Book Review by Dr. Brenda M. Greene

Legacy: A Black Physician Reckons with Racism in Medicine

By Uché Blackstock, MD Viking, 278.

“Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.” Harriet Washington, Medical Apartheid

Dr. Uché Blackstock’s Legacy: A Black Physician Reckons with Racism in Medicine (Viking, 2024) is a chilling reminder of the inequities faced by many Black and Brown people in the healthcare system. Blackstock chronicles her journey as a Harvard Medical student, Emergency Room Physician, Faculty Director for Recruitment, Retention, and Inclusion in the Office of Diversity Affairs at the NYU School of Medicine, Founder and CEO of Advancing Health Equity (AHM), and a strong advocate for addressing health disparities among Black and Brown people due to systemic and the institutionalized racism. Her memoir pays tribute to her mother, Dr. Dale Blackstock as well as her twin sister, Dr. Oni Blackstock. Collectively, the family represents a legacy. They are the first Black mother-daughter medical doctors to graduate from Harvard Medical School.

Through her journey, Dr. Blackstock comes face to face with the stark realization that the healthcare system is represented by two separate and unequal worlds. The words of her late mother, Dr. Dale Blackstock,  who wrote an essay in a medical journal about the experiences of women in education  reveal that racism more than sexism affected her career and practice as a physician.  Dr. Dale Blackstock writes:

“In looking back, I believe that many of my negative experiences were as a result of race, not sexism . . . . This is no to minimize the sluggishness of women’s progress in medicine, but in this society, race is such a major factor in our actions and policy making that not to acknowledge it is unrealistic and naïve.”  It took 

Dr. Uché Blackstock years to understand fully what her mother had endured. 

Readers will come away from Dr. Blackstock’s memoir with a realization of the depth of the inequities in the health care system. A major issue is the lack of Black doctors. Dr. Blackstock notes that the number of physicians who identify as Black in the United States is 5.4:  2.6 Black men and 2.8 Black women. The rationale for this inequity can be traced back to the Flexner Report in 1910. Black medical schools had begun to spread in the South during Reconstruction; however when the findings from the Flexner Report, a landmark study commissioned by the Carnegie Foundation were disseminated, the growth in the number of Black medical schools drastically declined.  All but two Black medical schools were forced to close.  The report used the John Hopkins Medical School in Baltimore to set standards for medical schools, thus forcing the closure of those medical schools that lacked the resources or endowments to maintain these standards. Dr. Blackstock posits that if Black medical schools had been allowed to remain open after the Flexner Report, they would have educated between 

25, 000 and 35,000 physicians. 

Dr. Blackstock cites numerous examples of the inequities in health care throughout the memoir.  The trauma of poverty; the lack of affordable housing and a quality education; and  limited employment opportunities are all social and structural issues that negatively impact Black residents throughout New York City and throughout the country. One major factor is de facto segregation in neighborhoods as a result of racist federal policies that redline certain neighborhoods. In her words, “zip codes are a much bigger determinant of health outcomes than your own DNA.”  In the chapter, “A Tale of Two Emergency Rooms,”  Dr. Blackstock provides examples of the differences in the healthcare provided to patients who were emergency room patients at NYU and those who were emergency room patients at Bellevue.  She makes it very clear that patients’ healthcare is based on their income and the resources available at the hospital. 

Memoirs provide insights, reflections, and opinions of the memoirist and reflect their growth as well as universal messages about the human experience.  The memoirist tells a story  and contributes to questions that are larger than the individual narrating the story. Like the fiction writer, the memoirist provides details that cause readers to empathize with the characters in the memoir and/or with the situation. Dr. Blackstock’s memoir engages readers and helps them to understand and deepen their knowledge about the complexity of health care disparities. Readers may find that they are angry and frustrated. The stories are moving. In addition to providing her observations about the health care system, Dr. Blackstock reflects on mothering, women in leadership, coping with death and grief, mental health, and self-care. Her book contributes to the scholarship and research on health inequities for women and is a good companion piece to  the  Harriet Washington’s award-winning Medical Apartheid: The Dark History of Medical Experimentation in Black America from Colonial Times to the Present (Doubleday, 2007) and Linda Villarosa’s award-winning The Hidden Toll of Racism on American Lives and on the Health of Our Nation ( Anchor, 2023).  

Legacy: A Black Physician Reckons with Racism in Medicine  is a reminder that we must be diligent about self-care and we have a responsibility to monitor what is happening regarding healthcare inequities in Black communities. As I read it, I could relate to the experiences of 

Dr. Blackstock from my perspective as a Black woman, a mother, and an academic in leadership. Prof. Linda Villarosa’s words underscore the significance of this memoir. 

“The something that is making Black Americans sicker is not race per se, or the lack of money, education, information, and access to health services that can be tied to being Black in America. It is also not genes or something inherently wrong or inferior about the Black body. The something is racism.” By Linda Villarosa, Under the Skin: The Hidden Toll of Racism on American Lives

Dr. Brenda M. Greene is Professor of English, Founder and Executive Director of the Center for Black Literature, and Senior Special Assistant to the Provost at Medgar Evers College, CUNY. For more information, visit https://www.drbrendamgreene.com