The current issue of the New England Journal of Medicine (NEJM), one of the most prestigious peer-reviewed medical journals in the country, lends its clout to a larger conversation about addressing issues of racism in the health care system.
Two articles published in NEJM this month implore medical professionals to do their part to further racial justice in America. The first focuses on raising awareness about the implicit biases embedded in the health care system that end up deepening racial disparities. The second urges health care workers to get more involved on the front lines of fighting for black lives.
In the first op-ed, two physicians from Chicago write that the medical community needs to “examine the implicit biases in our academic medical centers” and “audit the care we deliver to ensure that the right treatments are provided and the best outcomes are achieved regardless of patients’ race, class, or sex.”
The doctors cite previous research that suggests many physicians have an unconscious preference for white patients, which may lead them to spend less time with their African-American patients. This type of implicit bias could have a direct influence on the quality of health care services. A 2002 report from the Institute of Medicine found that black Americans received less effective care than their white counterparts for nearly every disease studied.
On top of that, if black Americans don’t feel welcome in the medical system, they’re more likely to delay treatment — something that could contribute to the fact that African-Americans are dying from diseases at higher rates than other racial groups.
In an interview with the Chicago Sun-Times, one of the doctors who penned that op-ed explained that it’s a good time for doctors to enter into the national conversation about racial justice. Dr. David Ansell, who has spent decades advocating for low-income and minority patients, referenced the recent groundswell of public activism in the aftermath in the deaths of Mike Brown in Ferguson and Eric Garner in New York City — both unarmed black men who died at the hands of police officers.
“We just felt in the face of Ferguson and Garner, we needed to talk openly about these gaps in health outcomes occurring in our health systems. We have all of these gaps and they haven’t gotten better after so many years,” Ansell said. He added that you “cannot underestimate the lingering effects of racism.”
Ansell’s article comes on the heels of student activism that initially sparked a dialogue about these issues at the end of last year. In December, dozens of medical students across the country staged “die-ins” to protest the police killings of people of color. They used the hashtag #WhiteCoats4BlackLives to make the point that the medical profession is invested racial equality as a matter of public health.
“We want to call attention to the fact that police brutality really endangers the lives and health of people of color in this country,” a first-year medical student at the University of Pennsylvania explained to the Guardian at the time. “As physicians and medical students it is our responsibility to take care of the health and wellness of our community, so we see it as a public health issue.”
That sentiment is echoed in the second op-ed published in NEJM this month, which calls on more doctors to follow in the footsteps of the students who have been outspoken in recent months.
“As New York City’s health commissioner, I feel a strong moral and professional obligation to encourage critical dialogue and action on issues of racism and health,” Dr. Mary Travis Bassett, who was appointed to her position at the beginning of this year, writes. “Let’s not sit on the sidelines.”
Bassett identifies three areas where doctors could start making a difference: Conducting more research to illuminate the existing racial gaps in health care; reforming the internal structures that have led to a dearth of black physicians; and publicly advocating for progressive changes in law and policy. “Rightfully or not, medical professionals often have a societal status that gives our voices greater credibility,” Bassett points out.
One of the the most important steps to making progress in this area could be to recruit more African-American applicants to medical school — particularly since the rate of black applicants has declined by 20 percent over the past several decades. According to Ansell, black medical students are more than twice as likely as their white peers to express a desire to use their skills to serve communities of color.