Uché Blackstock, M.D., on the conflicts and challenges of being a first

 

When Uché Blackstock and her twin sister Oni graduated from Harvard Medical School in 2005, they became the school’s first Black mother-daughter legacy—their mother, a practicing physician, had received her medical degree three decades before. In her new book, Legacy: A Black Physician Reckons with Racism in Medicine, Blackstock delves deep into the systemic inequities in health care while paying homage to her late mother. I sat down to talk with her about her new book, being a “first,” and her own legacy.       

Rebecca Carroll: The subtitle of your book takes on this idea of “reckoning” around racism, a phrase that has been rampant in public discourse over the past couple of years. What has “reckoning” meant for you? 

Uché Blackstock: The subtitle is really a reflection of my own journey from child to medical student to practicing physician. It probably started in my residency, but more so when I was caring for my patients and also dealing with toxic, sexist, and racist environments—and seeing how, as patients and physicians, we get it from both sides. 

And then, in 2020, the reckoning that we saw during [that time] gave me an opportunity to delve a little bit deeper into how, despite advances in innovation, technology, and research, we are having worsening health inequities in our communities. Not better. 

RC: There’s a lot of staggering data and evidence about the impact of racism on health outcomes that you’ve discovered in your research. What was some of the most surprising? 

UB: Black infants are more likely to die in their first year of life now than white infants, than 15 years before the end of slavery. So while the overall infant mortality rates have improved because of childbirth techniques, sanitation, [and] infection control techniques, Black babies are now more than twice as likely than white babies to die in their first year of life.

We know that there was a financial interest in keeping those babies alive during slavery, but we also know now what racism does to our bodies. When Black birthing people are pregnant, that stress actually gets transmitted to our babies. There’s something called epigenetics—it’s how stress influences gene expression. There’s some data that even shows that the stress that enslaved Black women endured has been transferred across generations, and that impacts the infant mortality of Black babies today.

RC: You mentioned unlearning things you were taught during your formal education. How do you do that?

UB: It shouldn’t be a process that we have to take upon ourselves. One thing I talk about in the book is a call to action: Medical schools need to think about educating future physicians to adequately and equitably care for Black patients in a world full of anti-Blackness. They have to be very intentional about what the curriculum looks like. It can’t just be one training or one workshop.

RC: You write in the book about how your mother always made sure that you and your sister felt good about your Blackness and how you were surrounded by representation, such as Black art and Black books. Can you talk about how that may have shielded you throughout your life?

UB: I grew up thinking that most physicians were Black and that most of them were Black women—my mother, my pediatrician, we had several Black doctors. And my mother was the first Black woman in New York State to get her MD; she [became] the president of the Dr. Susan Smith McKinney Steward Society, [and she] would take me and my sister to these meetings with her. And so, for a very long time, I saw that as a very tangible possibility for me. It really wasn’t until I got to college and was pre-med that I looked around and realized that there were not that many of us. And then, in medical school, there really weren’t that many of us. And then looking for my own physicians, [and] having a hard time finding people who look like me, [I recognized] that my experience growing up was such a rarity—it was a blessing, but also a rarity.

You would think that would have protected me from feeling inadequate or out of place. [But] later in my career in academic medicine, I literally got to a point where I felt undervalued and underappreciated. This is what predominantly white institutions do to us.

RC: We place a lot of emphasis on being a “first”—especially being a Black woman first—and it’s always framed as this amazing accolade for us instead of a failure on the part of the system. As a first yourself, what does it feel like to hold that moniker?

UB: I say it in a conflicted way. I say it proudly because I’m very proud of my mother and all that she accomplished…knowing that it wasn’t easy for her. But also, there were so many other brilliant Black children like her growing up in central Brooklyn who should have been at Harvard Medical School with her. My sister and I graduated in 2005 and became the first Black mother-daughter legacy at Harvard Medical School. That’s ridiculous. So that speaks to the work that these institutions that are so highly respected still have to do. 

RC: What are your thoughts about what happened to Claudine Gay?

UB: I’m devastated as a Black woman, [and] as an alumni of Harvard. What happens—and we see this often as Black women—is that we are put in these positions of power, and then we are not empowered. We’re not given the support that we need. I was actually nominated to be the Chief Marshall for my class reunion this May—my 25th reunion at Harvard. But I took my name off the ballot. I emailed them and said, “I don’t want to be considered for this because I’m very disappointed in the lack of support that President Gay received from Harvard.” You cannot put us in these positions and then let us flail on our own. 

RC: It speaks so succinctly to the way that we, as Black women, have had to exist according to tropes, but when we are put into these positions of power and then try to function in a way that is anti-trope, it becomes very clear that that’s not what we were anointed to do.

UB: Right. Exactly. This is why I left academic medicine. I was handpicked for this DEI role in the Office of Diversity Affairs at NYU. I was so excited. I was like, finally, I’m going to do the work that I want to do. And then come to find out it’s a figurehead position. And talk about that whole pet-to-threat [phenomenon], where they bring you in because you’ve done all these wonderful things, and then you start making these observations about the inequities in the system, and you become a threat. And then they isolate you and make things either so untenable for you that you want to leave, or they ask you to leave. This happens to Black women all the time.

RC: I think among the most frustrating things for those of us who interrogate systemic racism is identifying where there are improvements. Where do you see advancements?

UB: In the book, I talk about this birthing center, the Roots Birthing Center in Northern Minneapolis. And Northern Minneapolis has the worst racial inequities in health in every other area. This birthing center was founded by a Black midwife with the mission of serving Black birthing people with respect and dignity. That is just so simple. But what they’ve seen in some of the data that’s come out from there is that they have had a reduction in pregnancy complications compared to the Minneapolis average.

We need to look at models within our communities that actually are working. How can we support them? How can we give them more funding? We see that redlined neighborhoods correlate with the worst health outcomes. And so on a neighborhood level, if we can look at what we call the social determinants of health—education, housing, employment, and access to healthy foods, just like creating an environment in Black communities where Black people can thrive—that actually makes a difference.

RC: And also just being in community with each other.

UB: That’s a great point.

RC: And now that you are a mother, how does it feel to be passing on your own legacy? 

UB: My kids are seven and nine. I have two boys. Even though they’re not really clear about what I do, they know that I’m trying to make life healthier for Black people. I would just love for my children to be able to live long, full lives, and if I can help contribute to that in some way, that makes me happy.