These 'concrete steps' could help fight racism in health care

医生, hospitals and medical schools should take specific actions to fight the structural racism that threatens the health of millions of Americans, according to a new report meant to help guide the medical establishment.

建议包括, which are part of the 2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics report:

– Medical schools should require first-year students to take a course on social justice, 种族和种族主义, and trainees should spend time immersed in the communities they serve.

– Education about national, local and institutional history related to 种族和种族主义 should be a part of medical school curriculums and continuing education programs.

– Health care entities should conduct annual reviews that ask, "How is racism operating here?"

都是a的一部分 更广泛的报告, published simultaneously Tuesday in the AHA's journal Circulation and in the Journal of the American College of Cardiology. The report offers guidance for medical schools, physicians and other health care professionals.

It follows statements from several professional societies and the Centers for Disease Control and Prevention that acknowledge how racism threatens public health. But the report does more than just note the problem, said Dr. 卡马拉P. Jones, who co-wrote the section on social justice and racism.

"These are concrete action steps that can equip people who are trying to move to action to know what we do first,琼斯说。, 家庭医生, epidemiologist and past president of the American Public Health Association.

Most aspects of a person's health are determined by factors outside of a health care setting, 她说. Our health is "created by the conditions of our lives – by schooling, 通过住房, and by access to fresh fruits and vegetables, and by living in a clean environment, 还有收入和财富." In America, racism heavily influences all those conditions.

Dr. 威利E. 劳伦斯小., a cardiologist and co-chair of the task force that wrote the recommendations, said addressing racism is crucial to addressing all kinds of health problems, such as high blood pressure.

"If it is your goal as a medical institution to train physicians to provide better care to a broad range of people, then one of the things that you have to recognize is that it's not just what you learn in your pharmacology class that's going to lead to better management of hypertension,劳伦斯说, medical director for health equity at Spectrum Health in Michigan.

Factors such as the ones Jones listed, known as the social determinants of health, "may have a bigger impact on whether you get that patient's blood pressure controlled, whether you get that patient to actually take that pill."

Building community is one of the cornerstones of fighting racism, 琼斯说, which is why getting medical trainees to do home visits or work in community settings is essential.

劳伦斯 agreed, saying doctors need to know how to reach patients where they are. That applies to medical professionals of all backgrounds, and he used himself as an example.

劳伦斯, who was raised mostly in a single-parent home on the east side of Cleveland before attending Harvard University and training at Johns Hopkins Hospital, said it can be easy for any well-off doctor to overlook the challenges of being poor, when something as simple as a $4 co-pay for a medication can put it out of reach.

There can be "an assumption that somehow because I'm Black, I automatically understand my poor Black patients,他说. "Well, that's not necessarily a safe assumption. Because the fact is, there are some things I was never taught in medical school."

He didn't learn about the infamous 塔斯基吉梅毒研究 until he was well into adulthood, 例如, and was never taught about the history of discrimination against Asian Americans.

The knowledge of such things, he said, "makes us more compassionate. And I think it makes us better physicians."

That's the idea, 琼斯说.

The report's recommendation to require history lessons, 她说, came out of work she did recently that proved to be "revelatory" for the schools and hospital systems that took part. 对于参与者, knowing the history of their workplaces – how the location was chosen, who wasn't allowed as patients, or who was or wasn't allowed as physicians – "opened their eyes" to how racism works.

She and 劳伦斯 acknowledged the challenges ahead.

"I think that race is a very difficult subject to talk about," 劳伦斯 said. "And if you want to quiet down a room, you walk in and you start talking about some issue related to race. 它不舒服."

But the recommendations are not radical, he said. They would have "a significant impact" on medical school curriculum. 但在他们的核心, they want to foster the idea of allyship – working in partnership with people who are enduring structural racism or other systemic discrimination – and a greater understanding of patients.

"They're not really lofty goals,他说. "They're basic goals related to achieving health equity."

成功, 琼斯说, it will require support from and training for all levels of the medical establishment. "Because we certainly don't want the next generation to grow up still ill-equipped to deal with these broader issues" or to lack the understanding that anti-racism is a core part of their work as physicians.

“所以我要说的是, we are all planting seeds" that eventually will bear fruit within the world of health care and throughout society, 她说. "This is not the end of the story. 这是开始."

If you have questions or comments about this story, please email (电子邮件保护).