In a report released Wednesday, health care professionals from the Massachusetts Medical Society discussed the importance of acknowledging the role of structural racism in the field of medicine and how it has shaped scientific research and clinical practice.
According to the report, titled “Structural Racism and Supporting Black Lives — The Role of Health Professionals,” the key to unpacking trends like disproportionate rates in use of lethal force by police on Black Americans and disparate health outcomes between Black and white patients lies in understanding the influence of systemic racism and white supremacy.
“The term ‘racism’ is rarely used in the medical literature,” the report read. “Most physicians are not explicitly racist and are committed to treating all patients equally. However, they operate in an inherently racist system.”
“Like other epidemics, structural racism is causing widespread suffering, not only for Black people and other communities of color but for our society as a whole,” it continued. “It is a threat to the physical, emotional, and social well-being of every person in a society that allocates privilege on the basis of race.”
The authors asserted that the only way to curtail the systematic violence that cuts short the lives of thousands of Black people each year is for researchers and clinicians to take action in addressing the root cause in their work.
So how do clinicians go about doing this?
The first step is acknowledging that the history of America is rooted in a doctrine of white supremacy sought to suppress the political and economic rights of Black people, according to the authors. Influence of this outward racism is even more apparent in the field of medicine. For instance, experimentation on Black communities and segregation of care based on race have negatively impacted the U.S. health care system and beyond.
“Disparate health outcomes and systematic inequalities between Black Americans and white Americans in terms of wealth, well-being, and quality of life must be seen as extensions of a historical context in which Black lives have been devalued,” the authors stated. “We would argue that health care professionals have an individual and a collective responsibility to understand the historical roots of contemporary health disparities.”
The report went on to state that health care professionals also hold the responsibility of understanding exactly how racism shapes the way researchers and clinicians analyze these disparities. In the pre-Civil War Era, it was common for doctors to attribute the poor health of enslaved Africans to their racial inferiority rather than the conditions and/or tolls that servitude took on their bodies. Such false beliefs about Black people continue today.
According to the report, a study published earlier this year revealed that 50 percent of white medical students and residents hold false ideas about biologic differences between Black and white people — such as Black people have thicker skin, their blood clots more easily, etc.
Authors said unconscious bias is most likely to blame for these falsely held beliefs.
“Implicit bias and false beliefs are common — indeed, we all hold them — and it’s incumbent on us to challenge them, especially when we see them contributing to health inequities,” the report read.
The third and final step in clinicians’ active role in combating systemic racism is simple: define “racism.” The authors argued that it’s imperative to use consistent definitions and correct vocabulary for measuring, analyzing and discussing racism as it pertains to health.
Camara Jones of the National Center for Chronic Disease Prevention and Health Promotion defines racism as “a system of structuring opportunity and assigning value based on phenotype (race) that: unfairly disadvantages some individuals and communities; unfairly advantages other individuals and communities; [and] undermines realization of the full potential of the whole society through the waste of human resources.”
Per the report, race and racism as they relate to medicine starts to play out when patients check the race box on medical forms; when clinicians examine racial differences in care; or when researchers use race as a variable in regression models.
“When a person’s race is ascertained and used in measurement, is it merely an indicator for race, or does it mask or mark racism?,” the authors ask. “Perhaps if we shift our clinical and research focus from race to racism, we can spur collective action rather than emphasizing only individual responsibility.”
The report concludes by recommending that researchers and clinicians “shift the margins” — or focus their attention on the perspectives of marginalized groups rather than the majority — to provide clinical care that successfully ensures racial equity.
“Centering at the margins in health care and research will require re-anchoring our academic and health care delivery systems — specifically, diversifying the workforce, developing community-driven programs and research, and helping to ensure that oppressed and under-resourced people and communities gain positions of power,” it read.