What can inclusive healthcare look like?

The overall aim of this project is to generate positivity by uplifting the ways Black folks engage with their health. Black folks in the U.S. have faced and are currently experiencing disparities in the healthcare system as many institutions failed to address their needs. Persistent systemic racism and cis heteropatriarchy fuel the processes that exclude people from healthcare and that create disparate outcomes for a variety of marginalized groups. Therefore, we also focus on empowering providers to foster accessibility and inclusion for diverse communities. Due to our collaboration with the  Family Tree Clinic , we also focus specifically on advancing its efforts to support Black folks in target communities in taking care of their health.

Purpose and Motivation

One aim of this project is to generate positivity by uplifting the ways Black folks engage with their health. The project also focuses on empowering providers to foster accessibility and inclusion and aims to understand the Family Three Clinic’s target communities and how to support them in their health, more precisely, focusing on the paths Family Tree clinic should support Black folks in taking care of their health. 

Emergence of Research Questions

The seeds of this project were planted during the winter months of 2022. A mutual acquaintance connected, Jacki Trelawny, Director of Engagement at Family Tree Clinic, and Dan Trudeau, Professor of Geography at Macalester College in order to discuss a collaborative project. Since 2017, Family Tree Clinic had conducted interviews with people who are hardly served by the mainstream health care system, many of whom identify as Black or people of color as well as trans and queer. Jacki was interested in collaborating with researchers who would assist with analyzing the interviews. Dan wanted to connect his qualitative research class with a community-based inquiry. Their aspirations took root in creating a course at Macalester College that would work with the interview data to identify ways in which health care providers could better support the hardly served. As part of the creative process, Jacki and Dan engaged in conversations that generated the four questions this project engages:

1. How do Black folks in the Twin Cities engage in their own health? 
2. How can Family Tree Clinic support Black Folks in their own health and well being?
3. How can Healthcare Providers improve Black folks’ access to healthcare?
4. How can Family Tree Clinic be a place intersectional Black communities want to visit?

Research Methods

After splitting into groups to investigate each question, we used qualitative research methods to analyze interviews conducted previously by the Family Tree Clinic’s Community Engagement team between 2017 and 2021. The group working on question 1 chose descriptive codes as a group and separated them into analytical codes for past and future. Group 2 used the codes with the most quotations grounding them and used the larger relationships between their codes for analysis. Group 3 compared codes and findings amongst themselves to find patterns and overlap in their analysis. Group 4 created a chart with descriptive codes and relevant quotations which they used to then draw overarching themes. Each group then formulated a method to present their findings based on their analysis.

Themes

Each group came away with overarching themes and recommendations in response to their research question. Although groups explored various topics related to access and inclusion at Family Tree Clinic, there were some overlapping themes between them. Most of these themes take the form of actionable suggestions for health care facilities like Family Tree Clinic that will help them become more accessible and inclusive for Black communities. The Venn Diagram below visualizes the major individual and overlapping themes from each group:

Through qualitative research we determined various ways that Black folks engage in their own health in the Twin Cities, Minnesota. This exhibit seeks to disrupt narratives that are imposed on Black folks, rather than the ones that should be centered — the beliefs that come from lived experiences. From analyzing interviews we identified similar patterns and placed them here. The roots of the tree represent the ways Black folks engage in their own health in the present, and it contains a rich set of actions and tools that are currently effective for the interviewed individuals. The leaves represent the world that Black folks in the interviews imagined for the future. We felt this was key to include because imagining a better future is how it is created, thus imagining better ways to engage in health can lead to greater health. We drew this idea from adrienne maree brown who wrote about the dangers of living in someone else's imagination. Writing the potential future in the leaves provides a pathway for a new, more equitable world to be crafted. The trunk includes three words that illustrate the pathways that could bridge the gap between the present and the future: accessibility, support and wellbeing.

Our contribution takes the form of a brochure that can be displayed in the lobby of Family Tree Clinic. Our goal was to answer the question of how FTC can support Black Folks in their own health and wellness. We found that inside the clinic, patients would feel more supported by more diverse staff who listen and trust their experiences. Outside the clinic, patients seek more holistic and balanced health practices, which can include community and self-care. We hope to identify both the needs and barriers of Black Folks in the community so the clinic can better serve them.

We created a zine which is interactive both digitally and physically. This zine, using quotes and sentiments from interviews, walks through an idealized health care visit at Family Tree Clinic. We use this zine as a way to communicate information from interviewees about what they would like to see in clinics, and how they would like to be treated by healthcare providers everywhere.

At the core of our investigations is the question: how [do] populations of African descent around the world negotiate societies informed by anti-Blackness? This is an approach that we believe is integral in our attempt to make American healthcare more inclusive and accessible. Many Americans are quick to assert that our society has “moved-on” per-say out of anti-Blackness into some new and undefined era of greater tolerance, but most Black Americans are aware that this is not truly the state of our culture and society. Rather, it is common to encounter the following health narrative, wherein individuals who feel excluded or unheard by the providers of the healthcare system seek help and medical attention less, living with negative quality of life impacts as a result. The persistence of such health narratives is indicative of the level of distrust and hesitancy toward healthcare that Black Americans have, which may be read as evidence that our healthcare system is not approaching inclusivity and access in a sufficient manner.

