Leveraging Trust to Advance Science, Engineering, and Medicine in the Black Community: Proceedings of a Workshop (2025)
Chapter: 1 Introduction
1
Introduction
Surveys have shown that trust in institutions is declining in the United States and in other countries around the world (e.g., Pew, 2022; United Nations, 2021). For many Black Americans, trust in science, engineering, and medicine (SEM) institutions is affected by historic and current contexts. The decline in institutional trust has had significant consequences for Black Americans, including exacerbating health and economic inequities for this population. The COVID-19 pandemic provides an example of the negative consequences of mistrust in medical institutions. As a result of this mistrust, Black communities were more hesitant to receive the COVID-19 vaccine, which put an already vulnerable group at even higher risk of contracting or dying from the virus. Many SEM professionals recognize the importance of building trust with the Black community, and are looking for sustainable and effective ways to earn and nurture that trust.
As a step in this process, the Roundtable on Black Men and Black Women in Science, Engineering, and Medicine at the National Academies of Sciences, Engineering, and Medicine (the National Academies) convened a public workshop to examine local, national, and global strategies used by groups such as the Black Church to build institutional trust, in order to advance SEM issues within Black communities. The workshop, held December 14–15, 2022, was structured to identify organizations that have demonstrated success in building and maintaining trust with Black communities, highlight best practices for SEM professionals to develop sustainable
and effective relationships with the Black community, and examine how communication with Black communities influences trust and acceptance of SEM institutions.
CONTEXT FOR THE WORKSHOP
Welcome from the Roundtable Chair
Cato Laurencin, M.D., Ph.D. (University of Connecticut), welcomed participants and provided background about the Roundtable. In 2017, he and colleague Marsha Murray, M.S., published a paper on the dearth of Black men in medicine (Laurencin and Murray, 2017). They drew on data from the Association of American Medical Colleges (AAMC) that found that only 37.8 percent of Black people applying to medical schools were men and, more generally, that “despite some gains over the last few decades, African Americans, Latinos, and Native Americans remain underrepresented in the health profession relative to their proportion in the U.S. population.” With interest by the National Academy of Medicine (NAM) and other organizations in exploring this issue, Dr. Laurencin was asked to chair a planning committee to conduct a workshop on African American males in the medical profession. The proceedings from that workshop (NASEM, 2018) became a call to arms to address the need to increase the number of Black men in medicine. Substantial outcomes included recognition by the AAMC that the underrepresentation of Black males in particular must be part of the discussion about diversity in medicine. The Congressional Black Caucus was briefed and showed great interest. Members of NAM and the W. Montague Cobb Institute met with editors of U.S. News and World Report to discuss Blacks in medicine and the inclusion of racial and ethnic diversity as a factor in the publication’s influential ranking of schools. Although diversity has not been included in the rankings, Dr. Laurencin noted it did publish a ranking of the top 10 majority medical schools in the country by percentage of their Black enrollment.
Dr. Laurencin noted that discussions with leaders from the Aetna Foundation, Robert Wood Johnson Foundation, and Burroughs Wellcome Fund resulted in more permanent support for this and related issues, leading to the creation of the National Academies’ Roundtable on Black Men and Black Women in Science, Engineering, and Medicine. A steering committee
was formed to decide how the Roundtable would operate, including the formation of action groups as the Roundtable’s backbone.1
The action groups foster information sharing and development of an evidence-based approach, engage with key stakeholders and the broader community, and design and conduct activities for meaningful change. They are as follows: (1) Racism and (Conscious and Unconscious) Bias, (2) Financing, (3) Stakeholder Engagement, (4) Mentorship and Advising, (5) Pre-K to Graduate Education, (6) Health Equities and Disparities, and (7) Systematic Change to Overcome Psychological Barriers to Success. The first public workshop, in April 2020, was on the effects of racism and bias on Black people pursuing SEM careers (NASEM, 2020). Each action group has organized at least one symposium or workshop since then, with articles and proceedings available or in the process of being published for each.2 In addition, a Living Legends Conversation Series has been initiated, beginning with conversations with Louis Sullivan, M.D., and Shirley Malcom, Ph.D., in February 2022. Both leaders shared their experience, philosophies, and visions for the future.3
Dr. Laurencin reviewed the current workshop’s statement of task (see Box 1-1). He thanked the planning committee chairs and members, moderators, presenters, and panelists, as well as National Academies staff and the Roundtable funders.
