Racism within Medicine

Racism within Medicine

Section Leaders: Dr. Christopher Steele, MD MPH MS, and Emma Kryzanski

 

Introduction:

Racism is an organized social system in which the dominant racial group, based on an ideology of inferiority, categorizes and ranks people into social groups called “races” and uses its power to devalue, disempower, and differentially allocate valued societal resources and opportunities to groups defined as inferior.1 Despite having abolished slavery and segregation, racism still plagues people and institutions within the United States, including the health care system and its practitioners.

Marginalized racial groups tend to have an earlier onset of illness, more aggressive progression of disease, and poorer survival rates than White people, even after adjustment for socioeconomic status.1 A major determinant of these health disparities is racism, both between people and created by our institutions policies, laws, and practices.1,3 Health care professionals have a responsibility to mitigate racism in medicine by being antiracist and by advocating for antiracist institutions.1,2,3,11,19

The goal of this module is to introduce different forms of racism, and how they have plagued health care in the United States for centuries and still do today. Additionally, the module aims to introduce an antiracist approach to practicing medicine in order to create a more equitable health care system for all racial groups.

 

Learning Objectives

By the end of this module, learners will be able to do the following:

  1. Define race and racism
  2. Differentiate between different types of racism
  3. Describe racism’s impact on health
  4. Discuss the history of racism within American medicine and its relevance to practicing medicine today
  5. Define antiracism and explain the significance of being antiracist
  6. Discuss steps that health care professionals should take in order to practice anti-racist medicine

 

Content Materials

    1. E. Kryzanski Racism as a Social Determinant of Health
    2. E. Kryzanski History of Medical Racism
    3. E. Kryzanski An Antiracist Approach to Medicine
    4. Start reflecting on your own implicit biases by completing the Race, Asian, and/or Skin-tone Implicit Association Tests: https://implicit.harvard.edu/implicit/selectatest.html
    5. Williams DR, Lawrence JA, Davis BA. Racism and health: Evidence and needed research. Annual Review of Public Health. 2019;40(1):105-125. doi:10.1146/annurev-publhealth-040218-043750
      https://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-040218-043750 
    6. Vyas DA, Eisenstein LG, Jones DS. Hidden in plain sight — reconsidering the use of race correction in clinical algorithms. New England Journal of Medicine. 2020;383(9):874-882. doi:10.1056/nejmms2004740 
      https://www.nejm.org/doi/full/10.1056/NEJMms2004740 
    7. Crear-Perry J, Maybank A, Keeys M, Mitchell N, Godbolt D. Moving towards anti-racist praxis in medicine. Lancet. 2020;396(10249):451-453. doi:10.1016/S0140-6736(20)31543-9
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367678/ 

     

    Resources for Educational and Employment Institutions, Health Professionals, or Health Profession Students:

       

      Optional Reading Materials

         

