Healthcare: Analysis of the Tuskegee Syphilis Study's Impact

This essay analyzes the infamous Tuskegee Syphilis Study, conducted by the United States Public Health Service from 1932 to 1972, which observed the natural progression of untreated syphilis in African American men without their informed consent. The study, conducted in Macon County, Alabama, withheld penicillin, even after it became a known treatment, leading to severe health consequences, including death and congenital syphilis in the participants' families. The essay argues that the Tuskegee study has profoundly damaged medical research by creating mistrust, especially among the African American population, leading to health disparities and a reluctance to seek medical care. It further explores the historical context of racial discrimination, cultural incompetence, and the need for government intervention, including policy changes, increased representation of African Americans in healthcare, and cultural competency training to rebuild trust and address health inequalities. The essay emphasizes the importance of addressing the legacy of the Tuskegee study to improve public health outcomes and ensure equitable healthcare access for all.

Running head: HEALTHCARE
Healthcare
Name of the Student
Name of the University
Author Note

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The Tuskegee syphilis study of the untreated Syphilis in the Negro Male refers to the
clinical study that was conducted between the year 1932 and 1972 by the United States Public
Health Service1. The study had been conducted in order to observe the natural history associated
with untreated syphilis. As the participants of the research, the African American individuals
were used by the researchers, however, no prior concept was taken by the researchers from the
selected population and the population was told that they were receiving free health care from
the Federal government of US. The thesis of this study is “"How did the Tuskegee syphilis study
affect medical research and the black populations trust in the mosern health care system ".
The Tuskegee study had been conducted over the black population of America. In the
year 1932, the Public Health Service of UK initiated working on the study in collaboration with
the Tuskegee University which was a popular black collage in Alabama2. The researchers, as
their samples, that is participants on whom the experiment was done, enrolled a total of six
hundred African American share croppers from the Macon County of Alabama, As stated
earlier, they were not informed about the purpose of the study neither did the researchers take
their consent. They were stated that US was providing free healthcare service along with free
meals and burial insurance for participating in the study. Out of the selected participants, 399
1 Alsan, Marcella, and Marianne Wanamaker. "Tuskegee and the health of black men." The
quarterly journal of economics 133, no. 1 (2018): 407-
455.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258045/
2 Katz, R., A. Conguista, T. Tien, M. Chetcuti, R. McGowan, J. Lee, D. B. Casagli, K. C. Hill, and B. A. Dearing.
"Was the development of the mistrust-in-research (MIR) field of study yet another ‘legacy of the USPHS syphilis
study at Tuskegee’? A Case Study in Passing Ethics Research from ‘generation to generation,’." Journal of
Healthcare, Science and the Humanities 6, no. 1 (2016): 21-35.
https://www.tuskegee.edu/Content/Uploads/Tuskegee/files/Bioethics/JHSH-V6n1-Fall-Spring2016-spreads-
FINAL3-2.pdf#page=14

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participants had latent syphilis and 201 participants did not possess the disease3. In the mean
time of the study, penicillin was found to be an effective cure for syphilis. Even after the funding
that was assigned for the experiment was lost, the participants were not informed that they would
never be treated, nor were they provided with penicillin. The researchers withheld penicillin
along with the information about it from the participants. Not only this, the researcher also
prevented the participants from accessing the treatment program for syphilis that involves
penicillin and was given to all other residents of Alabama. The study continued under a good
number of Public HealthSupervisors till the year 1972, until the press leaked the news and finally
came to end in16th November 1972. As a result of the study, only 74 of the participants with
syphilis were alive4. Of the initial 399 participants, 28 died due to the disease, 100 were dead due
to the complications associated with the disease, 40 women, who happened to be the wives of the
participants were infected and 19 children were born with congenital syphilis5.
The Tuskegee Syphilis study has adversely affected medical research to a great extent. It
had created immense trust issues amongst the participants and as a result has imposed adverse
impact on their willingness to participate in a research. Especially when it comes to the African
American population, the degree of mistrust is much higher. After the mentioned study,
researchers that required participation of voluntary samples for conducting study, suffered to a
3Katz, R., A. Conguista, T. Tien, M. Chetcuti, R. McGowan, J. Lee, D. B. Casagli, K. C. Hill, and B. A. Dearing.
"Was the development of the mistrust-in-research (MIR) field of study yet another ‘legacy of the USPHS syphilis
study at Tuskegee’? A Case Study in Passing Ethics Research from ‘generation to generation,’." Journal of
Healthcare, Science and the Humanities 6, no. 1 (2016): 21-35.
https://www.tuskegee.edu/Content/Uploads/Tuskegee/files/Bioethics/JHSH-V6n1-Fall-Spring2016-spreads-
FINAL3-2.pdf#page=14
4 Noonan, Allan S., Hector Eduardo Velasco-Mondragon, and Fernando A. Wagner. "Improving the health of
African Americans in the USA: an overdue opportunity for social justice." Public health reviews 37, no. 1 (2016):
12.doi: 10.1186/s40985-016-0025-4
5 Earnshaw, Valerie A., Laura M. Bogart, Michael Klompas, and Ingrid T. Katz. "Medical mistrust in the context of
Ebola: Implications for intended care-seeking and quarantine policy support in the United States." Journal of health
psychology 24, no. 2 (2019): 219-228. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526737/

