February is Black History Month, and I want to use this space to talk about something that doesn't get nearly enough honest attention in healthcare: the significant, well-documented, and largely preventable health disparities that Black Americans face across nearly every major category of health.
This is not a comfortable topic. It involves confronting a medical system that has, at various points in history, actively harmed Black patients, dismissed their pain, experimented on their bodies without consent, and continues to deliver measurably worse care to this day. I think it's important to say that clearly rather than soften it into vague language about "inequities" that doesn't name what actually happened and what's still happening.
At the same time, I want this post to be useful. So let's talk about the history, the specific health areas where disparities are most stark, and what better care actually looks like.
Why Distrust of the Medical System Is Rational
When Black patients express distrust of the healthcare system, that distrust is not irrational or a barrier to be overcome with better patient education. It is a rational response to a documented history of medical abuse and neglect.
The Tuskegee Syphilis Study is the most widely known example: from 1932 to 1972, the US Public Health Service deliberately withheld treatment from nearly 400 Black men with syphilis to study the progression of untreated disease. The men were never told their actual diagnosis or that effective treatment existed. The study continued for 40 years.
Less discussed but equally important: J. Marion Sims, often called the "father of modern gynecology," developed his surgical techniques by operating on enslaved Black women without anesthesia, operating on the same women repeatedly, under the prevailing belief that Black people felt less pain than white people. That belief, that Black patients have a higher pain tolerance, has been shown in research to persist among medical students and residents today, and it directly affects pain treatment decisions.
Henrietta Lacks, a Black woman from Baltimore, had her cancer cells harvested without her knowledge or consent in 1951. Those cells, known as HeLa cells, became one of the most important tools in modern medical research and have generated billions of dollars in revenue. Her family received nothing and was not even told for decades.
These are not ancient history. They are within living memory, and their legacy shapes how Black Americans experience and navigate healthcare today. A patient who is cautious about trusting a provider or a system that has demonstrably harmed people who look like them is being reasonable, not difficult.
Cardiovascular Disease and Hypertension
Black Americans have the highest rates of hypertension of any racial or ethnic group in the United States, and they develop it earlier, at higher severity, and with worse outcomes than white Americans. Hypertension is a major driver of heart disease, stroke, and kidney failure, all of which are also disproportionately prevalent in Black communities.
The causes are multilayered. Chronic stress from racism and systemic inequality, a phenomenon researchers call "weathering," has measurable physiological effects on the cardiovascular system over time. Neighborhood-level factors like food access, green space, air quality, and exposure to violence contribute significantly. Genetic factors, including higher rates of salt sensitivity in Black Americans, play a role. And inadequate access to consistent primary care means that hypertension often goes undetected or poorly managed until it causes a crisis.
Diabetes and Metabolic Health
Black Americans are significantly more likely to be diagnosed with type 2 diabetes than white Americans, more likely to experience serious complications including kidney disease, amputations, and blindness, and more likely to die from diabetes-related causes. Much of this comes back to the same upstream factors: chronic stress, food environment, healthcare access, and the compounding effects of systemic inequality on overall metabolic health.
What's particularly frustrating is that diabetes is one of the most manageable chronic conditions when someone has consistent, proactive primary care, and in many cases it's reversible, particularly when caught early and addressed with real lifestyle support. The gap in outcomes isn't primarily about the biology of diabetes. It's about who gets the kind of care that actually manages it well.
Maternal Mortality
The maternal mortality disparity in the United States is stark and shameful. Black women are two to three times more likely to die from pregnancy-related causes than white women, and this disparity holds across income and education levels. A Black woman with a college degree is more likely to die in childbirth than a white woman who never finished high school.
Research points clearly to provider bias, dismissal of Black women's reported symptoms and pain, and systemic failures in recognizing and responding to complications in Black patients. Serena Williams has spoken publicly about having to forcefully advocate for herself after giving birth, insisting that her shortness of breath be taken seriously despite being initially dismissed, and ultimately being diagnosed with a pulmonary embolism. Her experience is not an outlier. It is a pattern.
Cancer Screening Disparities
Black Americans have higher mortality rates from several common cancers, including breast, colon, and cervical cancer, despite not always having higher incidence rates. The disparity is largely driven by later-stage diagnosis, which comes back to screening access, follow-up care, and again, a system that has historically made Black patients less likely to seek or receive preventive care.
