Terri Laws: Making our health care system more equitable is a matter of faith
Given the history of the racial inequities in U.S. health care, concerns about the coronavirus vaccine in the Black community are understandable, says the author. iStock / FG Trade
The coronavirus pandemic has made clear the inequities in our health care system, including Black underrepresentation in clinical trials, says a researcher of unequal access to innovative treatments.
Terri Laws recalls the moment she first learned that African Americans represented 14% of her state’s population but 40% of its COVID-19 deaths.
Even as a professional who studies health care inequities, she was shocked.
“I was driving on the highway, and I shared those numbers with a friend who lives in another state,” she said. “I could barely get it out, because I couldn’t breathe. I couldn’t breathe. I had no idea it was going to be that bad.”
Laws, a professor at the University of Michigan-Dearborn, started learning about the health care system as a child when her mother experienced a number of hospitalizations. Her mother’s self-advocacy -- at a time when self-advocacy was not common -- served as a lesson to Laws.
As an adult, Laws began to work in hospitals, where she saw both the good work and the troubling issues in U.S. health care. Later, when she discerned a call to ministry and went to seminary, she connected what she was reading with her life experience.
As a researcher, she has focused on the gaps in African Americans’ access to elite and innovative treatments, including their underrepresentation in clinical trials. Laws, who is an assistant professor of health and human services and of African and African American studies at UM-Dearborn, earned her Ph.D. at Rice University.
Laws spoke with Faith & Leadership’s Sally Hicks about the way in which the COVID-19 pandemic has highlighted the inequities in our health care system. The following is an edited transcript.
Faith & Leadership: Why focus on innovative health care or clinical trials as opposed to access to primary care or something like that?
Terri Laws: It isn’t an either/or. I am interested in how African Americans can gain access to treatments that offer opportunities for better health outcomes. In particular I'm interested in phase 3 therapeutic clinical trials as a potential strategy to reduce health inequity. Therapeutic trials move beyond standard treatments, which for African Americans, can be some of the harshest treatments and worst outcomes.
There’s a really famous text that was developed by a physician group, some of the smartest physicians in the country, called “Unequal Treatment,” and it’s really clear that African Americans are not in the most elite of treatment networks.
Part of that came out of my anecdotal experience as well. The hospital where I worked for all those years was a research facility, but while I was in seminary, I worked at a [predominantly white] church. I would say it’s a fairly well-off church.
I was an administrative assistant supporting the prayer ministry, and the members were coming in to participate in prayer, but they were then jetting off to clinical trials here and there.
It was very clear that prayer with resources was an answer.
I was already thinking about those kinds of things. So then this new thing called coronavirus shows up.
It became clear to everybody what those of us who [study it] have been talking about -- this idea of needing to have African Americans represented in clinical trials and other innovative treatments -- what we’ve been talking about for a few decades.
F&L: What do you see as the connection between the church and addressing health inequities?
TL: I do think that, as a nation, we have got to make some decisions about how we actually want to provide health care as a “greatest good,” as one might say in philosophy.
But also in a Christian sense, we understand that we essentially leave some people impoverished when it comes to health care. A question to ourselves must be, “Do we intend to do anything about it?”
I certainly advocate that -- as part of my faith -- that we continue to work to change the health care system. I’m aware that we can do much better, but we can only do better when we care that more people have access to the health care system that we have.
F&L: As you look at the situation that we face now, what are the most important steps to remedy these disparities both in the illness and also in the vaccine delivery?
TL: We in the church are very good at the immediate. We’re very good at charity -- we can use the word “benevolence.” That’s a word we use in my church.
We are very good at benevolence. But we must also work to understand the intermediate and the long-term needs. I’m advocating on all of those levels. I’m advocating both, in doing segments like this. I’m trying to talk to as many audiences as possible.
I’ve done work in conversation about what we need to do in the Black church as well.
The whole conversation about hesitancy is extremely important to me. We cannot leave people alone to make these very difficult decisions when we’re talking about innovative treatments. To do so is to leave them suffering alone, and I’m unwilling to do that.
I talk about this as an idea because that’s what I do as an academic. But I’m talking about it as an idea also because I think it’s important to the practical lives of people. COVID has made that more clear.
