Practical Steps for Healthcare Institutions to Address Historical Trauma

In recent years, healthcare institutions have increasingly recognised that legacy – and ongoing – medical racism and injustices continue to undermine trust, health outcomes and equity. As evidence mounts that racism in healthcare is both structural and persistent, organisations must go beyond statements of intent to embrace practical, actionable strategies that acknowledge past harm, build authentic outreach, and embed long-term trust-building mechanisms.
This article outlines a three-phase framework (Acknowledge → Outreach & Healing → Monitor & Sustain) that hospitals and health systems can adopt, illustrated by the city-wide trauma-informed care initiative in Baltimore, Maryland, as a blueprint. 

1. Acknowledge: Recognise the legacy and current impact of medical racism

Why this matters

• Enormous literature documents how racism in health care and public-health institutions persists, both historically and in contemporary settings. 
• Trust-barriers flow from lived experience: for example, qualitative research among Black patients found that the “history of medical racism” shapes expectations, experiences of dismissiveness and mistrust in emergency settings.
• Without explicit acknowledgement, outreach and healing efforts risk being superficial or seen as tokenistic. In trauma-informed care literature, racism is characterised as a form of trauma itself and must be treated as such.

Recommended actions

1. Institutional truth-telling: Create a public statement or internal white-paper that outlines the institution’s historical (and present) involvement in inequitable care, bias or discrimination. This does not need to single out individuals, but must show organisational accountability.
2. Leadership endorsement: The CEO/CMO should personally endorse this work, signifying buy-in at the highest level.
3. Baseline audit & listening sessions: Undertake an audit of institutional practices, policies and data around disparities, and hold facilitated listening sessions with historically marginalised patient groups and staff (especially from under-represented ethnic/racial groups).
4. Education & capacity-building: Provide mandatory training for clinical and non-clinical staff on medical racism, structural bias and trauma-informed care. For example, frameworks advise organisations to build knowledge of race, racial trauma and the impact of racism on care. 

2. Outreach & healing: launch authentic programmes with community partners

Why this matters

Acknowledgement alone is insufficient. Institutions must move into proactive collaboration, healing and trust-building. For example, the city of Baltimore’s initiative via the Baltimore City Health Department’s Office of Youth & Trauma Services created trauma-informed training across dozens of agencies, including health and community settings. 

Recommended actions

1. Co-design programmes with communities: Partner with community-based organisations (CBOs) representing historically disadvantaged groups to design outreach, screening, education or care-pathway programmes.
2. Embed trauma-informed, culturally safe care: Adapt care environments to reflect safety, empowerment, choice and cultural responsiveness. For instance, layout, signage, care teams and service workflows must reflect trauma-informed care principles. 
3. Healing initiatives for patients & staff: Recognise that staff from marginalised backgrounds carry historical and ongoing trauma. Offer peer support, reflective practice sessions, and healing circles. For patients, offer forums where concerns about historical harm in medical settings can be voiced and addressed.
4. Targeted outreach & access pathways: Develop programmes such as mobile clinics, health navigators or screening campaigns in communities impacted by past injustices (e.g., segregated care, limited access). Link these to the institution’s broader giving-back / community investment activities (for example, see our work at Giving Back).
5. Transparent communication & apology where appropriate: When historical harm is acknowledged, consider a public apology or commitment to remedy. Even if no litigation is involved, the act of acknowledgement helps shift power dynamics and rebuild trust.

3. Monitor & sustain: embed metrics, governance and long-term trust measurement

Why this matters

Trust is not built overnight. Without data, governance and sustained investment, efforts will fade or revert to the status quo. Medical mistrust has measurable consequences, including lower uptake of preventive care, treatment adherence issues and poorer outcomes. 

Recommended actions

1. Develop dashboards & equity metrics: Track disparities in access, outcomes, patient experience by race/ethnicity (and other relevant characteristics). Tie these metrics to executive dashboards and governance.
2. Patient-reported trust & experience surveys: Introduce and monitor specific trust-oriented questions (e.g., “I believe this institution takes my cultural background into account”; “I feel safe speaking up about my concerns”). Use segmentation by historically marginalised groups.
3. Governance and accountability structures: Form a steering committee (including senior leadership and community representatives) on historical trauma & equity-partnerships. Ensure budget and programme oversight sits at an executive level.
4. Continuous learning and iteration: Use qualitative and quantitative feedback loops (listening forums, community advisory boards) to refine programmes. Consider partnering with external evaluators.
5. Long-term community investment: Sustain outreach efforts beyond isolated projects. Allocate multi-year funding to community-led initiatives and build institution-community partnerships as co-owners of the trust-building mission.

Blueprint in action: Baltimore’s city-wide trauma-informed approach

The Baltimore example offers several lessons:

• The Office of Youth & Trauma Services created a trauma-informed self-assessment tool for agencies and provided no-cost trainings city-wide. 
• A documented initiative notes that in 2015-16, nearly 1,500 city employees across 78 agencies received introductory training in trauma-informed care as part of a city-wide programme led by Leana Wen. 
• The key insight: recognising trauma (including historical traumas rooted in racism, community violence, structural disadvantage) and embedding it into organisational practice can shift culture, policy and community partnerships.

Healthcare institutions can adapt this model by scaling it into their clinical and organisational settings, thus building a meaningful, measurable pathway to trust-equity.

Conclusion

When healthcare organisations intentionally acknowledge historic and structural racism, partner authentically with affected communities for outreach and healing, and sustain their commitment via governance and measurement, they position themselves not just as providers of care, but as trusted partners in community wellbeing and equity. For institutions seeking practical next-steps, consider linking community investment and mission-driven programmes (such as our Giving Back initiative) with this framework, thereby building enduring trust rather than one-off outreach. The equity dividend is real: improved access, better patient experience, stronger community reputation and ultimately better outcomes.