By Alexandra Power-Hays, M.D. and Patrick T. McGann, M.D.
The New England Journal of Medicine, September 1, 2020
The merciless killing of George Floyd by Minneapolis police officer Derek Chauvin and the more recent shooting of Jacob Blake by Kenosha police officer Rusten Sheskey have catalyzed the most widespread protests in American history, calling not only for an end to police brutality but also for a nation in pain to reflect on the layers of racism that allow such brutality to persist. Medicine is a mirror for the racial injustice in our society; it is a field riddled with racial disparities in everything from research funding to patient care to life expectancy. There may be no population of patients whose health care and outcomes are more affected by racism than those with sickle cell disease (SCD). Patients with SCD are too often marginalized and dismissed while seeking medical care when their bodies hurt and they cannot breathe. As medical leaders around the United States issue statements denouncing racial injustice and calling for us to “dismantle racism at every level,” we must ensure that these pledges translate into durable improvements for patients with SCD.
Unfortunately, the social construct of race in America requires the majority of patients with SCD not only to face the consequences of a serious health condition, but also to navigate a society in which the color of their skin is often an unfair disadvantage.
“Structural racism” refers to the system of discriminatory policies that assign privilege and power on the basis of race. For example, the legacy of redlining, a policy that allowed banks to deny mortgages to Black Americans who wanted to purchase homes in White-designated neighborhoods, persists today in the form of high rates of housing insecurity among Black Americans, including those with SCD. These racist policies have led to enduring cycles of poverty that result in food insecurity, fewer employment opportunities, and inconsistent health insurance coverage, all of which compound the challenges faced by people living with SCD.
United action against racism’s impact on the health of patients with SCD is long overdue. The most recent senseless murders of Black Americans and the subsequent wave of pledges to dismantle racism should be our call to action. Change begins with a conversation, but words are not sufficient; we must take action to make enduring improvements in the care of patients with SCD. In the box, we offer a framework and suggestions for initiating change. The current generation of patients with SCD should be allowed to lead full and healthy lives without fear or distrust of the health care institutions whose purpose should be to protect and serve.
Comment:
By Don McCanne, M.D.
How many of us have buried in our subconsciousness the concept – a concept that we have not even bothered to formulate in words – that structural racism is a scourge that dictates that those who perpetrate it should reform their ways as a step towards creating a more just society for all? Oops. Isn’t this very attitude part of the infrastructure that supports structural racism? Sort of like responding to “Black Lives Matter” with “Well, white lives matter too.”
The New England Journal of Medicine has made the full article excerpted above available to all for free – perhaps sort of their version of instructing others to address the scourge of structural racism. In the excerpt is mentioned a box that is also included at the link above which offers a framework and suggestions for initiating change in our attitudes toward and management of not sickle cell disease itself, but the racism associated with sickle cell disease. Hopefully this would serve in opening a door to enlightenment on this topic that has been suppressed and neglected throughout the history of our nation.
Too busy to read the full article? Clairvoyant enough to recognize that you are free of even the slightest taint of racism? How fortunate you are.
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