Opening Remarks from the National Academies
Victor Dzau, M.D. (National Academy of Medicine), underscored the milestones of the Roundtable since its formation, starting with its initial vision. He reiterated his support for the Roundtable’s mission and, specifically, this workshop’s examination of trust in the context of science, engineering, and medicine.
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1 For more information and the committee roster, see https://www.nationalacademies.org/our-work/roundtable-on-black-men-and-black-women-in-science-engineering-and-medicine.
2 To access the publications, see https://www.nationalacademies.org/our-work/roundtable-on-black-men-and-black-women-in-science-engineering-and-medicine/publications.
3 To view the videos, see https://www.nationalacademies.org/event/02-22-2022/the-roundtable-on-black-men-and-black-women-in-science-engineering-and-medicine-in-conversation-with-living-legend-dr-louis-sullivan and https://www.nationalacademies.org/event/02-24-2022/the-roundtable-on-black-men-and-black-women-in-science-engineering-and-medicine-in-conversation-with-living-legend-dr-shirley-malcom.
BOX 1-1
Workshop Statement of Task
A planning committee of the National Academies of Sciences, Engineering, and Medicine will organize a day-and-a-half public workshop to examine local, national, and global strategies used by community groups such as the Black Church across the Black diaspora to build trust and advance issues in science, engineering, and medicine (SEM) within Black communities. The workshop will provide a historical overview demonstrating the degradation of the trust of Black communities in scientific and medical institutions, leading to adverse health outcomes and environmental inequalities, spotlight practices and policies with demonstrated success in building trust within Black communities, and identify actions to build trusting relationships to address emerging public health and environmental issues impacting Black communities.
Major objectives of the workshop include the following:
- Identify organizations that have demonstrated success in building and maintaining trust with Black communities to address public health and environmental concerns.
- Highlight best practices for science, engineering, public health, and medicine professionals to develop sustainable and effective relationships with Black communities.
- Examine how effective and noneffective communication with Black communities influences trust and acceptance of SEM and how SEM professionals and organizations can improve perception and interactions.
Following the workshop, a rapporteur-authored workshop proceedings will be published.
The issue of trust, or lack of trust, of science by many in the Black community is well known, Dr. Dzau said, and has resulted from many years of experiences. He pointed to a Pew Research Center (2022) survey that found that most Black Americans are familiar with the history of research abuses on the Black community, including the experiments held at the Tuskegee Institute on Black men, the experiments of gynecologist Marion Sims on Black enslaved women and children, and the use of the cells of Henrietta Lacks without her or her family’s consent, compensation, or knowledge.
“Compounding these issues of misconduct are the situations of everyday racism against Black people within the health system,” he continued. He referred participants to a 2020 New York Times article that quoted Roundtable and NAM member Evelynn Hammonds, Ph.D., who said, “There never has been any period in United States history when the health of Blacks was equal to the health of Whites. Disparity is built into our system” (Frakt, 2020). Biases result in substandard care, ignored pains and symptoms, misdiagnoses, and withheld treatment for Black Americans. Blacks are more likely to live in communities with more pollution, noise, emissions, and other environmental concerns that are connected with health problems such as asthma and cancers. The pandemic further highlighted the mistrust of the medical system, as shown in vaccine acceptance, Dr. Dzau said.
Related to COVID-19, he noted that NAM members participated in hundreds of events to educate and share experiences about vaccines. Among other efforts, a video made by Black NAM members about the importance of the vaccine has been seen more than 250,000 times on YouTube.4 Dr. Dzau also called attention to the National Academies’ Societal Experts Action Network (SEAN), which was formed in response to COVID-19 but now is working more broadly.5 Among the lessons articulated by SEAN experts in the social, behavioral, and economic sciences are to focus on the delivery of a message, not just the content; build relationships; meet people where they are; partner with community organizations; collaborate with local champions; engage community ownership; and be transparent and clear.
