Call to action to excise racism from health care system

Gordon Bloomberg

By Gordon Bloomberg

When the COVID-19 virus stormed in nearly a year ago, not everyone was affected equally. People of color and other minority groups were the most vulnerable to an inadequate and unfair health care system, a system with cracks in its foundation rooted in racism that was exposed by the quake of a global pandemic. 

Like many other organizations, including the American Medical Association, the Jewish Coalition on Racial Equity recognizes racism as a public health issue and pledges to take immediate action to address inequities. As a retired physician and member of the organization, I join their call to action, knowing we can do better. 

There is a lack of access to medical care, a delayed response to needed care, not enough Black doctors and an absence of minority presence in clinical trials. Not being taken seriously or receiving substandard care is a common experience for people of color. I recall a conversation in which I was told, “You have to be half dead before they will see you in the emergency room.” 

In focusing on racism as a public health problem, I reflected upon opinion letters recently published in the New England Journal of Medicine and revisited my own experiences caring for children. 

I found that those who wrote letters expressed frustrations similar to mine. The physicians and public health experts felt a sense of responsibility for inequities in our health care system. 

The authors of one letter wrote that now is the time for change: 

“We — a Black medical student, a white medical anthropologist, a Black trauma surgeon and a white clinician educator —acknowledge that we are a part of medical institutions that have too often failed minority communities, and we wish for this moment of reckoning to be an inflection point in that history.” 

I was struck by another comment, both telling and sad: “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.”

Black physicians also can personally experience the pain of racism. One doctor wrote: 

“It still stings me every time a patient hands me their food tray, assuming I am a member of the cleaning staff rather than their physician, or comments on my skill with spoken English, ignorant of the fact that it is my first language.”

To be specific, a fundamental problem of our health care system is structural racism or the ways in which societies foster discrimination through mutual reinforcing systems. In other words, conditions such as unemployment, food insecurity, housing stability, household income and health insurance rates create an environment that has negative effects on health. 

As physicians, we must acknowledge that racism is deeply ingrained in our society and culture, informing unconscious judgment and implicit biases, even among the most well-intentioned clinicians. At this level, we need to fight to mitigate bias in caring for minority groups. 

The work has begun as physicians gather to discuss possible biases that might be considered racist. As a matter of training, much can be done in curriculum, lectures and patient rounds to recognize and encourage the sensitivity expected when treating patients of color. 

We should also be encouraging and supporting more people of color to pursue careers in medicine; most medical care for African Americans is delivered by a mostly white health care professionals.

As a physician specializing in childhood asthma, I have taken care of hundreds of African American children and, over time, became familiar with the daily burden of just living that parents had to endure. These children have higher rates of asthma, complications from asthma and mortality. Families face adverse social and economic issues that interfere with providing care for many of these children. 

Looking at the system as it exists, we must admit that inequalities in health, health care access and quality of care are ingrained in the U.S. health care system and work to eliminate them. 

There are some steps we can take to begin to address this complex problem.  

Here’s one: Let your elected officials know how you feel. Ask you legislators to support Missouri House Concurrent Resolution 14, which urges specific actions to address the economic and public health crisis caused by systemic racism and greatly magnified by the COVID-19 pandemic in Missouri.  

To learn more about the issue of racial disparities in access to health care, I invite you to join me March 10 for “The Great Divide: Race in Our Region.” This program will examine racism as a public health issue and how and why we must work to expand access to health care in our region. Registration is available at JCRCSTL.org.

Without addressing racism and attending to the cracks in the structure of our medical system, health disparities will continue. The time to action is now because if not now, when? 

Gordon Bloomberg is a retired pediatrician and professor of pediatrics emeritus at the Washington University School of Medicine. He is a member of the Policy/Advocacy Committee of the JCRC’s Jewish Coalition on Racial Equity.

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