Speaker: ‘Naming’ racism, and the harm it causes, essential to closing health inequities
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Acknowledging racism is a primary cause of health inequities is necessary if the medical community is to begin working toward closing these gaps, according to the chief health equity officer for the AMA.
Aletha Maybank, MD, MPH, who also serves as senior vice president for the AMA, contended that digital transformations have presented opportunities for people across the country to better understand racism and to feel more comfortable “naming it.” She provided the example of the murder of George Floyd which, she suggested, shows that racism is a public health threat; recently, it has become less taboo to acknowledge the role racism plays and the harm it inflicts, according to Maybank.
Racism
“It has been a tremendous opportunity to know that we can name racism and we need to name racism in causing these inequities that have existed in our country for centuries,” she said during her virtual presentation at the National Kidney Foundation Spring Clinical Meetings. “The critical questions now are: How do we move beyond declarative advocacy, or just the conversation and words? What does organized medicine need to do? What do associations need to do? What do policy makers need to do?”
Before embarking on the technical steps, Maybank stressed the importance of starting from the foundation in considering how “we value people, how we value society and the stories that we have about people and communities that impact the decisions that we make, and impact how we show up in our power and in our responsibility.”
Harm and Trauma
Here, she pointed to the trauma and harm caused by all forms of systemic oppression (including oppression on the basis of race, gender, class and LGBTQ+). These harms, she argued, not only cause damage to communities, but to the health of the individual body. According to Maybank, those on the receiving end of various kinds of oppression are more likely to develop chronic stress.
“The trauma shapes our genes over time,” she said. “It’s an environmental stressor that increases allostatic load and stress load within our body, leading to inflammation over time.”
To further exemplify this point, Maybank quoted from Ta-Nehisi Coates’ Between the World and Me, in which he wrote: “You must always remember that the sociology, the history, the economics, the graphs, the charts, the regressions all land, with great violence, upon the body.”
According to Maybank, it is essential to reflect on the harm that has caused marginalized groups to “die early and to die unjustly.”
“It’s not simply about the graphs and the numbers and the charts,” she said. “It’s about the experiences of people. It’s about the experiences of families. It’s about the experiences of children and what they’re going to pass from generation to generation.”
Responsibility and opportunity
As individuals working within the health care community, Maybank reminded the audience that their code of ethics compels them to “do no harm.” As this is a fundamental responsibility for those in the medical profession, she argued reflecting on the harm that has been caused – and the myths that may influence beliefs about certain communities – is a central piece of work. Some of these myths involve “individualism,” which falsely suggests that individual patients are solely responsible for “right or wrong choices about lifestyle choices” and are, therefore, responsible for poor health outcomes (this line of thinking has been brought to the forefront during the COVID-19 pandemic, she said). Instead of accepting these myths, Maybank said, these must be challenged and that the medical community must recognize the political, structural and social determinants of health that lead to health inequities. According to Maybank, this will lead to understanding the root causes and the root sources of disparities in health outcomes.
“I have a lot of experience as what it means to do organizational change work to advance equity,” she said. “It’s that inside-outside strategy that I think is critical. We can’t say we’re doing equity on the outside of the organization if we have not focused on and challenged how we think about, and how we understand, how our decisions may potentially exacerbate inequities or maybe improve them and close the gaps. If there is anything to walk away from presentation with, it is this: We all have the power and we all have the responsibility. This is not the burden of Black and Brown people, or any group that is marginalized. This is work for everybody.”
According to Maybank, this is an opportune moment for change, as evidenced by the executive order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.
“We’ve never been at this time before,” she said. “We haven’t ever been at a time when government at the federal level has named racial equity.”
In concluding her talk, Maybank urged the medical community to take the opportunity to do work that advances health equity.
“This is the moment when we need to capitalize on the doors that are open,” she said. “In my experience, I’ve learned that these doors open and close. And the doors right now are open and we need to push as fast and as far as we can.”
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Maybank A. Keynote: Operationalizing racial justice. Presented at: National Kidney Foundation Spring Clinical Meetings (virtual meeting); April 6-10, 2021.
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