Typically, modern medicine in the United States is based upon a white Eurocentric perspective when taught to medical professionals. This fact can be evidenced by the pervasiveness of white bodies in medical literature when referring to anatomy and diseases depicted on pale skin types. Furthermore, mental health professionals may not always be well-equipped to handle the experiences of those in the racial/ethnic minority. These instances may not always be from explicitly malignant intentions. Rather, these result from institutional racism that had been established from the beginning of medical studies in the United States. In this analysis, the antecedents of institutional racism will be looked into, alongside the current strategies to remedy this problem.
Antecedents
Culture and socioeconomic differences have only been recognized as having a crucial impact on patient health outcomes in recent history. A review published by Shaw et al. argued these held beliefs contribute to an individual’s ability to effectively receive care from healthcare providers. These beliefs also cause physicians to make generalizations and miscommunicate with patients who have identities that are foreign to the provider’s paradigm. (Shaw et al., 2009). This seminal article highlights a symptom of the broader problem found in healthcare. One proper solution to this would be to advocate for a more holistic and inclusive medical education for healthcare professionals. However, although this isframed as a matter of cultural competency, it is necessary to go beyond this symptom and confront institutional racism in America.
African Americans consistently report higher levels of medical mistrust than their White counterparts (Williamson, 2021). This discrepancy has been highlighted in the Tuskegee experiments and has been the primary antecedent of focus. However, an experiment by Williamson sought to surveil the effect of mediated vicarious experiences through the news media. The results showed the differences between general and race-based medical mistrust, and that these vicarious experiences have a significant impact on how those populations perceive the medical community at large (Williamson, 2021). Ultimately, this study serves to highlight the need to bridge this divide through recognition of the deep-seated wounds from mistrust that are pervasive in the community. Healthcare professionals may not always recognize or understand the struggles that people in the ethnic/racial minority face, and it is important for the institution to reaffirm this reality. Community organizing strategies
The Bronx Health REACH coalition came together as a coalition of 40 different community and faith-based organization. They were able to assess the differences between races and within institutions which resulted in a separate and unequal distribution of care. In order to come to this conclusion and find solutions to these inequities, they generated a report about their research and findings studying medical apartheid in New York City. (Calman, et al., 2005). They responded to these inequities through a host of community organizing strategies. These strategies included the sponsoring of several community health and disease prevention programs, as well as community advocacy events and volunteer coordination. (Calman, et al., 2005).
Furthermore, a perspective in the New England Journal of Medicine detailed the “White Coats for Black Lives” demonstrations. This coordinated protest was done in response to the killing of an unarmed black man, but also drew attention to the institutional racism present within medical centers and academia at large. The community organizing strategy was done through a call to action posted online. This was followed up by medical students in California who coordinating thousands of medical students from 70 different schools across the United States. They protested through holding large die-ins for the administrations of these institutions to examine their bias (Ansell and McDonald, 2015).
Other health education methods
A seminal report by the Aspen highlighted the importance of the structural racism framework for community building and health education. They support the idea of practitioners viewing the problem with a race-conscious perspective. This is an active approach that not only engages the community, but also promotes advocacy for system-level change. To that end, they highlight the need to invest in local community-building organizations, identifying key policies that need reform, and acknowledging the existing disparities (Lawrence et al., 2004).
New York City’s health commissioner, Mary Bassett, detailed her recommendations in a perspective piece published in the New England Journal of Medicine. She highlights critical research, internal reform, and public advocacy to combat institutional racism. The research aspect would highlight identifying the forms of racial and social inequality that persist within our understanding of health and health outcomes. Internal reform was described as coming from a place of direct representation and community engagement. Finally, she recommends that physicians and other healthcare professionals use their social status and credibility to amplify the demands to change health policies and call out inequities (Bassett, 2015).
An editorial piece by Ramaswamy and Kelly echoed this sentiment and identified public health nurses as being critical as teachers and advocates (Ramaswamy and Kelly, 2015). They describe the problem being perpetuated by policymakers, politicians, employers, hospital administrators, urban planners, and housing authorities. The reason why they would be great teachers and advocates is because they are uniquely situated to have firsthand experience confronting these inequities on a daily basis. Based on that experience, they would be able to speak on it to administrators who would be in a position to make the necessary changes.
Conclusion
Modern medicine may not always consider a healthcare perspective that considers the effects of race/ethnicity and social determinants of health. Ultimately, this issue is not novel in its conception, and has been an active reality for many Americans that has been glossed over in the past. Although there have been steps taken to reduce these disparities caused by race, it is important to remember the systems and institutions that serve to perpetuate these situations. Current strategies that address this topic take into account a multidisciplinary approach that considers the larger structures that allow institutional racism to persist. Through community organizing, it is possible to advocate for a more holistic and inclusive medical education for healthcare professionals.
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