Above photo: Bryce Hill stands in line to vote while wearing his “Black Lives Matter” mask at the Durham County Library on the first day of early voting in Durham, North Carolina on October 15, 2020. Cornell Watson/Getty/Washington Post.
NOTE: To learn more about racism in the United States’ healthcare system, check out our toolkit.
Racism creates and entrenches health inequality.
The AMA said it would enact new policies to address the injustice and work to support research in the area.
The American Medical Association has officially defined racism as a public health threat that has created substantial health inequality.
Racism, both systemic and structural, has historically perpetuated health inequality and cut short the lives of many Black, indigenous, and people of color (BIPOC) in the US and around the world.
Over the last year, a number of county and state authorities have also labelled racism a public health threat.
Among them are county councils in San Bernardino, California, and Montgomery, Maryland, as well as authorities in Michigan, Nevada, Cleveland, Denver, and Indianapolis.
“The AMA recognizes that racism negatively impacts and exacerbates health inequities among historically marginalized communities,” Willarda Edwards, an AMA board member, said in a statement published Monday.
“Without systemic and structural-level change, health inequities will continue to exist, and the overall health of the nation will suffer.”
Dr. Jessica Shepherd, a Black OG-GYN in Dallas, told Business Insider AMA’s move is critical to address racial disparities in healthcare from the top down.
“We fail to realize that there are so many things that occur at the systemic part of healthcare that if we don’t make changes such as the one we’re discussing now, then we’ll never really get to the heart of the problem,” Shepherd said.
Still, there’s a lot more work to be done. “Meaningful impact happens when words become action,” Dr. Jose Torradas, an emergency medicine physician who’s worked extensively with Spanish-speaking and low-income populations, told Business Insider.
“Our asymmetric approach to public health and the distribution of resources has taken form over decades, and change won’t happen overnight.”
COVID-19 has disproportionately affected people of color
The disparity has been extremely apparent during the coronavirus crisis, in which BIPOC have been disproportionately affected.
Black Americans and Hispanic Americans are dying in greater numbers than any other ethnic group and, according to an analysis from The New York Times, are three times more likely to catch the novel coronavirus and twice as likely to die from COVID-19 than white Americans are.
The largest analysis of its kind, released last week, found Black people in the US and in the UK were twice as likely to contract the illness than white people.
Reports from early April showed that Black Americans had so far made up up 39% of deaths in Chicago, 42% in Illinois as a whole, 40% in Michigan, and 81% in Wisconsin’s Milwaukee County.
Pregnant women of color also seem to be at higher risk for severe COVID-19 cases, with one study in the UK finding that more than half of hospitalized pregnant COVID-19 patients were from ethnic minority groups.
Why racism, not biology, drives up rates of preexisting conditions among POC
BIPOC tend to have health conditions that make them statistically more susceptible to infectious diseases. But that’s not simply genetics; it’s access to care, fresh food, and exposure to dangerous environments.
“We have to make sure that people understand that race is not biology,” Dr. Camara Jones, an epidemiologist and physician with affiliations at Morehouse, Emory, and Harvard universities, previously told Business Insider. “This false narrative of biologically-based differences in the races? It has been debunked.”
Studies have also found that Black people in the US are less likely to seek medical help for ailments. That’s influenced by the historically racist American health system, which, for example, allowed Black men to die, go blind, and experience other severe health effects from untreated syphillis as a part of the infamous Tuskegee experiment.
Reluctance to seek medical care is also influenced by the fact that people of color are underrepresented in the medical community, which affects patient care, Shepherd said.
“Many times we have seen that communication can differ, and placing people in the community who look like them can have great impact on outcomes,” she said. One study found that Black babies are three times as likely to die as white babies when cared for by white doctors. Another found Black men who had a Black doctor received more effective care.
Torradas said that rather than overt racism, racial disparities in access to care is the threat to public health. When he worked in a low-income California county, for example, there were far fewer clinics and much longer waits than his training location in an affluent corner of New York.
“Even with insurance many people in the US have to wait weeks or months to get care,” he said, “but it’s even more pronounced in poorer areas.”
Studies have found Black people receive different treatment
Systemic racism plays out in other ways, too.
“To this day, Black people are less likely to get the same treatment in terms of pain medication, they’re more likely to wait longer in the ER, they’re less likely to be taken seriously — it’s a holdover from the days of slavery,” Dr. Jennifer Lincoln, an OB-GYN, said on TikTok in response to the death of Nicole Thea, a London-based social media star, who died July 11 along with her unborn child at 8 months pregnant.
Lincoln highlighted a study showing that 50% of doctors and residents surveyed falsely believe Black people experience pain differently than white people, leading to inappropriate treatment.
The announcement initiates several new policies
It is unclear exactly what the incorporation of the new definition means for the AMA.
In 2018, the AMA itself came out to apologize for actively discriminating against Black doctors and physicians between the 1800s and the 1960s, preventing many from joining medical societies.
The AMA apologized “for its past history of racial inequality toward African-American physicians, and shares its current efforts to increase the ranks of minority physicians and their participation.”
On Monday, the association said it would enact several new policies, including:
- To “encourage governmental agencies and nongovernmental organizations to increase funding for research into the epidemiology of risks and damages related to racism and how to prevent or repair them.”
- To “encourage the development, implementation and evaluation of undergraduate, graduate and continuing medical education programs and curricula that engender greater understanding of the causes, influences, and effects of systemic, cultural, institutional and interpersonal racism.”
Torradas told Insider he’d like to see racial disparities addressed by moving away from for-profit health systems and a fee-for-service payment model, incentivizing medical providers to practice in poorer neighborhoods.
“If someone has to choose between their medicine and keeping the lights on or feeding their family, they will most certainly forego the medication all together or start rationing their pills,” Torradas said.
‘It is not sufficient for medicine to be nonracist’
Michael Suk, an AMA board member, said Monday: “AMA is dedicated to dismantling racist and discriminatory policies and practices across all of health care, and that includes the way we define race in medicine.”
“We believe it is not sufficient for medicine to be nonracist, which is why the AMA is committed to pushing for a shift in thinking from race as a biological risk factor to a deeper understanding of racism as a determinant of health.”
Shepherd told Business Insider that it’s important for organizations that take responsiblity for making changes like these, rather than leaving the onus on individuals.
“I’ve been pleasantly and unpleasantly surprised with how far we’ve gotten, and I can only imagine how far we can get if we continue to have these conversations,” she said. “This is not going to happen overnight. This is something that’s going to a while to get to some feeling of resolution.”