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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.

How structural racism impacts healthcare

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.

How the AMA plans to enact change

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?

Experts weigh in on methods to initiate meaningful change

MNT spoke with four experts about structural racism in medical communities and ways to bring this deeply rooted issue to the forefront and promote impactful change.

Prof. Derek M. Griffith, Ph.D., is the director of the Center for Research on Men’s Health and professor of medicine, health, and society at Vanderbilt University in Nashville, TN.

After July 1, 2021, Prof. Griffith will assume the role of founder and co-director of the Racial Justice Institute, founder and director of the Center for Men’s Health Equity, and professor of health systems administration and oncology at Georgetown University in Washington, D.C.

Dr. Tiffany Green, Ph.D., is an author and assistant professor of population health sciences and obstetrics and gynecology at the University of Wisconsin-Madison.

Dr. Winston Morgan, B.Sc., Ph.D., FHEA, is reader in toxicology and clinical biochemistry and the director of Impact and Innovation at the School of Health Sport and Bioscience at the University of East London in the United Kingdom.

Dr. Jameta Nicole Barlow, Ph.D., M.P.H., is an assistant professor of writing in The George Washington University’s University Writing Program and Women’s Leadership Program. She is also affiliated with Milken Institute of Public Health, holding secondary appointments in women’s, gender, and sexuality studies and in the Department of Health Policy and Management.

Dr. Barlow is also an affiliate faculty member in the Global Women’s Institute, the Africana Studies Program, and the Jacobs Institute of Women’s Health.

What meaningful steps can medical associations, professional groups, and researchers take to eliminate racism and promote health equity?

Acknowledging the structural racism present in the medical community is only the beginning of what needs to happen to advance health equity.

Dr. Morgan told MNT: “As someone who has been working on social justice for many years in education, science, and medicine — the strategic [AMA] plan represents a great start. When I read the document, I was pleasantly surprised at the content, what was being accepted and proposed by the AMA. It was obvious the document was written by individuals who understood the racial landscape, who are the key thinkers, and what needed to be done.”

However, Dr. Morgan noted the challenge of implementing such change in an organization as large as the AMA.

“Many inside and outside of the AMA of all races have been living in denial that the disparities in medical outcomes have nothing to do with them — this plan challenges that, and it will make members uncomfortable,” Dr. Morgan explained.

“The other challenge is that the AMA only represents a third of all doctors in the [U.S.] — at best, those in the AMA are more likely already to be accepting of some of these ideas — getting acceptance from the wider profession will be the greatest challenge,” he said.

Dr. Green recently addressed health equity in organizations in a commentary that appears in the journal Obstetrics & Gynecology.

To foster health equity, Dr. Green said, “we need to stop treating racism as just an individual-level problem and recognize it as a structural one that impacts every aspect of our lives (including medical care).”

Dr. Green proposed that actions to accomplish this need to include and prioritize the voices of historically marginalized groups, diversify leadership, and create environments that practice a zero tolerance policy toward discrimination and where Black scholars and other scholars of color can thrive.

“Finally, while medical care is critical, the social determinants of health matter far more when it comes to promoting health equity. Such an approach will mean addressing structural racism in housing, employment, and education in order to improve the health and well-being of marginalized groups,” Dr. Green said.

In addition to this, Dr. Barlow suggested, “professional groups and medical researchers can work with Black health organizations and researchers to create strategies and approaches to health equity.” She recommended reaching out to organizations including the Black Women’s Health Imperative, the Council on Black Health, the Community Healing Network, and the Association for Black Psychologists.

According to Prof. Griffith, organizations such as the AMA have perpetuated racist ideas for more than a century. Therefore, they need to initiate tangible actions with measurable definitions and use their influence to move issues of racism from the margins of the medical community to the center.

What about diversity training for eliminating racism in healthcare?

Using diversity training as a tool to mitigate structural racism is one concept that many feel would improve health equity. However, all four experts we spoke with said that there is little evidence to suggest that this type of intervention is effective.

Still, Dr. Morgan pointed out that implementing diversity training as an integral part of medical training could be effective — as long as it takes place throughout the organization.

Will enacting a ‘Marshall Plan’ strategy advance health equity?

On June 5, 1947, Secretary of State George C. Marshall proposed a post-World War II plan to help Western Europe rebuild infrastructure and aid economic recovery.

Adopting a Marshall Plan strategy may be effective in overcoming structural racism in healthcare. But would it work?

According to Prof. Griffith, “In terms of health equity, AMA journals and others could publish strategies to create the infrastructure needed to achieve and maintain health equity, or studies that describe, simulate, or test strategies to achieve and sustain equitable outcomes in health.”

Because of the correlation between socioeconomic status and health outcomes, Dr. Morgan believes that implementing a Marshall Plan strategy to address structural racism in the medical community would need to happen on a societal level to benefit health outcomes and promote an increase in Black medical and public health professionals.


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