By Rupinder K. Legha, David R. Williams, Lonnie Snowden, and Jeanne Miranda
Health Affairs Blog, November 4, 2020
The coronavirus pandemic has exposed the racist structures, policies, and ideologies that are killing Black lives with impunity. Then on May 25th, 2020, a police officer charged with protecting the community instead exerted the weight of his knee and the force of his power to end George Floyd’s life, a painful visual depiction of racism that most were unable to deny. Health care workers have joined worldwide protests against the pandemic of American racism; but we, too, must ask how we can get our knees off Black people’s necks.
Racism and anti-Blackness in our country’s structures and medical systems can be seen as clearly as the footage of Mr. Floyd’s life being taken. They warrant immediate reform. Drawing upon Ibram Kendi’s scholarship, we propose an anti-racist approach to medical care that emphasizes recognizing racism’s historical roots, identifying racism within ourselves and our medical systems, and then dismantling it with the ultimate goal of challenging enduring racial health disparities.
An Anti-Racist Approach to Clinical Care: Five Core Components
- Learn the legacy of racism in American medicine to avoid perpetuating it.
- Admit to being racist to become anti-racist.
- Slow down: Pause to heighten racial consciousness and prepare for challenging racism.
- Identify and oppose racism at the individual, institutional, and policy level.
- Our hospitals and health care institutions must become involved in human capital and economic development in local communities. Health systems often serve as anchors in communities and should, therefore, take an active part in building health equity.
(Each of these components is discussed in the article.)
An anti-racist approach to medical care cannot overcome the structural racism embedded within our country nor rectify centuries of oppression and injustice. Nor does it address the racism and racist abuse experienced by Black medical students, residents, and attending physicians. Despite its shortcomings, however, an anti-racist approach empowers health care providers to immediately challenge the racism and anti-Blackness that ended George Floyd’s life. By admitting to being racist in order to become anti-racist, we can redirect the weight of our authority to get off Black people’s necks and to protect them instead. We encourage similar approaches focused on other racial, sexual, and gender minority communities, too.
Rupinder Legha, MD, is an assistant clinical professor in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles.
David R. Williams, PhD, MPH, is the Florence Sprague Norman and Laura Smart Norman Professor of Public Health and chair of the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health. He is also a professor of African and African American studies and sociology at Harvard University.
Lonnie R. Snowden, PhD, is a professor of health policy and management at the University of California, Berkeley School of Public Health.
Jeanne Miranda, PhD, is a professor in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles.
By Don McCanne, M.D.
Enough stress lately? We need to refresh our thinking.
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