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great extent. Limited number of participants agreed to participant in the study even after a
detailed consent form stating the purpose the study is provided to them. A fear of getting
mistreated as well as misguided has got developed amongst the participants after the blunder
caused by the Tuskegee Syphilis study. Lack of enough participants has already resulted in
closure of many researchers and thus has taken a toll on the research community of USA6.
Researchers have pointed that According to a good number of researchers, the disclosure
of the infamous Tuskegee Syphilis study in the year 1972 has resulted in increased medical
mistrust amongst the African American population, especially amongst the older generation of
the black population in USA7. The ensuing mistrust of the African-American medical
establishment seems to have extended well beyond the Deep South, where the infamous
experiment of public health has taken place. Researchers have pointed out that lack of trust
amongst the black population that has resulted due to the occurrence of Tuskegee Syphilis study
has resulted increased heath gap as well as mortality amongst the African American population8.
As per data obtained from the research, the life expectancy at the age of 45 years of a African
American male has fell up to 1.5 years in response to the disclosure of the unethical experiment
which accounts to approximately 35 percent of thee 1980 life expectancy gap that existed
between the white and the black population. It can be clearly understood that the mistrust that
6Pellowski, Jennifer A., Devon M. Price, Aerielle M. Allen, Lisa A. Eaton, and Seth C. Kalichman. "The differences
between medical trust and mistrust and their respective influences on medication beliefs and ART adherence among
African-Americans living with HIV." Psychology & health 32, no. 9 (2017): 1127-1139
https://www.tandfonline.com/doi/abs/10.1080/08870446.2017.1324969
7Williamson, Lillie D., and Cabral A. Bigman. "A systematic review of medical mistrust measures." Patient
education and counseling 101, no. 10 (2018): 1786-1794. https://doi.org/10.1016/j.pec.2018.05.007
8 Katz, R., A. Conguista, T. Tien, M. Chetcuti, R. McGowan, J. Lee, D. B. Casagli, K. C. Hill, and B. A. Dearing.
"Was the development of the mistrust-in-research (MIR) field of study yet another ‘legacy of the USPHS syphilis
study at Tuskegee’? A Case Study in Passing Ethics Research from ‘generation to generation,’." Journal of
Healthcare, Science and the Humanities 6, no. 1 (2016): 21-35.
https://www.tuskegee.edu/Content/Uploads/Tuskegee/files/Bioethics/JHSH-V6n1-Fall-Spring2016-spreads-
FINAL3-2.pdf#page=14

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got developed in the mind of the black population, hinder their way to seek medical treatments
from the USA healthcare services. Majority of them are afraid of being cheated or mistreated
again which may even result in death.
Already a commendable amount of healthcare gap existed prior to the Tuskegee Syphilis
study. The enhancement of healthcare disparity that has result after the disclosures has made it
highly difficulty for the healthcare service providers to close the gap between white and black
healthcare service users in USA. Today, African-American people have the worst results for
wellbeing among all large cultural, religious and demographic groups in the United States. For
black men, life expectancy is three years shorter than their male white counterparts at the age of
45, and for black women it is five years shorter. Not only this, it has been fund that African
American population are at 70 percent higher risk of developing heart failure compared to white
men. The risk of death due to cancer is 67 percent and for diabetes is 82 percent higher amount
the black population compared to the white population of UK.
Researchers have found that the degree of mistrust is much higher in the baby boomers
amongst the black population compared to the millennial. While 90 percent of baby boomers
show lack of trust in the modern healthcare system, the percentage gets reduced to 52 when it
comes to African American individuals of the age ranging from 18 to 30 years. Researchers have
pointed out that the chief reasons behind enhanced amount of mistrust amongst the older
population is they have evidenced the direct and immediate impact of the tragic experiment and
hence are more sympathetic, evidencing the blunder has made them more scared of being
mistreated9.
9Pellowski, Jennifer A., Devon M. Price, Aerielle M. Allen, Lisa A. Eaton, and Seth C. Kalichman. "The differences
between medical trust and mistrust and their respective influences on medication beliefs and ART adherence among
African-Americans living with HIV." Psychology & health 32, no. 9 (2017): 1127-1139.
https://doi.org/10.1080/08870446.2017.1324969