This experience is explained by medical anthropologist Arthur Kleinman, in his article called “Writing at the Margin” which explains that in our modern industrialized biomedical system “the doctor is expected to decode the untrustworthy story of illness as experience…biomedicine is also led to discount the moral reality of suffering while affirming the objective bodily indices of morbidity…The physician constructs the object of therapeutic work without legitimizing suffering.” This means that since suffering, or lessened quality of life is not experienced by the healthcare practitioner it is easier for those providers to justify not expending greater energy in healing holistically the individual who is forced to describe their pain and suffering in that environment devoid of empathy. In our current biomedical system in America we have seen the harmful effects such perspectives have on those seeking to be healed, these people expect that they must live with their suffering and in fact re-tell it over and over often without experiencing meaningful change to the state of their health. 

By not legitimizing the stories of suffering which are shared in the pursuit of greater health and quality of life in order to always root out the biomedical “truth” of a patient and what “exactly” seems to be the issue, sight is lost of the total environment that impacts a human life. This exclusionary perspective allows for very specific treatments to be provided in cases where it is needed, but for a majority of cases which need a more holistic perspective on medicine and healing to be largely ignored in favor of these other more “adequate” situations where the medicine available matches up perfectly to the issues a certain patient is experiencing.

The legacy of slavery still permeates the U.S. in every way, to such an extent that current inequalities in the provision of health care can be understood in terms of segregation and structural racism. Black bodies have routinely been subjected to inhumane treatment due to these systems of oppression, and in order to repair this trust between Black folks and our American Healthcare system there needs to be more collaboration between healthcare practitioners and their patients, a greater level of trust and genuine care in their health storytelling, and more space where different earthly energies matter.  Health means different things to different people therefore there is not one right way to “solve” a problem. Our lifeworlds and upbringings play an integral role in how we interpret caring for ourselves and others. We hope this project can emphasize Black community experiences in healthcare treatment as both individuals and a group and serve as a guiding step in the framework for future healthcare. 

In order to move forward successfully, we believe Americans should collectively accept that the healthcare system we have in place first needs some deconstruction, before new inclusivity and increased access programs can successfully be implemented at a local level. For example we could target high insurance cost at a systemic level in order to rebuild these practices with a more inclusive approach. The inertia of our healthcare system is too great for amendments and that we must rather rebuild from the ground up a new healthcare practice with a more internalized sense of empathy and a genuine desire to be inclusive and spread greater access to medicine. The current system is too directly descended from the pervasive history of American exclusionary practices.

The stories of those who have worked with or sought help at Family Tree Clinic are essential to understanding the role the clinic has played in its environment. We suggest that a determined approach to sharing the storytelling of health narrative from local patients and providers would achieve the more holistic approach to providing healthcare that we are advocating for. 

We are a group of students from a Geography class called "Building a More Inclusive Healthcare System: Collaborative Research with Family Tree Clinic at Macalester College." Collectively, this class is studying Geography from a wide variety of different perspectives and backgrounds. The Family Tree Clinic on Nicollet in Minneapolis has a long history of working alongside Macalester students and staff since the clinic’s founding by a Macalester graduate in 1971. Students and staff have monitored, maintained, and expanded the mutually beneficial relationship between Family Tree Clinic and the Twin Cities community to continue to provide personalized and equitable care. 

In the current version of our class, students are coming together to use each of our unique perspectives and engage with the work and view-point of Family Tree Clinic. We were asked to consider the Family Tree Clinic as a resource for the local community, and to investigate an aspect of the Family Tree Clinic’s function with regards to accessibility and inclusivity.  Our group was curious about how the Family Tree Clinic is integrated into the Black and African-American community of the Twin Cities region, we are asking the following; How do Black folks’ in Twin cities engage in their own health; How can Family Tree Clinic support Black folks’ in their own health and wellbeing; How can can healthcare providers improve Black folks’ access to health care; How can Family Tree Clinic continue to be a place intersectional Black communities want to visit? Family Tree Clinic of course, already serves the Black community of the Twin Cities openly, we are now envisioning this safe and accessible space for Black healthcare to expand to a greater population of Black and Brown Americans in our local area. 

Discovering answers to our research questions will provide us insight into the individual experiences of those seeking healthcare at the Family Tree Clinic, alongside allowing us to see how this particular healthcare institution operates within the social environment and culture of Minneapolis St. Paul. The results of achieving such insights can be provided to the Family Tree Clinic in a way that makes our data meaningful, we anticipate that our findings could even lead to the adjustment of how the clinic provides support and treatment to those seeking help. With this project, we aim to provide an interdisciplinary perspective aiding in the creation of a more accessible and inclusive healthcare system for our neighbors. 

We have a lot of people to thank for supporting this process. First, we want to thank Family Tree Clinic for their time, support, data, and trust in us. Specifically, we thank Jacki Trelawny for her vision, feedback, collaboration, and belief in our work. We want to give thanks to Professor Dan Trudeau for his guidance and instruction. A special thanks to Dan and the Geography department for housing and supporting this class. Thanks to Noah Velick, our TA, for his behind-the-scenes work. Lastly, a special thank you to WITTYWIDZ for working with Group 4 and illustrating the comic.