Want to fix structural racism in health care? Start here, panel says

By Michael Merschel, American Heart Association News

Clockwise, from left: Donald Lloyd-Jones, MD, ScM, FAHA; Lisa A. Cooper, MD, MPH; Sonia Angell, MD, MPH; Ted Love, MD; Michelle A. Albert, MD, MPH; Keith Churchwell, MD; Paula A. Johnson, MD, MPH; Hannah Valentine, MD.
From top left: Dr. Donald Lloyd-Jones, Dr. Lisa A. Cooper, Dr. Sonia Angell, Dr. Ted Love, Dr. Michelle A. Albert, Dr. Keith Churchwell, Dr. Paula A. Johnson and Dr. Hannah Valentine. (American Heart Association)

Structural racism is limiting institutions, holding back future medical professionals and harming the health of millions of Americans, a panel of prominent doctors and other leaders agreed Saturday morning.

But that same panel, convened as part of the American Heart Association's Scientific Sessions, said such discrimination could be thwarted with science, data and conversation.

The deep-seated history of structural racism, and the many ways it continues to harm Americans, was outlined earlier this week in an AHA presidential advisory. Such racism shaped neighborhoods, and that shapes lives, said David R. Williams, chair of the department of social and behavioral sciences at the Harvard T.H. Chan School of Public Health in Boston.

"Think of segregation as a burglar at midnight that slips into the community," he said. "And as soon as segregation enters, valuables disappear – like good schools. And safe playgrounds. And good jobs. And a healthy environment. And safe housing. And good transportation. And access to high-quality medical care.

"All of these things vary, powerfully, by place," Williams said.

There are other sobering indicators of the harm caused by structural racism. He noted a recent study out of Florida showing that when cared for by white doctors, Black babies are three times more likely than white newborns to die in the hospital. This disparity is cut in half when Black babies are cared for by a Black doctor.

A diverse medical workforce can help with many problems, said Dr. Lisa A. Cooper, founder of the Johns Hopkins Center for Health Equity at Johns Hopkins University in Baltimore. But people of color are underrepresented in the ranks of doctors and academia.

"There's a striking loss of scientists from underrepresented backgrounds as we move across the career spectrum," she said.

Dr. Paula A. Johnson, president of Wellesley College in Massachusetts, emphasized the need for data-driven, evidence-based ways to address institutional barriers in academia. She said her school is attempting to do so in the classroom, residential life, jobs and internships.

"And what it's doing is really leading to a remapping of entire curricula," she said. "It's leading to a rethinking of mentoring and support – not in a way that says to a student, 'You are lesser than,' but says to an institution, 'What is it that we need to do to embrace change?'"

Dr. Sonia Angell, who has served in public health roles in New York and California, and others agreed the conversation needs to shift from a focus on interpersonal racism – the type of racism most people are familiar with – to the broader issues of structural racism. In making that shift, she said, the most important skill she employs is listening.

"I think particularly at this time (when) we have such divisions in our country, listening becomes a really important part of being able to really move forward in ways that bring us all together and help us understand one another's perspectives, positions, vision or views," Angell said.

But solutions need data, so researchers need to start spending more time on the structural causes of health disparities, she said, and not just the health outcomes.

Dr. Ted Love, president and chief executive officer of the biotech firm Global Blood Therapeutics, said solutions needed to be backed by dollars. "One of the things that I focus on is investment. Someone said to me a long time ago, 'A budget is a moral document.'"

He noted that historically, for example, many more government research dollars flowed into cystic fibrosis than sickle cell disease, even though the latter is much more prevalent. Both are rare diseases, but sickle cell predominantly affects people of African descent.

Cooper said diversity and inclusion are "not only the right thing to do, they're also the smart thing to do," because they make institutions better and people healthier.

In the end, Angell said, solutions will come from bringing people together.

"Evidence is the cornerstone for good policy," she said. "But it needs to be interpreted through people who really understand what structural racism is, and what the solutions will be. And we need those people at the table as part of the individuals informing the policy, as well as the communities being affected."

Find more news from Scientific Sessions.

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