OUR STORY IN BRIEF: THE HISTORICAL RELATIONSHIP BETWEEN AMERICA, BLACKS, HEALTH AND MEDICINE Marc Imhotep Cray, M.D. June, 2010, Last Updated March, 2011

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OUR STORY IN BRIEF:
THE HISTORICAL RELATIONSHIP BETWEEN AMERICA, BLACKS, HEALTH AND MEDICINE
Marc Imhotep Cray, M.D.
Institute for Minority Physicians of the Future (IMPF)
Health disparities across racial and ethnic groups in the United States have been well
documented for over a century .These disparities have remained remarkably persistent in
spite of the changes in many facets of the society over that period. Despite dramatic
improvements in overall health status for the U.S. population in the 20th century, members of
many African- American populations experience worse health along many dimensions
compared with the majority white population (1). Because many minority neighborhoods
have a shortage of physicians (2) and less access to medical care, increasing the supply of
minority physicians has been proposed as an intervention that may help to ameliorate
differences in health status.
Medical training for African-Americans first became a topic of policy debate in the United
States in the context of the post-Civil War south as a way to address the health needs of the
African-American community. Disparities between the health status of Whites and African-
Americans have been observed throughout American history. In the antebellum South, slave
owners documented health problems that threatened productivity, and pointed out health
disparities between African-Americans and Whites to reinforce beliefs that “biogenetic
inferiority of blacks” justified slavery (3). Conditions in the South after the Civil War were not
dissimilar to other post war periods, with many blacks left homeless – refugees in search of a
place to live and a way to make a living (4). Lack of food, water and sanitation exacerbated
OUR STORY IN BRIEF:
THE HISTORICAL RELATIONSHIP BETWEEN AMERICA, BLACKS, HEALTH AND MEDICINE
Marc Imhotep Cray, M.D. June, 2010, Last Updated March, 2011

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what had already been extremely poor living conditions. The result was major outbreaks of
pneumonia, cholera, diphtheria, small pox, yellow fever and tuberculosis. Yet, very few white
physicians were willing to see black patients, and very few African-Americans could afford
their fees. The education of African-American physicians and other health professionals was
seen as a necessary step to improve the health of Blacks and to protect the public health of
the communities where African-Americans lived, primarily in the South. African-American
medical schools were founded to address this need. Against the backdrop of sociostructural
and institutional racism and legal segregation, Flexnor (5) echoed both social justice and
public health arguments for training black physicians in his famous report, with the underlying
assumption that the best way to meet the great health needs of black communities in the
United States was by providing more black physicians. His recommendation was to
concentrate resources on two black medicals schools (out of seven) that he believed had the
best chance of meeting the standards being set for modern medical training programs,
Howard and Meharry. The preface to his recommendation reflects the tension between the
societal goals for improving access to care by training more black physicians, while
simultaneously maintaining an unstated goal and trend of restricting entry of blacks into the
profession (6). As recently as 1965, only 2% of all medical students were black, and three-
fourths of these students attended Howard or Meharry. The human rights and civil rights
movements, the assassination of Malcolm X, Martin Luther King Jr., , and a rash of
urban riots and uprisings woke many White Americans up. And academic medicine
was one the first to respond to the wake-up call. Dr Jordan Cohn, AAMC President, in his
“Bridging the Gap” address, explains the consequences of these sociopolitical events most
eloquently. “This brought about a significant rise in admissions of minorities to medical
schools. This wasn’t because of scores on the Scholastic Aptitude Test, grade-point
averages and Medical College Admission Test scores of minorities suddenly skyrocketing.
Rather, academic medicine began to take affirmative action to increase racial, ethnic and
gender diversity in medical school classes. Enrollment of underrepresented minorities in U.S.
medical schools rose rapidly to about 8% of all matriculants by early 1970. Then progress
stalled in the mid 1970s, with admissions remaining flat for the next 15 years. To make
matters worse, the fraction of individuals from the same groups in the U.S. population that
were underrepresented in medicine continued to grow during this periodminority
populations increasing from 16% in 1975 to 19% in 1990.”(Source: www.AAMC.org Dr
Jordan Cohn’s AAMC President / Bridging the Gap)
OUR STORY IN BRIEF:
THE HISTORICAL RELATIONSHIP BETWEEN AMERICA, BLACKS, HEALTH AND MEDICINE
Marc Imhotep Cray, M.D. June, 2010, Last Updated March, 2011