Black women are more likely to be diagnosed with triple-negative breast cancer, an aggressive subtype with fewer targeted treatment options and worse prognosis. They are also more likely to be diagnosed at a later stage. Earlier, more consistent screening and a provider relationship built on trust can actually change outcomes here.
Chronic Pain and Under-Treatment
The research on this is disturbing and consistent. Black patients are undertreated for pain compared to white patients across clinical settings, including emergency departments, postoperative care, and cancer pain management. Studies have shown that Black children with appendicitis are less likely to receive pain medication than white children with the same diagnosis. The false belief that Black people have higher pain tolerance, a myth rooted in the same pseudoscientific racism that justified slavery-era medical experimentation, continues to influence clinical decision-making in demonstrable ways.
Undertreated pain is not just uncomfortable. It leads to worse outcomes, delayed diagnosis, and patients who stop seeking care because they've learned they won't be believed or helped.
Lupus and Autoimmune Conditions
Systemic lupus erythematosus affects Black women at significantly higher rates than white women, and with more severe manifestations. Black patients with lupus are more likely to develop serious kidney complications, experience more frequent disease flares, and have worse long-term outcomes. The reasons involve a combination of genetic susceptibility, environmental triggers, and again, disparities in access to the kind of consistent specialist care that lupus requires.
Autoimmune conditions in general are an area where diagnostic delays are common for everyone, but particularly for Black patients whose symptoms may be attributed to other causes or dismissed entirely before the correct diagnosis is reached.
HIV/AIDS Disparities
Black Americans represent about 13% of the US population but account for approximately 40% of new HIV diagnoses. Black gay and bisexual men are particularly affected, as are Black women, who account for a disproportionate share of new diagnoses among women. These disparities are driven by a complex intersection of stigma, healthcare access, mistrust of the medical system, and the concentrated effects of poverty and incarceration in Black communities.
Effective HIV prevention and treatment exists. PrEP, which prevents HIV transmission in people who are HIV-negative, is dramatically underutilized among Black Americans compared to white Americans, even as need is higher. It's worth knowing that PrEP is widely accessible regardless of insurance status through programs like Ready, Set, PrEP, which provides it at no cost to those who qualify, and many clinics offer it on a sliding scale. The barriers to PrEP access are real, but cost and coverage don't have to be among them. Closing the utilization gap requires providers who are culturally competent, trustworthy, and willing to have the conversation proactively.
Mental Health Disparities
Black Americans are less likely to receive mental health treatment than white Americans, more likely to receive lower quality care when they do, and face unique stressors related to racism, discrimination, and racial trauma that are often not adequately addressed in clinical settings. At the same time, there is significant cultural stigma around mental health in some Black communities, rooted in a history of having "mental illness" used as a tool of oppression, including the now-discredited diagnosis of "drapetomania," a supposed mental illness used in the 19th century to explain why enslaved people wanted to escape.
Culturally competent mental health care that understands this history and these specific stressors is not optional. It's what actually helps.
What Better Care Looks Like
None of these disparities are inevitable. They are the product of specific historical and systemic forces, and they can be addressed through specific changes in how care is delivered.
Relationship-based primary care is one of the most powerful tools available. When a patient has a provider they trust, who knows their history, who has time to actually listen, who takes their symptoms seriously, and who follows up consistently, outcomes improve dramatically. That's not a radical idea. It's just good medicine, and it's what DPC is built around.
Staywell Health is an explicitly inclusive and affirming practice. If you or someone you care about has experienced dismissal, mistrust, or inadequate care in traditional healthcare settings, I want you to know that this is a space where that history is understood and where you will be heard.
If you want to learn more or get involved, the National Medical Association is the oldest and largest organization representing Black physicians in the United States, with a long history of advocating for Black health equity. It's a good place to start.
Black History Month is a good time to name these things clearly. But the work of addressing them doesn't stop in February. It's ongoing, it's urgent, and it matters.
Daniel Corbin, DNP, APRN, FNP-C
Board-certified Family Nurse Practitioner and founder of Staywell Health, a direct primary care practice in Raleigh, NC specializing in whole-person care, LGBTQ+ health, and lifestyle medicine.