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dcyphr | Dismantling Structural Racism, Supporting Black Lives and Achieving Health Equity: Our Role

Introduction

On July 7, 2016, Philando Castile was shot and killed by a police officer. The unnecessary force of this incident can be seen in the past two weeks since this publication with the death of Terence Crutcher and Keith Scott. The disproportionate use of lethal force against communities of color is not a new phenomenon. However, the production of video evidence has allowed the traumatizing experience of black Americans to be more readily seen. The cause of this force is rooted in the structural racism present in America. This structural racism is a result of practices and behaviors that has been perpetuated by institutions, culture, history, and ideology to continue inequality felt by communities of color. This is what cuts the lives of too many black Americans short. 


The word racism was only found in 14 NEJM articles within the last 11 years. Most physicians are not explicitly racist and are committed to treating all patients equally, but they operate in an inherently racist system. The evidence that documents unequal health outcomes based upon race is rapidly evolving. In order to help beat the structural racism found in medicine clinicians and researchers need to take an active role in defining the root cause. 

Structural racism is related to, but separate from interpersonal racism and increases deaths in colored communities. This is all too prevalent and is a threat to the physical, emotional, and social well-being of every individual that gives power “privilege” based on race. The researchers of this study offer 5 suggestions for other clinicians and researchers to help dismantle the structural racism inherent in the medical systems. 


  1. Learn, understand and accept America’s racist roots

Structural racism was born from the teachings and rules of white supremacy which was invented to justify mass oppression for economic and political exploitation. This was seen through the centuries of slavery based upon race and the constitution literally said that a black life was equal to ⅗ a white life. This has led to scientific research and clinical practice to be based upon race and has led to structural racism inherent in the US healthcare system. This has led to worse health outcomes for the lives of black Americans and can be seen as an extension of the historic belief that white lives are worth more than a black life. Health care professionals should collectively and individually understand the historical roots of health inequity in order to help dismantle it now. 


  1. Understand how racism has shaped the disparities narrative 

Researchers and clinicians have long upheld a narrative that there are innate biological differences between the races. Recent studies of medical studies show that 50% fo white medical students still believe in certain false beliefs: black blood coagulates quickly, black skin is thicker. These implicit biases are false beliefs and we all hold them. It is vital that we observe them and understand how they contribute to health inequalities. 


  1. Define and name racism 

Race is defined as the “social classification of people based on phenotype” and racism is defined as “a system of structuring opportunity and assigning value based on phenotype (race) that: unfairly disadvantages some individuals and communities; undermines realization of the full potential of the whole society through the waste of human resources”. It is vital that identifying the discussion of race is separated from the racism present in our work and writing. As researchers our interactions will permit us greater depth in understanding this if we make an effort to combat it. 


  1. Recognize racism, not just race

When we indicate our race in various forms for clinicians is this information acquired to indicate race or for racism?  Race is often used when referencing that Black Americans have on average worse outcomes with diabetes. In order to combat this clinical research must change its focus from race to racism.


  1. Center at the margins 

To provide equal medical care it is vital to shift the focus from the majority to the minority. As historical views shaped by centuries of explicitly and implicit bias bolster the experience of white Americans.  Refocusing at the margins will require clinicians and researchers to redefine what is considered “normal”. Health care professionals will need to understand how they arrive at certain conclusions so as to understand any potential racial biases. This will provide better health equity to the disenfranchised and will reveal new clinical information. Health care professionals have an obligation and most importantly the power to help change this system and in doing these 5 suggestions will help to give a voice to those who are voiceless.