Once we get past this COVID moment, what we cannot do is think that it is OK to go back to the inequitable health care system that we continue to have. We have to make a decision about how we’re going to improve equity.
That of course then also means economic equity, because that’s where some of the inequity comes from. We’ve got to find a way to provide health care for persons who are at the lowest wages in our country so that they won’t have to be afraid to take a vaccine that they’re afraid might take them out for a few days when they can’t afford to be off their jobs.
F&L: You’ve talked about Black Americans’ distrust of the vaccine and the ways in which that distrust is in fact rational. Say a little bit about that rational distrust.
TL: It’s rational given the 400-year history. Over 400 years, a relationship of trust has never been established. Medicine, law and religion have been three components of our society that have created these categories that we call “race” that we then turn around and misuse, and that creates the distrust.
As Christianity was being shared, it was not being shared only for the benefit of the persons who were receiving it. It was talked about in ways that intended to subjugate Black folks. This is part of the distrust, then, that also gets built into medical experimentation well beyond the Tuskegee Syphilis Study.
For example, John Brown was an enslaved man who later, in telling his own life story, talked about the medical experiments that were perpetrated upon him by a physician by the name of Dr. Hamilton for the benefit of [developing] treatments for sunstroke.
These things are not new. Distrust has a long history. The distrust is something that we have to decide to work on.
We have to decide, just like we have to decide that long term we want an equitable health care system. We have to decide that we want a relationship of trust, and that can only be built on relationship over the course of time.
There was a survey just a few years ago about [interracial friendships]. It found that the average white person has 1 Black friend [out of 100].
And so the question really is, Are they a friend? Have they ever been in your home? Have you gone to dinner with them? Do you let your kids play with their kids?
Trust is built in relationship. There’s no other way.
F&L: How can churches help build that trust?
TL: Initially, when we were here a year ago, there was some talk that Black people don’t get COVID, so there was misunderstanding in the beginning.
But I live in Detroit. That was not misunderstood here, because people started dying very quickly, and it was frightening. The numbers were horrific, and at that time the first set of numbers that got released was that African Americans are 14% of the state but were 40% of the deaths.
[Nationally,] we know the race of only about half the people who have gotten [one dose of] the vaccine. So we don’t really know how big our problem is right now. Of the half that we know about right now, in the last figures that I saw, 8% of the vaccines that have been put into arms have been in African Americans’, when African Americans are 13% of the population.
We have media reports of persons from well-off parts of town in Washington, D.C., for example, scooping up the appointments that are actually intended for persons in low-wealth communities.
These are things that are directly attributable to faith.
We can be teaching about whether or not it’s ethical -- and bioethicists are starting to put this information out -- whether or not it’s ethical to jump the line, whether or not it’s ethical to go to another part of town when the vaccine appointments have been actually intended for persons who are living in communities seeing greater death. All of these things are part of the Christian witness.
In terms of African American churches, again, there’s beginning to be reporting, and I know from my own anecdotal conversations, that African American pastors are very concerned. We understand the greater illness and the greater death.
African American churches are starting to become vaccination sites. Here in Detroit, they quickly -- the state and the city government -- made a decision to start vaccinations in African American churches, one on the east side, one on the west side.
Pastors have responded by allowing the churches and their parking lots to be testing sites so that the need has begun to be met or [help has] begun to be offered -- what the Black church has long been about at the benevolent level -- as well as beginning to have education programs.
F&L: Is there something I didn’t ask about that you’d like to add?
TL: Here’s the part that has to be clear: to focus on the lives that are most in need does not take away from anyone else.
The reality is if we don’t understand anything else from this past year, we absolutely must understand -- especially those of us who claim the Christian faith -- that this is an interconnected conversation. This is not about dividing people.
I think it’s no mistake that we have a racial justice movement at the same time that we have an opportunity to see how deeply and how broadly we absolutely must go [to improve the health care system].
It’s been more than unfortunate that we have been forced to see things in a new way. I grew up during a time of assimilation -- “Can’t we all just get along?” This is not that time.
This is a time for us to be clear about our goals, because this will not be easy.