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Researchers have stated that the connection of the Tuskegee Syphilis study with the
cultural discrimination cannot be ignored. The history plays a major role here. Once enslaved,
the African Americans were forced to work in situations of physical and social significance to
their health. Slaves endured physical, psychological, and emotional violence from African
Americans for over 250 years. The abolition of slavery did not mean a sudden healthful life for
African Americans. In comparison, despite the 150 years since slavery has been abolished, they
have suffered systemic injustice and inequality. This past can be seen in terms of safety which
can contribute to two outcomes. In this group, the people who had survived the subjection with
In this group, the people who had survived the subjection with the intolerable pain become the
most resilient member of the group. However, this legacy of slavery and racial inequality
amongst the back and white population of USA is evidently responsible for poor health status of
the African American. Moreover, it is also responsible for the prolonged mistrust between the
black and the white population in USA. The Tuskegee Syphilis study has further proved the
existence of major discrimination between the white and black population of USA. Considering
the fact that that only black men were selected for this study, it points out the fact that for the
contemporary healthcare services like Public healthcare, the life of a white men was considered
to be much more valuable compared to that of a black men. This discrimination naturally
resulted in lack of trust as well as the fear of getting mistreated by the white population
dominated heath care sectors of USA.
The enhanced mistrust amongst the black people in healthcare that have resulted from the
mistrust is affecting the black population in several ways10. Considering the fact that the poverty
10Noonan, Allan S., Hector Eduardo Velasco-Mondragon, and Fernando A. Wagner. "Improving the health of
African Americans in the USA: an overdue opportunity for social justice." Public health reviews 37, no. 1 (2016):
12. doi: 10.1186/s40985-016-0025-4

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rate of the African American population is much higher than that of the white population and
hence for former population does not possess the potential to make a segregated heath care
system for themselves. Along with this lack of education, job opportunity has resulted in higher
rate of unemployment. It has also been found that the rate of drug and alcohol abuse is also
higher amongst the black population of USA. When it comes to healthcare facilities, it has been
seen that there existed huge amount of discrepancy in the provision of healthcare that includes
huge amount of cultural difference and lack of healthcare facilities. Low employment rate, high
poverty rate and lack of effective health care, along with the mistrust have resulted in the huge
gap in healthcare. Medical inequalities between blacks and whites are running deep in the United
States. For example, the levels of diabetes, obesity, and heart failure in black individuals are
greater than in other populations, and black children are 500 percent higher than white children
in terms of asthma mortality.
Researchers have pointed out that the impact of the Tuskegee Syphilis study, is much
lower amongst the millennial African American population compared to that of the older black
population. According to researchers, in a survey conducted in 2017, more than 67 percent of the
millennial stated that they opt for healthcare services provided by the government. However,
majority of them pointed out that even in this era a good amount of discrepancies exists in
healthcare services provided t0 the black population compared to that of the white population.
One of the major reasons that helped in prolonged survival of the mistrust among the black
population is lack of initiatives taken by the government to deal with the mistrust. Still now there
exists noticible cultural incompetence in the healthcare industry. Along with this, lack of
campaigns and other initiatives to reach out to the black population is highly rare. According to
research paper, only 30 percent of the modern healthcare system in Australia is comprised of

