What we need to advance equity: reflection, partnership, accountability
Significant progress towards equity in medicine begins with acknowledging the existence of structural racism, and then with an honest effort to understand how deeply systems of oppression and discrimination can influence the health of our patients.
As a family physician on the South Carolina coast for over 30 years, I have seen first-hand the results of centuries of health inequities – rooted largely in racism and social injustice – that have had devastating consequences for Black, Latin, Asian and Indigenous communities, but also for LGBTQ + people, people with disabilities and those living in rural areas.
Ours is a health care system that – in the words of Camara Phyllis Jones, MD, MPH, PhD, at the Morehouse School of Medicine – has attributed value and benefits to some communities while disadvantaging others.
These benefits can be seen across healthcare, starting with the examination room if we ignore our patients’ concerns about pain or deny them access to certain treatments or tests. Black women, for example, are less likely to be referred for cancer screening than white women, even when their own family history puts them at greater risk.
But we also see the attribution of values across society when cities neglect and discourage investment in black communities, or when racist housing and lending practices go unchallenged. We see it in rural communities where doctors’ offices are scarce and public transport often non-existent. We see it in the healthy food deserts that surround poor neighborhoods. And we see it, too often, in the police violence and brutality inflicted on black and brown communities everywhere.
These examples only scratch the surface, but they can dramatically influence a person’s chances of leading a healthy lifestyle. It has taken far too long for our community of physicians and our healthcare system to come to this conclusion, but we now know that these and other factors are a major reason why historically marginalized groups suffer from higher rates. high rates of heart disease, diabetes and other chronic conditions.
These conditions, along with the barriers that prevent access to care, have contributed to disastrous results over the past year, as communities of color have been much more likely than whites to suffer severe consequences from COVID- 19.
It is not just unfair and unfair. It is heartbreaking. It is also completely preventable.
Building on the momentum that began with a public apology in 2008 to recognize WADA’s own history of discriminatory actions against black doctors, and a growing movement within our House of Delegates (HOD) and to outside our organization, one of my first acts as chairman of the WADA board in 2017 was to appoint a health equity working group to explore these issues and come back with specific recommendations that would guide our work in the future. Their recommendations, combined with the strong support of our HOD, the AMA Board of Directors and management, ultimately led to the creation of the AMA Center for Health Equity and the development of a strategic plan on health equity. fairness across the organization that we are publishing today.
5 keys to moving forward
This plan provides a framework for advancing greater equity in health care through five strategic actions that advance equity and justice, address inequalities and, most importantly, strive to improve outcomes for patients and the quality of care for all.
Today, WADA is committed to:
- Integrate fairness and racial justice throughout WADA expanding the capacity to understand and implement anti-racism equity strategies through practices, programs, policies and culture.
- Build alliances with marginalized physicians and other stakeholders developing structures and coalitions to enhance the experiences and ideas of marginalized and minority health leaders.
- Pushing upstream to tackle the determinants of health and the root causes of inequalities by strengthening, empowering and equipping physicians with the knowledge and tools necessary to eliminate the structural and social factors of health inequalities.
- Ensure fair structures and innovation opportunities integrating and advancing racial justice and health equity into WADA’s existing efforts to advance digital health.
- Fostering Pathways of Truth, Racial Healing, Reconciliation and Transformation for WADA’s Past taking into account how policies and processes have excluded, discriminated against and harmed communities; and amplifying and integrating the stories of historically marginalized physicians and patients.
To be a leader in medicine – to fulfill our mission of promoting the art and science of medicine and improving public health – requires us, as an organization and as a profession, to recognize the wrongs of the past and take meaningful action to correct them.
It forces us to be honest and vulnerable on issues of injustice. It forces us to be humble enough to admit that we don’t know everything, but that we are committed to finding out. It forces us to learn, understand, and help lead through new partnerships and alliances.
WADA is not a pioneer in this effort. Many organizations have spoken out against racial and social injustices in health and have worked to resolve them for decades. We congratulate all those who have shone the spotlight on inequality and sought to address it. We want to be part of this solution because we think we can help. We believe that by harnessing the power of our members, our influence and our reach, we can help bring about real and lasting change in medicine.
Social inequalities and their consequences for families, for health care and for the future of our nation are far too great for WADA to be a passive spectator. We must, and we will, play an active role in building alliances, bringing together stakeholders and rallying our community of physicians around a common cause.
As WADA’s elected president, I am fully committed to this cause, its purpose and the work ahead. We are called at this time. I invite you to join us as we walk towards a more just, equitable and healthy future for all.