Race in Health Care and How Thought Can Kill
“Death is the consequence of failure.”
Racism in health care is at the forefront of recent conversation. However, is the action at the forefront of the industry as well? Building an equitable care environment necessitates learning first, yes. However, we as an industry need to note that action must follow quickly thereafter. It’s not enough to just talk about it.
In the “The Road to Equity: Examining Structural Racism Virtual Forum,” hosted by the Center for Medicare and Medicaid Services and Office of Minority Health, leaders in the industry came together to discuss the mechanics of how to get work surrounding health equity off the ground for impact that shows results.
The Problem at Hand
There are four forms of racism:
- Structural
- Institutional
- Interpersonal
- Internalized
Structural and Institutional racism are part of a larger overarching problem. To change the quality of care delivered in the health system, health care workers can focus on the last two: interpersonal and internalized.
Interpersonal racism is bigotry and bias that is expressed and experienced by individuals. Internalized racism is dependent on to what extent all of the previous three forms of racism give a person a sense of inferiority or superiority.
Therefore, health care workers will be fighting against structural and interpersonal racism as they try to dismantle the other two. One major blockade that stems from these first two categories of racism is mistrust and distrust. Mistrust is hesitation; distrust is based on experience.
On the side of the oppressed, mistrust and distrust can stem from years of historical racism within the country and within our systems. Many scientists have conducted unethical experiments on black patients such as:
- The Tuskegee experiment (1932–1972)
- The Study of Henrietta Lacks (1951)
Other atrocities have been committed such as forced sterilizations and eugenics as well.
As it is apparent, these unequitable crimes are not too far in the past for its effects to be felt. This generational uncertainty can be passed down. But that’s only one part of the problem.
Acting on Implicit Biases
Although these practices may no longer be in effect, many health care providers continue to promote distrust by way of implicit bias. Implicit bias is the unconscious way in which an individual makes assumptions about another. Very often, this is a very harmful assumption that promotes a power imbalance between two or more parties.
Reed Tuckson, founder of the Black Coalition against COVID-19 and speaker of the event, argued that a higher moral operative has to be at work to begin to remedy these disparities. This means that a conscious effort has to be made to address any implicit biases harboring in the mind. Which means it will require effort, uncomfortable conversations and action that swiftly follows that discomfort. Because what’s the consequence of failure? It is death, as Tuckson would say.
“The sense that what I do affects you; that I, through my behavior, can kill you, that ought to have a much higher operative relationship that would cause me to behave in morally and ethically responsible ways.”
The existence of distrust and implicit bias cannot be denied if we expect to move forward.
Moving Forward, Instead of Nowhere
So where to next? Karthik Sivashanker, VP at Birgham Health Equity, highlighted a five-driver framework to help the health industry take steps that move us forward, rather than keep us in one place.
The steps are as follows:
- Integrate equity into quality and safety risk analyses
- Use quality and safety education to anchor that work
- Use data to support equity improvement
- Leadership awareness and engagement
- Organizational accountability
The framework above demonstrates steps the industry can take on an interpersonal level to lessen the trust gap. However, as stated before, structural and institutional racism operate on a higher level. That means to eliminate the bigotry and bias that systemically feeds interpersonal workings, policymakers, government agencies and other organizations need to use their upper hand to create opportunities that make that possible.
Some health initiatives, and accompanying grants, are already in work to do so. For example, the Accountable Health Communities Model is a five year test that aims to link individuals with community resources that address their health-related social needs. This can include housing instability, food insecurity, interpersonal violence and more. Opportunities like these not only promote the conversation that social determinants of health (SDOH) and racism are closely intertwined, but they help turn conversation into action.
So as teams in the industry continue the conversation around health equity, it’s time to ask the question “How Will We Act to Help?” We can no longer let the pressing issue remain dormant in a cycle of discussion.
