The AMA and its House of Delegates overwhelmingly voted for the first time to adopt policies that name and act on racism as a public health threat.
By Aletha Maybank
Essence, November 18, 2020
Betsey, Lucy, and Anarcha. The names of three enslaved women were memorialized on screen during the third episode of the first season of HBO’s Lovecraft Country. These names symbolize three women who were stripped further of any sense of human dignity during their time held captive and surgically experimented on without anesthesia for years by a prominent, white physician, J Marion Sims, to preserve one of the earliest engines of capitalism: the Black woman’s womb.
Dr. Sims has been considered the ‘father of gynecology’ — he invented the vaginal speculum still used today, and in 1875, he was elected President of the American Medical Association (AMA), the oldest, largest, and considered the most powerful organized body of medicine in the country. In reality, Sims’ presidency despite his gross use of power and disturbing legacy is not an isolated moment of racist norms within the AMA. This troubling history of medical experimentation is deeply connected to the health inequities Black women still experience to this day — a heartbreaking reminder of how systemic racism and health care have been intertwined for centuries.
In recent years, AMA has begun to reckon with not only its own racist past, but also the racist past of the larger field of medicine, in which it has been highly influential.
And this past Monday marked an historic day for the entire of community of medicine and the broader society at large: the American Medical Association and its House of Delegates for the first time in its history passed and adopted policy that sheds light on the harms and tragedies of racism for all of society and medicine to see. The 600+ delegates from across the nation voted overwhelming to adopt policies that name and act on racism as a threat to the public’s health, rid our healthcare system of racial essentialism, and support the elimination of race as a proxy for ancestry, genetics, and biology in medical education, research, and clinical practice.
It is racism, not race that produces higher death rates among Black women during childbirth, and of the babies that they bear. Years of institutional and structural racism has produced the highest rates of heart disease and high blood pressure for Blacks. Racism has produced the highest rates of getting and dying from COVID-19. How powerful it is that one of this nation’s founding tenets is now a recognized threat to its existence and the existence of the most targeted and harmed by the profession whose code of ethics demands that we “do no harm.” But we know that racism in medicine has created and perpetuated generations of harm.
While not exactly known, a confluence of events pushed the AMA to this critical juncture in history – the presidency of the first Black AMA President, the leadership of the Black Lives Matter movement, resurgence of white supremacist action and terror, previous efforts of AMA’s Commission to End Health Disparities, recent AMA policy for the establishment of the AMA’s Center for Health Equity, the exposure of long-standing inequities by COVID-19, and the countless public murders of Black women and men at the hands of police, to name a few.
As a matter of time, most would say AMA’s recent actions are long overdue. We cannot go back. However, we can and must now better understand the harms of racism and work to dismantle and redesign injustice out of our culture and systems.
A core strategy to ensure justice in our systems is centering the voices of those most marginalized. Many of our brave leaders of the reproductive justice movement have long said, “listen to Black women.” Black women bring their minds and their hearts, as well as their lived experiences to justice work – it is personal in every way. The toll racism takes upon Black women, whether advocating inside or outside of organizations, is often underappreciated.
This Tuesday, as the deliberations of the AMA’s House of Delegates ensued, Black women physicians shared their stories experiencing and witnessing discrimination and racism at the hands of medicine and of police. Their stories, along with other AMA voices of student and physicians, changed hearts and minds and moved the house of medicine toward a brighter day.
As Black women leading justice work – formally and in our everyday lives, exhaustion permeates our minds and hearts. Black women have fought in body and voice, in silence and with great stir. And the cost to our health has been great and unjust exemplified by the extraordinary lives of Betsey, Lucy, and Anarcha – our ‘mothers of modern gynecology.’
The way forward for the AMA and other historically white institutions in our nation necessitates meaningful and deliberate action from many more accomplices, not only those of us most marginalized historically, operating in coalition and with great urgency.
Our collective freedom demands it.
Aletha Maybank, MD, MPH, recently joined the American Medical Association (AMA) in April 2019 as their inaugural chief health equity officer and vice president. Her role is to embed health equity in all the work of the AMA and to launch a Health Equity Center.
AMA: Racism is a threat to public health:
By Don McCanne, M.D.
With all of the bad things happening recently, one good that has come out of this is the awakening of those of us who have long recognized that racism is still with us and that is a bad thing, but who have been insensitive to the prevalence and intensity of structural racism. By our passivity and sometimes blindness to subtle and even frank racism, we have been unintentional accomplices to the perpetuation of structural racism. Our awakening allows us to first recognize our role and then to do something about it (which won’t be addressed here because of the complexity of the subject).
Although Physicians for a National Health Program (PNHP) has long supported primarily single payer health care reform, we also support other policies of health care justice, including addressing the racial inequities and injustices that can result in adverse health outcomes. In our reawakening we are currently revising our mission statement which should more clearly express this goal.
The American Medical Association (AMA) has, through the decades, supported the interests of physicians. They have not been very big on issues of health care justice, although they have not been totally blind to the topic. On average, their membership has been more politically conservative than the membership of PNHP, though there is overlap in both organizations, but that has caused the AMA to continue to reject comprehensive, universal, equitable health care coverage for everyone. However, especially with the input of students in medicine and the other health professions, that resistance has been subsiding.
This week the AMA House of Delegates has taken a giant leap forward by approving “policy that sheds light on the harms and tragedies of racism for all of society and medicine to see.”
It is hoped that this introduces a new era for the AMA in which they join with organizations such as PNHP in strongly supporting health care justice for all. Since their current policies on health care financing fall far short and would perpetuate most of the current injustices, we would urge them to finally come on board and support single payer improved Medicare for All. At least, considering the HOD resolution they adopted this week, we know that they do have their compass pointed in the right direction.
(Don McCanne is a member of both PNHP and the AMA.)
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