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Doctors Call On Health Systems To Take Action To Reduce Racial Inequity

Doctors are calling on healthcare systems to take the lead advocating against police brutality, to diversify their work forces to better reflect their patient population, and to incorporate addressing racial health disparities as part of Physician training.

Physicians writing in the New England Journal of Medicine discuss how systemic racism has negatively impacted the health of African Americans and how now is the time change must be made.

An article in the Journal said, “Police brutality against Black people, and the systemic racism of which it is but one lethal manifestation, is a festering public health crisis. Can the medical profession use the tools in its armamentarium to address this deep-rooted disease?”

Doctors from another NEJM article recommend that health care systems engage, at the very least, in five practices to dismantle structural racism and improve the health and well-being of the Black community and the country.

5 Best Practices

Divest from racial health inequities. Racial health inequities are not signs of a system malfunction: they are the by-product of health care systems functioning as intended. For example, the U.S. health insurance market enables a tiered and sometimes racially segregated health care delivery structure to provide different quality of care to different patient populations. This business model results in gaps in access to care between racial and ethnic groups and devastating disparities like those seen in maternal mortality. Universal single-payer health care holds the promise of removing insurance as a barrier to equitable care.

Desegregate the health care workforce. The health care workforce is predominantly white at essentially every level, from student and staff to CEO. This lack of diversity must be understood as a form of racial exclusion that affects the economic mobility and thus the health of nonwhite groups. For example, health care systems are often the economic engines and largest employers in their communities. Extending employment opportunities to those communities can extend the employer-based insurance pool, raise the median wage, support the local tax base, and counter the gentrification and residential segregation that often surrounds major medical centers — each of which improves population health.

Make “mastering the health effects of structural racism” a professional medical competency. In 2016, we asked individual clinicians to “learn, understand and accept America’s racist roots.” In 2020, it is clear that clinicians need to master learning the ways in which structural racism affects health. We believe that medical schools and training programs should equip every clinician, in every role, to address racism. And licensing, accreditation, and qualifying procedures should test this knowledge as an essential professional competency.

Mandate and measure equitable outcomes. Just as health care systems are required to meet rigorous safety and quality performance standards for accreditation, they should be required to meet rigorous standards for addressing structural racism and achieving equity in outcomes.

Protect and serve. Health care systems must play a role in protecting and advocating for their patients. Victims of state-sanctioned brutality are also patients, who may present with injuries or disabilities or mental health impairments, and their interests must be defended. Health care systems should also be on the forefront of advocating for an end to police brutality as a cause of preventable death in the United States. They should take a clear position that the disproportionate killing of black (and indigenous and Latinx) people at the hands of police runs counter to their commitment to ensuring the health, safety, and well-being of patients.

Major medical organizations, like the American Medical Association, the American Academy of Pediatrics and the American College of Physicians, have backed some of the same suggestions written in the Journal.

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