Black neighborhood has a 10-year shorter life expectancy than a child born in a higher-income, predominantly White neighborhood.
This is the legacy of segregation and slavery expressed in present-day systemic racism. These health inequities are the outcome of differences in funding for education, economic opportunities and access to justice across our region. While most of us have been outraged by recent videos of police brutality, we should be equally outraged by the embedded influences of systemic racism.
So, as I knelt, I thought about the roots of health inequities concealed in the ground below me and in the communities around me. Tackling these challenges will take a tremendous amount of will by all of us to reform health care, policing, education, housing and employment. We need to close gaps between races on pre-K education, high school graduation, income attainment and eviction rates. And, we need to stop losing a disproportionate number of young Black people to murder. All of these are social determinants of health that drive the difference in life expectancy.
Frankly, taking down statues is just the first step.
Kneeling recommitted me to working for equity, and l pray that we have strength and moral clarity to achieve justice.
Alan Dow, M.D., MSHA, is a professor of internal medicine at Virginia Commonwealth University School of Medicine and a general internist at VCU Health. He can be reached at [email protected]