Health care must lead the way in acknowledging and challenging health care disparities. When we think of the legacy of racism in the U.S., hospitals aren’t one of the first places we imagine – but they should be. “It’s never going to change.” “Sometimes it’s too heavy to bear.” ‘”I’m so angry – I’m just tired of holding it all in.” These statements reflect the pain of our patients of color. They may resonate with all of us in our country’s current climate, as the COVID-19 pandemic and Black Lives Matter movement collide, but they are anything but new. Those who are forced to navigate the racism and discrimination embedded in the social fabric of our nation face these concerns daily. Many Americans are just awakening to the realization that there is a common thread between police brutality, incarceration, and health disparities in this country. That common thread is anti-black racism, where white signifies dominant culture, and black represents “otherness.” It is historically rooted in systems, institutions, policies, and practices that create and perpetuate inequality based on race. Racial equity cannot be achieved unless the issues surrounding systemic and individual racism are addressed. Health care must lead the way in acknowledging and challenging these disparities. While the media has tried to address disparities in access to health care, particularly during the past decade, less attention has been paid to the role that health care professionals play in perpetuating these inequities, whether consciously or unconsciously. The COVID-19 pandemic has only underscored inequity in our health care system, where racial disparities have contributed to disproportionately higher rates of COVID-19 infections among people of color, who are dying at two to three times the rate experienced by whites when adjusted for age. The principle of equity tells us that care should be delivered to provide equal outcomes for all populations, many of which start with disadvantages. Yet we tolerate significant differences in, for example, maternal health. Black and indigenous women in the U.S. are three times more likely to die from pregnancy-related causes than white women. This statistic has not changed in the last ten years nor across states. And while educational levels for white women seem to protect against maternal death, black women with college degrees are still five times more at risk than their white counterparts. As health care providers, educators, and administrators, we witness and, at times, even perpetuate the practice of unequal delivery in health care services, particularly among overweight or obese women of color. The underlying and silent bias is one that unfairly presumes a lower level of cognition and willingness to assume self-health responsibility. “If she were smarter, she wouldn’t be so fat.” “She just wants pain medications.” “She’s just angry.” Such judgments are deeply rooted in the implicit biases borne of our privilege. Health care reflects such biases in our society, manifesting in hospitals, operating rooms, and clinics. Discussions about social justice may feel political, but are inherently health care issues. These conversations are integral to how nurses, doctors, and other health care professionals view the health of their patients. Shining a light on anti-black racism and the unconscious bias of health care providers is uncomfortable, but in order to change, we must become comfortable with being uncomfortable. We call on all health care professionals to: 1) identify, acknowledge, and change individual racist attitudes, mindsets, and implicit biases and the impact they have on the care we provide; 2) create space for patients’ voices in their care during visits and through ongoing evaluation; 3) analyze how organizational policies and practices either contribute to or disrupt institutional racism; and 4) make a commitment to developing and implementing an action plan to dismantle policies and practices that perpetuate systems of oppression. Social justice is health. We have a duty as health care professionals to demand change. We should not accept anything less. Kimberly Grocher, Divya K. Chhabra, Yolanda Kirkham, Naila Russell, Mary Pan Wierusz, Susan Dix Lyons, Adham Sameer A. Bardeesi, and Gillian S. Gould are media and medicine fellows, Harvard Medical School, Boston, MA. Source
