Tuesday 15 June 2021

Structural racism in medicine: An in-depth look at ways to promote meaningful change

 Deeply engrained structural racism within the healthcare system has harmed historically marginalized people for centuries. Recognizing their role in this, the largest medical association in the United States pledges to help eradicate inequity in medicine. We asked four experts for their opinion on how to do this in a meaningful way.

The American Medical Association (AMA), one of the largest and most influential medical associations in the world — along with its publication, the Journal of the American Medical Association (JAMA) — has recently unveiled its “Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity.” The AMA has also publicly recognized its contribution to structural racism through harmful and unjust practices and proceedings.

Throughout this 3-year plan, the AMA vows to promote equity throughout its vast organization and within its “domains of influence.” This commitment to racial and social justice is long overdue and has the potential to bring much-needed restructuring to a healthcare system that, to this point, has severely underserved historically marginalized groups.

In this Special Feature, Medical News Today takes an in-depth look at structural racism and inequity in medical organizations, research, and health reporting. We also talk with four experts about some actions necessary to promote meaningful change.

Structural racism goes beyond individual prejudice. It is a perpetual inequity deeply engrained in social policy, legislation, law enforcement, the economic system, and the healthcare system, to name only a few of the areas that it affects.

It results from a pervasive, misaligned thought process that places one racial or ethnic group above another. This is often driven by white supremacist beliefs, underlying white privilege, and a failure to understand that all humans share 99.9%Trusted Source of their DNA.

Within the healthcare system, structural racism has profoundly impacted the mental and physical health of historically marginalized groups. For example, reports indicateTrusted Source that Black people have lower life expectancies than white individuals and that predominantly Black communities are more likely to experience a shortage in primary care physicians.

On a deeper level, the medical community has promoted structural racism throughout decades of biased research and papers published in medical journal publications. A staggering number of research studies fail to incorporate diversity in recruiting participants, and consumer-facing media have perpetuated the issue by continually assuming that their audience is white.

These practices have had a profound effect on the healthcare that historically marginalized people receive, as health conditions, reactions to medications, and risk factors for disease can differ among racial and ethnic groups.

Realizing its role in this, the AMA has openly acknowledged its history of actively harmful practices and longstanding silences that have promoted health inequity.

To promote racial justice and advance health equity throughout its organization and in its domains of influence, the AMA vows to incorporate the following strategies:

  • Embed racial and social justice in AMA businesses, cultures, systems, policies, and practices.
  • Build alliances and share power with historically marginalized and “minoritized” physicians and other stakeholders.
  • Ensure equitable structures and opportunities in innovation.
  • Push upstream to address all determinants of health and root causes of inequities.
  • Create further pathways for truth, racial healing, reconciliation, and transformation for AMA’s past.

AMA developments highlight continued ignorance

Despite its positive intonations, this call to action has brought upheaval and controversy to the AMA and unveiled a continued ignorance of racial inequity issues, as a small group of AMA delegates wrote in a letter in which they expressed concern over the pledge.

Also, recently, Dr. Howard Bauchner — editor in chief of the JAMA — stepped down from his position due to an incident surrounding a previous JAMA podcast and tweet.

According to a news article in the BMJTrusted Source, the podcast in question was promoted with a Twitter post claiming, “No physician is racist, so how can there be structural racism in healthcare? An explanation of the idea by doctors for doctors in this user-friendly podcast.”

In the AMA press release announcing the move, Dr. Bauchner says, “I remain profoundly disappointed in myself for the lapses that led to the publishing of the tweet and podcast. Although I did not write or even see the tweet, or create the podcast, as editor in chief, I am ultimately responsible for them.”

Despite the controversy and internal discord, the organization plans to push its 3-year plan into high gear and be the driver of health equity for “minoritized” people.

However, will this strategy be an effective solution to a problem deeply engrained within the medical community?

Source: Medical News Today

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