Moving beyond mistrust: Centering institutional change by decentering the white analytical lens

The topic of Black mistrust of medical institutions and health care has received a great deal of attention over the course of the Covid-19 pandemic, especially with the arrival of vaccines and the emergence of a gap in vaccination rates by race. This article examines current discourses and debates over medical mistrust, and describes the limitations of the mistrust framework for identifying and addressing the institutional change necessary to remedy racial health inequities. As numerous observers have pointed out, the mistrust discourse largely places the burden of change on historically exploited and mistreated populations, rather than on the medical institutions that committed the violations and continue the mistreatment that are often identified as sources of mistrust. However, even the analytic shift to focus on the trustworthiness of institutions narrows the scope of the issue to the relationships of medical institutions to specific communities. While the mistrust literature has made important contributions to centering and valuing Black perspectives, this framework delimits the focus to Black perceptions and behaviors rather than on medical institutions and the health care system. Whereas the predominately white analytic lens of bioethics scholarship has centered Black populations by making them the subject of study, this article draws a distinction between simply analyzing, versus meaningfully centering and deriving an analysis from the perspective of marginalized populations within scholarship. This article suggests moving beyond the mistrust framework and the assumption of white normativity to conduct the type of institutional analysis necessary for addressing racial health inequities.