“There is another kind of violence, slower but just as deadly, destructive as the shot or the bomb in the night. This is the violence of institutions; indifference and inaction and slow decay. ”
Unbeknown to most patients, race is incorporated into numerous medical decision-making tools and formulas that providers consult to decide treatment for a range of conditions and services, including heart disease, cancer and maternity care, according to a 2020 paper published in the New England Journal of Medicine. The unintended result has been to direct medical resources away from black patients and to deny some black patients treatment options available to white patients.
The tools are often digital calculators on websites of medical organizations or - in the case of assessing kidney function - actually built into the tools labs use to calculate normal values of blood tests. They assess risk and potential outcomes based on formulas derived from population studies and modeling that looked for variables associated with different outcomes.
The New England Journal paper built on a collection of recent findings and assessments, including those in a recent paper about kidney function by Dr. Nwamaka Denise Eneanya and her colleagues at the University of Pennsylvania.
Dr. Darshali A. Vyas of Massachusetts General Hospital, who is first author of the New England Journal paper, said the ultimate goal is for doctors and researchers to rethink the assumption that they can use a patient’s race in making medical decisions.
“This is a challenge to the field about how we think about race and what our default assumptions are about race,” she said.
Summary adapted from a June, 2020 New York Times article.
Dr. Camara Phyllis Jones presenting at Yale University on Achieving Health Equity: Tools for Naming and Addressing Racism and Other Systems of Structured Inequality. Dr. Jones MD, PhD, MPH is a family physician and epidemiologist whose work focuses on the impacts of racism on the health and well-being of the nation. In this excellent TEDx talk, she uses four allegories to illuminate topics that are otherwise difficult for many Americans to understand or discuss. She hopes through her work to initiate a national conversation on racism that will eventually lead to a National Campaign Against Racism.
Professor Nancy Krieger (Harvard, UCB Alum) along with Professors Mahasin Muhajid and Corinne Ridell (UCB) will engage in conversations about the impact of racial discrimination, social class and place on the excess disease and death rates from COVID19 among African American and other communities of color. The session will focus on some of the thorny issues related to collecting and analyzing relevant social data on COVID19; and also on advancing a social justice agenda in addressing racial/ethnic disparities in disease rates.
UCSF assistant professor Brittany D. Chambers, PhD, MPH, discusses the relationship between racism and infant/adolescent health outcomes, and describes policy recommendations to improve educational opportunities and economic growth in black communities. Presented at UCSF Child and Adolescent Psychiatry Grand Rounds on Jan. 22, 2020.
Is my healthcare making me sick? Microaggressions in American Indian Health Care.
Keynote Presentation: "Reaping What We Sow: Structural Racism as a Driver of Health Disparities" Rahsaan D. Hall, Esq. Director, Racial Justice Program, American Civil Liberties Union (ACLU) of Massachusetts
Panel Discussion: Luis R. Castellanos, MD, MPH, Associate Clinical Professor of Medicine, Division of Cardiology, Director of Diversity in Medicine and Faculty Outreach, UC San Diego Health and Sulpizio Cardiovascular Center Nancy Krieger, PhD, Professor of Social Epidemiology, American Cancer Society Clinical Research Professor, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health Audra R. Meadows, MD, MPH, Instructor in Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Brigham and Women's Hospital
Podcasts
On this Curbsiders episode, Dr. Utibe Essien @UREssien walks us through key terminology and evidence necessary to understand anti-Black racism in medicine. Dr. Essien provides insights into ways that racism impacts our work in the clinical and academic settings and offers approaches for addressing anti-Black racism in these settings.
Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).
This podcast episode, An Invisible Evil, from Harvard School of Public Health addresses structural racism. Structural racism is often called an invisible evil because it's so pervasive, but also hidden in some ways. It involves interconnected institutions—housing, education, health care—that foster discrimination against racial groups. And this structural racism can play a role in health disparities across the United States. In this week's podcast we speak about structural racism and its health effects with Zinzi Bailey, ScD, '14, director of research and evaluation in the Center for Health Equity at the New York City Department of Health and Mental Hygiene. Bailey was recently co-author on a paper in the Lancet, that explored the history of structural racism and health inequities in the United States, and also ways to combat this discrimination moving forward.
Professor and author Dr. John Rich talks about applying a systems approach to tackling the consequences of trauma in the lives of young African-American men. Dr. Rich is the author of "Wrong Place, Wrong Time: Trauma and Violence in the Lives of Young Black Men." Now a professor at the Drexel University School of Public Health, Dr. Rich previously served as medical director of the Boston Public Health Commission, and as a primary care physician at Boston Medical Center.
Misdiagnosis, Mistreatment, and Harm — When Medical Care Ignores Social Forces
The Case Studies in Social Medicine published in the New England Journal of Medicine demonstrate that when physicians use only biologic or individual behavioral interventions to treat diseases that stem from or are exacerbated by social factors, we risk harming the patients we seek to serve.
Structural Racism and COVID-19
This journal article discusses how the novel coronavirus disease (COVID-19) pandemic has unveiled underlying health inequities throughout the United States.
This New England Journal of Medicine article addresses one example of how structural racism results in health disparities and unequal care.
Interactive Module
Health Equity Rounds: An Interdisciplinary Case Conference to Address Implicit Bias and Structural Racism for Faculty and Trainees
Free MedEdPORTAL module
Introduction: The medical community recognizes the importance of confronting structural racism and implicit bias to address health inequities. Several curricula aimed at teaching trainees about these issues are described in the literature. However, few curricula exist that engage faculty members as learners rather than teachers of these topics or target interdisciplinary audiences. Methods: We developed a longitudinal case conference curriculum called Health Equity Rounds (HER) to discuss and address the impact of structural racism and implicit bias on patient care. The curriculum engaged participants across training levels and disciplines on these topics utilizing case-based discussion, evidence-based exercises, and two relevant conceptual frameworks. It was delivered quarterly as part of a departmental case conference series. We evaluated HER's feasibility and acceptability by tracking conference attendance and administering postconference surveys. We analyzed quantitative survey data using descriptive statistics and qualitatively reviewed free-text comments. Results: We delivered seven 1-hour HER conferences at our institution from June 2016 to June 2018. A mean of 66 participants attended each HER. Most survey respondents (88% or more) indicated that HER promoted personal reflection on implicit bias, and 75% or more indicated that HER would impact their clinical practice. Discussion: HER provided a unique forum for practitioners across training levels to address structural racism and implicit bias. Our aim in dissemination is to provide meaningful tools for others to adapt at their own institutions, recognizing that HER should serve as a component of larger, multifaceted efforts to decrease structural racism and implicit bias in health care.