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Increasing diversity of physicians might decrease disparities in health by three separate
pathways. The first pathway is through the practice choices of minority physicians, which
may lead to increased access to care in underserved communities. Since the 1970s and
1980s, when minority students were first admitted to medical schools in large numbers, a
number of studies have examined the practice patterns of minority physicians compared with
white physicians. Despite their differences, empirical analyses regarding the practice
location and patient population of minority physicians have been remarkable consistent.
Minority physicians tend to be more likely to practice in underserved areas and to have
patient population with a higher percentage of minorities then their white colleague (7-9).
Evidence also suggest that minority physicians tend to have a higher percentage of patient
populations with lower incomes and worse health status and who are more likely to be
covered by Medicaid (10-13). The second pathway is through improvement in the quality of
health care due to better physician – patient communication and greater cultural competency.
The foundation of this hypothesis is that for many minority patients, having a minority
physician my lead to better health care because minority physicians may communicate better
and provide more culturally appropriate care to minority patients. If minority physicians
provide high-quality care to minority patients along the interpersonal dimensions of care,
including doctor-patient communications and cultural competence, this could result in higher
patient trust and satisfaction. This may in turn facilitate better health outcomes (14-21). The
third pathway by which increasing diversity in the health professions might serve to decrease
health disparities is through improvements in the quality of medical education that may
accrue to medial students as a result of increasing diversity in medical training. This would
expose physicians-in-training to a wide range of different perspectives and cultural
backgrounds among their colleagues in medical school, residency and in practice. Such
exposure may provide physicians with experiences and interactions that will broaden their
interpersonal skills and help in their interactions with patients (22).At the same time minority
populations are increasing, data from the American Association of Medical Colleges show a
marked decline in the number of African-Americans and Hispanics admitted to medical
schools (23). These declines coincided with two significant events. First, in 1995, the United
States Court of Appeals for the Fifth Circuit in Hopwood v. Texas, struck down as
unconstitutional an affirmative action program that had been placed in the University of Texas
law school. In doing so, the court effectively precluded higher education institutions as well
as other entities in the Fifth Circuit, which cover Texas, Louisiana and Mississippi, from
taking race or ethnicity into account in the admissions process. Secondly, the Regents of the
OUR STORY IN BRIEF:
THE HISTORICAL RELATIONSHIP BETWEEN AMERICA, BLACKS, HEALTH AND MEDICINE
Marc Imhotep Cray, M.D. June, 2010, Last Updated March, 2011

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University of California banned the use of race as a factor in admissions. With the passage
of Proposition 209, public higher education institutions in California are no longer free to
consider race, ethnicity or gender in admissions decisions, in recruiting programs, or even in
planning and implementing minority-targeted outreach activities, such as tutoring programs
and educational enrichment courses. California, Texas, Mississippi and Louisiana, these four
states alone contain 35% of the minority population that remain underrepresented among
medical students, and 75% of those from the Mexican-American community.
REFERENCES
1. Kington, R.S., & Nickens, H.W. (2001) Racial and ethnic differences in health: Recent
trends, current patterns, and future directions. In America becoming: Racial trends
and their consequences, NJ Smelser, WJ Wilson, and F Mitchell. (Eds). Washington,
DC, National Academy Press.
2. Komaromy, M.; Grumbach, K., et al. (1996). The role of black and Hispanic physicians in providing
health care for underserved populations. New England Journal of Medicine; 334, pp. 1305-1310.
3. Savitt, L. (1985). Black health on the plantation: masters, slaves and physicians. In
Sickness and health in America, J. Leavitt & R. Numbers (Eds.) University of
Wisconsin Press.
4. Summerville, J. Educating Black Doctors: a History of Meharry Medical College.
University, Alabama: University of Alabama Press, 1983.
5. Flexnor, A. (1910). Medical Education in the United States and Canada. Carnegie
Foundation for the Advancement of Teaching. Merrymount Press: Boston, MA.
6. Starr, P. The Social Transformation of American Medicine. New York: Basic Books,
1982.
7. Rocheleau, B. (1978). Black physicians an ambulatory care. Public Health Reports;
93(3):278282.
8. Lloyd, S.M., & Johnson, D.G. (1982). Practice patterns of black physicians: Results
of a survey of Howard University College of Medicine Alumni. Journal of the National
Medical Association; 74(2), pp. 129-141.
9. Keith, S.N.; Bell, R.M., et al. (1985). Effects of affirmative action in medical schools:
A study of the class of 1975. New England Journal of Medicine; 313, pp. 1519-1525.
10. Davidson, R.C., & Lewis E.L. (1997). Affirmative action and other special
consideration admissions at the University of California, Davis, School of Medicine.
JAMA; 278(14), pp. 1153-1158.
OUR STORY IN BRIEF:
THE HISTORICAL RELATIONSHIP BETWEEN AMERICA, BLACKS, HEALTH AND MEDICINE
Marc Imhotep Cray, M.D. June, 2010, Last Updated March, 2011

