“But in spite of a decade of significant progress, the problem is far from solved. The deep rumbling of discontent in our cities is indicative of the fact that the plant of freedom has grown only a bud and not yet a flower.”
As. Dr. King addressed the audience in Atlanta, GA in his now famous speech, titled “Where Do We Go from Here,” he was inspired to look back. To look back over a decade of victories, from the lunch counter to the voting booth, for Black Americans. He reflected over the opportunities that had arisen as a result of efforts that Black, and white people, across the nation were leading to ensure civil rights for all Americans.
A new year offers an opportunity to reflect. To look back at where we’ve been over the past year, as a way to guide us to where we are going. As a physician, I reflect on the hundreds of thousands of Americans who have lost their lives from the Covid-19 pandemic. As a health equity researcher, I reflect on the millions of Black, Latinx, and Native Americans who have disproportionately felt the toll of this virus, physically, mentally, and economically. And as a Black man, I reflect on the many names that were added to the canon of Black Americans whose lives were lost as they did what we all have the right to do: running, sleeping, breathing.
The addition of these names, including Ahmaud Arbery and Breonna Taylor, along with the health disparities that the pandemic exposed, produced public cries to finally treat racism as a public health crisis. They also pushed many towards the recognition that saying “I’m not a racist” is different from actively working to dismantle racist policies, ideas, and practices that are baked into everyday life. In other words, becoming “antiracist.”
As support for antiracism and the Black Lives Matter movement reached an all-time high globally, health care organizations around the U.S. made historic commitments and developed policies in support of racial justice and equity. These included the American Medical Association, which for over a century barred Black physicians from joining their ranks, as well as the American Public Health Association. President-elect Joe Biden appointed Dr. Marcella Nunez-Smith to co-chair his Covid-19 advisory board and lead a new White House task force on health equity. Nonetheless, despite unprecedented support for these issues, we must now ask, how do we sustain antiracism beyond a moment and into a movement? Here are a few ways how.
Desegregate The Healthcare System
While black and white photographs of “Coloreds Only” clinic waiting rooms remind us of a chilling past in America, the legacy of that segregation persists in our health system today. My own research has found Black and Latinx patients are more likely to be cared for by a resident physician in training than white patients. A recent study from a teaching hospital in Boston, MA showed that Black patients with heart failure were less likely to be admitted to specialized cardiology units in the hospital, despite their level of care needs. To sustain antiracism in medicine, we must ensure that regardless of race, or insurance status, all patients can have access to the highest quality of care.
Divest From Racist Practice And Policy
When the news that Jacob Blake remained handcuffed to his hospital bed after gunshots by police in Kenosha, WI left him paralyzed, the public demanded that something be done. Yet this is the scene in emergency departments every day across the country, as doctors and nurses provide care for incarcerated individuals, many of whom are Black and brown. Furthermore, research has shown that Black patients are more likely to have hospital security called for them than white patients. For medicine to truly be antiracist, we must address decades-long health system policies and practices that are disproportionately punitive for patients of color.
Diversify The Medical Workforce
Several research studies have now shown that when a Black patient is treated by a Black doctor there is higher health care engagement, from receiving the flu vaccine to deciding to go along with an invasive cardiovascular procedure. Still, the rates of minorities in medicine remain desperately low, including Black men, who make up 1.5% of the physician workforce. Sustaining antiracism in medicine will require that those with lived experiences are leading efforts to address the far-reaching tentacles that racism has on nearly all aspects of health and health care.
Develop Antiracist Medical Training
While over 90,000 research papers have been published on Covid-19 since the start of the pandemic, merely 22 published medical school curricula exist to teach antiracism. Thus, despite centuries of discrimination and bias, often promoted by scientific and health care leaders, medical trainees remain underexposed to this history. A history that results in dangerous false beliefs about biological differences between Blacks and whites. The time is now to push forth an antiracist educational agenda, across all healthcare professional training, and adopt measurable competencies and targets that will sustain these efforts long after we are finally able to return to the classroom.
Deepen Investments In The Community
As the pandemic has revealed, the social determinants of health are just as critical, if not more so, as the pills a physician prescribes. For example, studies have found that when people have stable housing options, they are more likely to see a primary care doctor and lower their overall healthcare costs. The health system has to boldly move beyond what we have traditionally seen as our lane of office and hospital-based care to fully embrace our role as anchor institutions, providing food, housing, and employment support to the communities we serve.
As the start of this year has reminded us, we still have a long way to go on our journey towards antiracism in the U.S. And so just as Dr. King asked over 50 years ago, I ask you today, where do we go from here? Are we willing to rest on the accomplishments of the past year? Or are we ready to run forward, with the lessons learned, towards equity and antiracism in medicine?