By Dr. Carol Penn, DO, MA, ABOM, FACOFP
“Of all the forms of inequality, injustice in health is the most shocking and inhuman.” Martin Luther King, Jr.
I believe that the lens of racism is so uncomfortable and disquieting, people feel compelled to turn away from this soul sucking almost fundamentally unsolvable infected pathogen of racism. I am concerned if people who are working in the Diversity, Equity, and Inclusion (DEI) arena keep down the path of asking individuals to account for their racism, white privilege etc., we might not get any closer to ending it then we have in the past 400 years. This issue feels too big, too overwhelming for any one individual to take on, especially if you have been on the side of the color line that has benefitted disproportionately. It is so insidious that an individual’s nervous system simply seems to short circuit rather than expand in a way that allows for integration of the information within the confines of any one being or psyche.
In her book, The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together, author Heather McGhee asks the following question: “It is progressive economic conventional wisdom that racism accelerates inequality for communities of color, but what if racism is actually driving inequality for everyone?” (McGhee, 2021).
Here’s the truth folks: “The logic that launched the zero-sum paradigm-I will profit at your expense-is no longer sparing millions of white Americans from the degradations of American economic life as people of color have always known it.” (McGhee, 2021).
“The coronavirus pandemic is a tragic example of governments and corporations failing to protect Black, brown and Indigenous lives-though, if they had, everyone would have been safer.” (McGhee, 2021)
The core principle of what we do in health care is ‘to first do no harm.’ Due to structural racism, this is almost if not impossible to accomplish since the system is fundamentally designed within this zero-sum paradigm. The number of physicians, nurses, and other health care professionals experiencing moral injury is at an all-time high, leading to increasing mental health disorders and ever-increasing numbers of death by suicide within the ranks of the healing professions.
The New England Journal of Medicine and authors Zinzi D. Bailey et al. in the article “How Structural Racism Works-Racist Policies as a Root Cause of US Racial Health Inequities,” posits the thesis that “As a legacy of African enslavement, structural racism affects both population and individual health in three interrelated domains: 1. Redlining and racialized residential segregation, 2. Mass incarceration and police violence, 3. And unequal medical care. These examples among others, share certain cardinal features: harms are historically grounded, involve multiple institutions, and rely on racist cultural tropes.”
Homework: Please read the article. Look at the racial composition of your own neighborhood, your property values, and what services you have access to in your neighborhood and ask yourself, how did this come to be? Do you know what the Homeowners Loan Corporation is and how it came to be? While you were growing up, were you ever told that there was a ‘’bad’’ side of town? If so, what was that based on and why?
Contemporary U.S. Policing has its roots where and historically in what state? After the Reconstruction era, policing aided and abetted what practices that contributed to the historic establishment of healthcare disparity that continues to this day? What are some examples of how policing and incarceration impact the health of Black people? What are some of the ways, white people have been advantaged by this system economically?
What are some of the ways scientific racism and eugenics have laid the groundwork for structural racism? Who is J. Marion Sims and why and how did he get to be known as the ‘father of modern gynecology’?
In a study conducted in 2016 (Hoffman, et al., 2016), white medical students came to what conclusions regarding black patients?
Both this article and McGhee’s book suggests ways that we can all move forward and perhaps get somewhere on the other side of racism. Specifically, the article suggests 4 key areas for healthcare professionals to look:
Document the health impact of racism. Demand that funders, editors, and reviewers see racism and inequities in social determinants of health as topics that are just as valid for research as are biologic markers (and both can be combined.)
We need data collection to improve on race and ethnicity as well as improved measures regarding structural racism.
Both the medical and public health communities must turn the lens on ourselves as individuals and within our institutions. We need to demand that the National Institute of Health examine its own practices around funding Black researchers and its hiring practices. We need to reach out and encourage Black students to excel and choose careers in Medicine AND we need to examine why there is a growing under representation of Black students in medical school as well as other healthcare professions; Occupational Therapy, Physical Therapy for example.
Structural racism has been most successfully challenged by mass social movements.
Why are movements like “White coats for Black Lives” so important at this time. Why is “Black Lives Matter” important and necessary at this time?
The field of medicine has both much to regret for our participation in structural racism and at the same time has much to offer when it comes to making right our historical wrongs as well as present day ongoing wrongs that are based on the collective history of what has occurred in the United States.
If you work in the field of health care, you have a choice now, today to do something. What will history say about your choice? What will history say about our choice?
Join us on a six-week CME/CE journey to dismantle and Unpack Racism for HealthCare Professionals. Use this link to register for the course and bring a friend or colleague for free!
McGee, H (2021). The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together. One World.
Bailey, Z., Feldman, J., Bassett, M. (2021). How Structural Racism Works – Racist Policies as a Root Cause of U.S. Racial Health Inequities. New England Journal of Medicine (384), 768-773. DOI: 10.1056/NEJMms2025396
Hoffman. K.M., Trawalters, S., Axt, J.R., Oliver, M.N. (2016) Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci USA, 113: 42966-4301.