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11. Moy, E.; Bartman, B.A.; & Weir, M.R. (1995). Access to hypertensive care. Effects of
income, insurance, and source of care. Archives of Internal Medicine; 155(14), pp.
1497-1502.
12. Cantor, J.C.; Miles, E.L., et al. (1996). Physician service to the underserved:
Implications for affirmative action in medical education. Inquiry, summer; 33, pp. 167-
180.
13. Gray, B. Stoddard, J.J. (1997). Patient-physician pairing: Does racial and ethnic
congruity influence the selection of a regular physician? Journal of Community
Health; 22(4), pp. 247-259.
14. Department of Health and Human Services OOMH. (2000). Office of Minority Health
national standards on culturally and linguistically appropriate services (CLAS) in
health care. Federal Register; 65(247).
15. Lavizzo-Mourey, R., & Mackenzie, E.R. (1996). Cultural competence: Essential
measurements of quality for managed care organizations. Annals of Internal
Medicine; 124, pp. 919-921.
16. Coleman, M.T., Lott, J.A., & Sharma, S. (2000). Use of continuous quality
improvement to identify barriers in the management of hypertension. American
Journal of Medical Quality; 15(2) pp. 72-77.
17. Chinman, M.J.; Rosencheck, R.A.; & Lam, J.A. (2000). Client-case manager racial
matching in program for homeless persons with serious mental illness. Psychiatric
Services; 51(10):1265-1272.
18. Rosenbeck, R., Fontana, A., & Cottrol, C. (1995). Effect of clinician-veteran racial
pairing in the treatment of posttraumatic stress disorder. American Journal of
Psychiatry; 152(4), pp. 5550-5563.
19. Thom, D.H., Ribisl, K.M., Stewart, A.L., et al. Further validation and reliability testing
of the trust in physician scale. Medical Care; 37(5), pp. 510-517.
20. Saha, S., Komaromy, M. et al. (1999). Patient-physician racial concordance and the
perceived quality and use of health care. Archives of Internal Medicine; 159, pp. 997-
1004.
21. Morales, L.S., Cunningham, W.E., & Brown, J.A. et al. (1999). Are Latinos less
satisfied with communication by health care providers? Journal of General Internal
Medicine; 14, pp. 409-417.
22. Rathore, S.S.; Lenert, L.A. et al. (2000). The effects of patient sex and race on
medical students’ ratings of quality life. American Journal of Medicine, 108(7), pp.
OUR STORY IN BRIEF:
THE HISTORICAL RELATIONSHIP BETWEEN AMERICA, BLACKS, HEALTH AND MEDICINE
Marc Imhotep Cray, M.D. June, 2010, Last Updated March, 2011

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561.566.
23. See www.AAMC.org.
Further Study:
IVMS Race Trust and Tuskegee-Medical Ethics Broken Trust and Health Disparities/Ppt
Black and White: Health Disparities in America / Marc Imhotep Cray, M.D./Doc
American Health Dilemma: Race, Medicine, and Health Care in the United States.
OUR STORY IN BRIEF:
THE HISTORICAL RELATIONSHIP BETWEEN AMERICA, BLACKS, HEALTH AND MEDICINE
Marc Imhotep Cray, M.D. June, 2010, Last Updated March, 2011

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Medical ethicist Harriet A. Washington Random House "The fear of medicine is based on real
events. And real events go way beyond -- way before and way after -- Tuskegee," says
Harriet Washington. "There are things that are happening now that will keep [African
Americans] from going to the hospital."
http://www.youtube.com/watch?v=mcOTMSZTLSs
OUR STORY IN BRIEF:
THE HISTORICAL RELATIONSHIP BETWEEN AMERICA, BLACKS, HEALTH AND MEDICINE
Marc Imhotep Cray, M.D. June, 2010, Last Updated March, 2011

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ABOUT The Institute for Minority Physicians of the Future
Mission Statement
THE INSTITUTE FOR MINORITY PHYSICIANS OF THE FUTURE is a
collective voice of African American, Native American, Hispanic
American and progressive European American physicians and medical
scientists. IMPF believes that the root cause of minority under-
representation in United States medical schools is academic
disadvantage borne by lack of access to high-quality high school and
college preparation. Consequently, IMPF mission is to become a leading
organizational force for parity in medical education by helping minority
students develop the skills that will enable them to compete on a more equal footing in the medical
school admission process, and once in medical school, provide them with learning aids from the best
medical education communities around the world . The Institute for Minority Physicians of the Future
elucidates, distills and fuses educational psychology, information technology and undergraduate
medical education data; and then develops programs, projects and products that serve to increase
recruitment, admission and retention (RAR) of underrepresented minorities (URM) in major United
States medical schools. The ultimate goal being for these students to defend, define and develop
medical careers that will be committed to the elimination of health disparities in racial/ethnic minorities
and the poor.
Vision Statement
THE INSTITUTE FOR MINORITY PHYSICIANS OF THE FUTURE is a national professional
educational organization representing the interest of minority high school and college students with the
aptitude and desire to become physicians and medical scientists. Established in 1999, the collective
body is committed to the vision of improving the health and well-being of future U.S. generations by
increasing the minority physician/medical scientist workforce in such a way that the professions of
medicine and biomedical research are reflective of the racial/ethnic profiles of the people physicians
and medical scientists will serve. IMPF’s vision is directly linked to the AAMC data minority physicians
are four times more likely than are others to practice in undeserved communities. Such communities
are more frequently than not overwhelmingly populated by racial/ethnic minorities.
Core Strategy
THE INSTITUTE FOR MINORITY PHYSICIANS OF THE FUTURE’S core strategy is to identify,
inform, recruit, assist, advise and educate promising African-American, Native-American, and
Hispanic-American, high school and college students in order to increase the number of minority
medical students and PhD candidates in United States medical schools.
“Come on and chill wit us on the Atlantic Ocean during our annual retreat and at the same TIME
LEARN what it means to become a Healer and Medical Scholar in the 21st century”.
OUR STORY IN BRIEF:
THE HISTORICAL RELATIONSHIP BETWEEN AMERICA, BLACKS, HEALTH AND MEDICINE
Marc Imhotep Cray, M.D. June, 2010, Last Updated March, 2011