Dr. Dzau concluded by referring to a commentary in Science by Reed V. Tuckson (2020) entitled “The Disease of Distrust.” COVID-19 highlighted a truth that already existed, Dr. Tuckson wrote, and he called for building relationships between patients of color and health professionals in all parts of the healthcare system (see also Chapter 9 for the workshop presentation by Dr. Tuckson). “These are not simple tasks, but they are necessary to achieve the mission that we have all set out to do, to improve the health for all,” Dr. Dzau said. He expressed the hope that the workshop would be the steppingstone to many important insights.
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4 The video is available at https://www.youtube.com/watch?v=_2qQxFrdNSw.
5 For more information, see https://nap.nationalacademies.org/resource/25826/interactive/.
Remarks by the Co-Chairs
Workshop co-chair Randall Morgan, M.D., M.B.A. (W. Montague Cobb/National Medical Association), reflected on the workshop statement of task (see Box 1-1). He noted as the planning committee developed the workshop, certain truths became clear, as highlighted by Dr. Dzau. First, he said, in Black communities across the nation, large or small, rural or urban, mistrust and misunderstanding are pervasive. Second, the creation of an environment that exhibits trust is very difficult. Third, the implementation of new and old techniques requires trust. Finally, the history of health care in America, dating back to 1619, gives little evidence that Black and Brown people should trust the process or be comfortable with the results. He thanked his fellow members of the Health Equities and Disparities Action Group, National Academies staff, and presenters.
Workshop co-chair Cedric Bright, M.D. (East Carolina University), provided participants with an overview of the workshop agenda.
ORGANIZATION OF THIS PROCEEDINGS
The remainder of this publication summarizes the presentations and discussions from the workshop. The workshop began with a keynote address by M. Roy Wilson, M.D., president of Wayne State University, which is summarized in Chapter 2. Chapter 3 takes a historical look to explain the lack of trust, while Chapter 4 delves into the causes and implications of miscommunication and mistrust. Representatives from federal agencies share information and perspectives in Chapters 5 and 6. Chapter 7 extends beyond traditional health issues to emerging public health and environmental justice concerns. Chapters 8 and 9 highlight two sectors that can help bridge trust between SEM professionals and the Black community: the Black Church (Chapter 8) and nonprofits (Chapter 9). Brief concluding remarks are included in Chapter 10. The workshop agenda and biographical sketches of the speakers can be found in the appendixes.
In accordance with the policies of the National Academies, workshop participants did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues discussed by the speakers and workshop participants. In addition, the planning committee’s role was limited to planning the workshop. This proceedings was prepared by a rapporteur as a factual summary of what occurred at the workshop.
REFERENCES
Frakt, A. 2020. Bad medicine: The harm that comes from racism. The New York Times, January 13; updated July 8, 2020. https://www.nytimes.com/2020/01/13/upshot/bad-medicine-the-harm-that-comes-from-racism.html.
Laurencin, C., and M. Murray. 2017. An American crisis: The lack of Black men in medicine. Journal of Racial and Ethnic Disparities 4: 317–321.
NASEM (National Academies of Sciences, Engineering, and Medicine). 2018. An American Crisis: The Growing Absence of Black Men in Medicine and Science: Proceedings of a Joint Workshop. Washington, DC: The National Academies Press. https://www.nap.edu/catalog/25130/an-american-crisis-the-growing-absence-of-black-men-in.
NASEM. 2020. The Impacts of Racism on Black People Pursuing Careers in Science, Engineering, and Medicine. Washington, DC: The National Academies Press. https://www.nationalacademies.org/our-work/the-impacts-of-racism-and-bias-on-black-people-pursuing-careers-in-science-engineering-and-medicine-a-workshop.
Pew Research Center. 2022. Black Americans’ Views of and Engagement with Science. https://www.pewresearch.org/science/2022/04/07/black-americans-views-of-and-engagement-with-science/.
Tuckson, R. V. 2020. The disease of distrust. Science 370I(6418): 745.
United Nations. 2021. Trust in Public Institutions: Trends and Implications for Economic Security. https://doi.org/10.18356/27081990-108.
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