        References

        1. Williams DR, Lawrence JA, Davis BA. Racism and health: Evidence and needed research. Annual Review of Public Health. 2019;40(1):105-125. doi:10.1146/annurev-publhealth-040218-043750
        2. Vyas DA, Eisenstein LG, Jones DS. Hidden in plain sight — reconsidering the use of race correction in clinical algorithms. New England Journal of Medicine. 2020;383(9):874-882. doi:10.1056/nejmms2004740
        3. Rastetter M. How racism is a structural and social determinant of health. The Ohio State University Wexner Medical Center. https://wexnermedical.osu.edu/blog/racism-is-a-social-determinant-of-health. Published March 25, 2021. Accessed August 23, 2021.
        4. 4 types of racism. Race and Social Justive Initiative Resources. http://www.seattle.gov/Documents/Departments/RSJI/Resources/RSJI-4-Types-of-Racism-August-2021-City-of-Seattle-Office-for-Civil-Rights.pdf. Accessed August 23, 2021.
        5. Institutional racism. CommonBondz Resources. https://commonbondz.org/resources-1/institutional-racism. Accessed August 23, 2021. 
        6. Structural racism. CommonBondz Resources. https://commonbondz.org/resources-1/structural-racism. Accessed August 23, 2021. 
        7. Interpersonal racism. CommonBondz Resources. https://commonbondz.org/resources-1/interpersonal-racism. Accessed August 23, 2021. 
        8. Arias E, Tejada-Vera B, Ahmad F. Provisional life Expectancy estimates for January through June, 2020. Vital Statistics Rapid Release. 2021;(10). doi:10.15620/100392
        9. Ruane M. Freedom and slavery, the 'central paradox of American history'. The Washington Post. https://www.washingtonpost.com/local/freedom-and-slavery-the-central-paradox-of-american-history/2019/04/30/16063754-2e3a-11e9-813a-0ab2f17e305b_story.html. Published April 30, 2019. Accessed August 24, 2021. 
        10. Nuriddin A, Mooney G, White A. Reckoning with histories of medical racism and violence in the USA. The Lancet. 2020;396(10256):949-951. doi:10.1016/s0140-6736(20)32032-8
        11. Legha RK, Williams DR, Snowden L, Miranda J. Getting Our Knees Off Black People’s Necks: An Anti-Racist Approach to Medical Care. Health Affairs Blog. November 2020. https://www.healthaffairs.org/do/10.1377/hblog20201029.167296/full/. Accessed August 18, 2021.
        12. Kyere E. Enslaved people's health was ignored from the country's beginning, laying the groundwork for today's health disparities. The Conversation. https://theconversation.com/enslaved-peoples-health-was-ignored-from-the-countrys-beginning-laying-the-groundwork-for-todays-health-disparities-143339. Published July 30, 2020. Accessed August 24, 2021. 
        13. History of minorities in medicine. Office for Diversity and Inclusion - School of Medicine. https://www.uab.edu/medicine/diversity/initiatives/minorities/history. Accessed August 18, 2021.
        14. Hunkele KL. Segregation in United States Healthcare: From Reconstruction to Deluxe Jim Crow. University of New Hampshire Scholars' Repository Honors Theses and Capstones. 2014;188. 
        15. Forrest CB, Hawkins JE, Whelan E-M, King TE, Wheeler MB. Chapter 3: Financing and Organization of Health Care for Vulnerable Populations. In: Medical Management of Vulnerable and Underserved Patients: Principle, Practice, and Populations. 2nd ed. McGraw Hill; 2016:25-33.
        16. Figure 18. percentage of all ACTIVE physicians by race/ethnicity, 2018. AAMC. https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018. Accessed August 24, 2021. 
        17. Preidt R. Little progress in boosting numbers of Black American doctors. U.S. News & World Report. https://www.usnews.com/news/health-news/articles/2021-04-21/little-progress-in-boosting-numbers-of-black-american-doctors. Published April 21, 2021. Accessed August 24, 2021. 
        18. Kendi IX. Ibram X. Kendi defines what it means to be an antiracist. Penguin Books UK. https://www.penguin.co.uk/articles/2020/june/ibram-x-kendi-definition-of-antiracist.html. Published June 9, 2020. Accessed August 24, 2021. 
        19. Crear-Perry J, Maybank A, Keeys M, Mitchell N, Godbolt D. Moving towards anti-racist praxis in medicine. Lancet. 2020;396(10249):451-453. doi:10.1016/S0140-6736(20)31543-9
        20. Anti-racism, inequity, and implicit bias in health care: Books. LibGuides. https://iupui.libguides.com/healthequity/books. Accessed August 24, 2021.
        21. Ramirez A. Achieving a Cohesive Culture for Health Equity in Latino and All Communities: A Research Review. Salud America. https://salud-america.org/achieving-a-cohesive-culture-for-health-equity-in-latino-and-all-communities-a-research-review/. Published September 15, 2020. Accessed July 7, 2021.
        22. Rameswaram S, Katz L. Professor Ibram X. kendi on why it's not enough to admit when you're being Racist: "Challenge those racist ideas". Vox. https://www.vox.com/2020/6/1/21277220/george-floyd-protests-ibram-x-kendi-today-explained. Published June 1, 2020. Accessed August 23, 2021.
        23. Kirwan Institute for the Study of Race and Ethnicity. Implicit Bias Module Series. Implicit bias module series. https://kirwaninstitute.osu.edu/implicit-bias-training. Accessed August 23, 2021.
        24. Evans MK, Rosenbaum L, Malina D, Morrissey S, Rubin EJ. Diagnosing and treating systemic racism. New England Journal of Medicine. 2020;383(3):274-276. doi:10.1056/nejme2021693
        25. Alonge T. Medical schools, it's time to get real about becoming anti-racist. AAMC. https://www.aamc.org/news-insights/medical-schools-it-s-time-get-real-about-becoming-anti-racist. Published September 23, 2020. Accessed August 18, 2021.