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Marc Imhotep Cray, M.D.
drcray@imhotepvirtualmedsch.com
Visit Our Online Classroom Environment
The e-Teaching Community on WiZiQ
http://www.wiziq.com/drimhotep
Founding Director: Office of Medical Education
Institute for Minority Physicians of the Future (IMPF)
OUR PRODUCT IS IMHOTEP VIRTUAL MEDICAL SCHOOL
ABOUT IMHOTEP VIRTUAL MEDICAL SCHOOL:
IVMS is the ultimate medical student Web 2.0 companion. This SDL-Face to Face hybrid
courseware is a digitally tagged and content enhanced replication of the United States
Medical Licensing Examination's Cognitive Learning Objectives (Steps 1, 2 or 3). Including
authoritative reusable learning object (RLO) integration and scholarly Web Interactive
PowerPoint-driven multimedia shows/PDFs. Comprehensive hypermedia BMS learning
outcomes and detailed, content enriched learning objectives.
OUR STORY IN BRIEF:
THE HISTORICAL RELATIONSHIP BETWEEN AMERICA, BLACKS, HEALTH AND MEDICINE
Marc Imhotep Cray, M.D. June, 2010, Last Updated March, 2011

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Dr. Marc Imhotep Cray is originally from Newark, New
Jersey. He is a physician and medical teacher,
independent undergraduate medical education consultant
and USMLE tutor. From 1999-2004 Dr. Cray served as
director of the Office of Medical Education at American
International School of Medicine in Georgetown, Guyana,
and associate professor of basic medical sciences and
campus curriculum coordinator at International University
of Health Sciences-School of Medicine in Saint Kitts,
West Indies. Dr. Cray earned a Bachelor of Science in
pharmacy at Massachusetts College of Pharmacy in
1980. Next he received his medical doctor degree from
New Jersey Medical School in Newark, NJ in 1984. Later, he completed training as a
post graduate intern at Columbia Presbyterian College of Physicians and Surgeons at
Harlem Hospital Medical Center in 1985, worked in private general practice at Harlem
Community Medical Clinic. Dr. Cray served on the NYC Committee of Interns and
Residents in New York from 1986-1989 where he planned, developed, implemented and
coordinated the medical license review course, was an educational coordinator &
lecturer in pharm & medical therapeutics. From 1990-1991 he worked at Morehouse
School of Medicine in the department of community health and prevention as a research
associate/ programs coordinator for community health and awareness programs. From
6/1991‑4/1992 Dr. Cray studied at Morehouse School of Medicine as a PGY‑2 resident
in Psychiatry. From 1993-1996 he worked as a medical emergency house physician at
Georgia Regional Hospital of Atlanta and Royce Occupational Health Group, returned to
Morehouse School of Medicine as a senior research associate under a NASA
commission grant from 1997-1998, and was director of clinical diagnosis at The Primary
Care Center in Decatur, Ga 1999-2002. Dr Cray is an expert in case-based learning with
experience as a facilitator of USMLE Step 1 level proficiency in the “4 P’s”-Physiology,
Patho-physiology. He is an experienced web developer, e-Professor / Online Lecturer
and author of several e-articles, e-books, and e-magazines. He has designed USMLE
tagged virtual medical school course ware. He is currently working on a project in
medical pharmacology and therapeutics with specialty in autonomic and cardiovascular
and introduction to clinical Medicine.
OUR STORY IN BRIEF:
THE HISTORICAL RELATIONSHIP BETWEEN AMERICA, BLACKS, HEALTH AND MEDICINE
Marc Imhotep Cray, M.D. June, 2010, Last Updated March, 2011