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black healthcare service providers. Not only is this, in majority of the healthcare system, highly
limited amount of money invested for training the employees and educating them on cultural
incompetence. Additionally, very few campaigns from the end of the government, till now has
been conducted in order to eradicate the issue associated with mistrust of the black population of
Australia due to the infamous Tuskegee Syphilis study. Racial health inequalities in the US have
been well established and government efforts to eliminate such inequalities have been pursued.
The 1985 Secretary's Tasking Force on Black and Minority Health Study, which highlights the
need for programs and strategies to tackle health inequities in the United States, was one of the
earliest federal efforts to increase awareness of racial differences in safety. All these are
eventually leading to high mortality rates and greater risk of various diseases in the black
population.
According to researchers, it is high time for the government of US to pay special
attention to the issue of mistrust associated with the Tuskegee Syphilis study11. The health care
policies needs to rechecked and effective steps to integrate additional facilities for the minority
population of the country needs to be ensured. Along with this, more and more candidates from
the African American background needs to recruited in the Modern healthcare system. It possess
the potential to eradicate the mistrust since incorporating the black population in the healthcare
system will make the people aware of the ethical heath care service provided by the modern
healthcare system. Not only this, effective cultural competency training should be provided to
the healthcare service users so that an effective bond can be developed between the service
providers and the African American service users, Researchers have also stressed on the
importance of campaigns. More and more online as well as offline campaigns needs to be
11Alsan, Marcella, and Marianne Wanamaker. "Tuskegee and the health of black men." The quarterly journal of
economics 133, no. 1 (2018): 407-455. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258045/

8HEALTHCARE
conducted in order to make e the people aware of the new polices and ethical practice of the
modern healthcare system.
It can be clearly understood that the mistrust resulted due to the infamous Tuskegee
Syphilis study has imposed highly negative impact on the health and well being the African
American population if USA. The mortality rate of the mentioned population is found to be high.
Along with this, enhanced disparities in heath care resulting in greater health risk amongst the
black population of USA is also evident. The above mentioned strategies needs to implement in
order to eradicate the impact of the Tuskegee Syphilis study on the trust of the black population
of USA in near future.

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Bibliography
Alsan, Marcella, and Marianne Wanamaker. "Tuskegee and the health of black men." The
quarterly journal of economics 133, no. 1 (2018): 407-
455.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258045/
Katz, R., A. Conguista, T. Tien, M. Chetcuti, R. McGowan, J. Lee, D. B. Casagli, K. C. Hill, and
B. A. Dearing. "Was the development of the mistrust-in-research (MIR) field of study yet
another ‘legacy of the USPHS syphilis study at Tuskegee’? A Case Study in Passing Ethics
Research from ‘generation to generation,’." Journal of Healthcare, Science and the Humanities
6, no. 1 (2016): 21-35. https://www.tuskegee.edu/Content/Uploads/Tuskegee/files/Bioethics/
JHSH-V6n1-Fall-Spring2016-spreads-FINAL3-2.pdf#page=14
Noonan, Allan S., Hector Eduardo Velasco-Mondragon, and Fernando A. Wagner. "Improving
the health of African Americans in the USA: an overdue opportunity for social justice." Public
health reviews 37, no. 1 (2016): 12.doi: 10.1186/s40985-016-0025-4
Pellowski, Jennifer A., Devon M. Price, Aerielle M. Allen, Lisa A. Eaton, and Seth C.
Kalichman. "The differences between medical trust and mistrust and their respective influences
on medication beliefs and ART adherence among African-Americans living with HIV."
Psychology & health 32, no. 9 (2017):
1127-1139https://www.tandfonline.com/doi/abs/10.1080/08870446.2017.1324969
Pellowski, Jennifer A., Devon M. Price, Aerielle M. Allen, Lisa A. Eaton, and Seth C.
Kalichman. "The differences between medical trust and mistrust and their respective influences
on medication beliefs and ART adherence among African-Americans living with HIV."

10HEALTHCARE
Psychology & health 32, no. 9 (2017): 1127-
1139.https://doi.org/10.1080/08870446.2017.1324969
Williamson, Lillie D., and Cabral A. Bigman. "A systematic review of medical mistrust
measures." Patient education and counseling 101, no. 10 (2018): 1786-
1794.https://doi.org/10.1016/j.pec.2018.05.007
Earnshaw, Valerie A., Laura M. Bogart, Michael Klompas, and Ingrid T. Katz. "Medical mistrust
in the context of Ebola: Implications for intended care-seeking and quarantine policy support in
the United States." Journal of health psychology 24, no. 2 (2019): 219-228.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526737/