In this episode of Clinical Problem Solvers: Anti-Racism in Medicine, we are joined by Aletha Maybank MD, MPH, the American Medical Association’s (AMA) inaugural Chief Health Equity Officer and director of the AMA’s Center for Health Equity, and Camara Jones MD, PhD, MPH, thought leader in the fields of health equity and public health and former president of the American Public Health Association (APHA). We discuss policy, professional organizations, and history as they relate to advancing health equity, and imagine what the anti-racist health system of the future looks like.
After listening to this episode listeners will be able to…
- Recognize that racism is both structural and interpersonal, and that both aspects must be addressed simultaneously.
- Appreciate the importance of acknowledging history and sustaining institutional memory in advancing anti-racism efforts and achieving structural change.
- Understand that collective action and a focus on community, rather than individualism, are most effective in combating racism and achieving health equity.
- Written and produced by: Rohan Khazanchi, LaShyra Nolen, Naomi Fields, Dereck Paul, MS, Utibe R. Essien, MD, MPH, Michelle Ogunwole, MD, Chioma Onuoha, Jazzmin Williams, and Jennifer Tsai MD, M.Ed
- Hosts: Rohan Khazanchi, LaShyra Nolen, Naomi Fields
- Infographic: Creative Edge Design
- Show Notes: Chioma Onuoha
- Guests: Aletha Maybank MD, MPH, (@DrAlethaMaybank) and Camara Jones MD, PhD, MPH (@camarajones)
Episode 5: Racism, Power, and Policy: Building the Antiracist Health Systems of the Future
01:14 Guest Introductions
03:09 Framing Racism
05:15 Allegory: Cement Dust in Our Lungs
07:00 The AMA’s Declaration on Racism as a Public Health Threat
13:28 History and the AMA and APHA Movements
15:20 Barriers to Achieving Health Equity in Medicine
20:55 Documenting, Centering, and Institutionalizing “The Work”
23:30 The AMA’s Racist Past
31:00 How Do We Create Sustainable Work?
35:25 Creating and Maintaining Urgency
39:00 Racism Saps the Strength of the Whole Society
43:43 Building an Anti-Racism Health Care System from A Grassroots Level
52:15 Building an Anti-Racism Health Care System from A Governmental Level
53:45 Health is Not Created with the Health Sector
56:53 Why Must All Health Workers Practice Anti-racism?
- Name Racism for What It Is
If we don’t explicitly say the word racism, and identify its historical context, then we are complicit in its denial. Racism denial is deeply ingrained in our society and it needs to be called out and recognized as a system in order to be addressed. Though the field of medicine often fails to think systematically, it is imperative that all healthcare workers learn to recognize racism, actively practice anti-racism, and acknowledge the many systems that impact people and community’s health.
Four Key Messages for Naming Racism:
- Racism Exists
- Racism is a System
- Racism Saps the Strength of the Whole Society
- We can Act to Dismantle Racism
- History and Documentation are Key
Our country habitually denials racism by working to make its impacts invisible. Remembering history and collecting institutional memory avoids the danger of repeating work, wasting labor, and makes clear racism’s long standing effects. Part of this effort also includes learning the history of the organizations and institutions we are a part of.
- Focus on the Community
While the health sector is where illness and ailments are often treated, a person’s health largely manifests outside of the health sector and is impacted by their community and environment. One of the biggest barriers to health equity is the narrow focus on the individual and a failure to see health as a widespread community issue. We must recognize that all policy is health policy and that which affects someone outside of the health sector may also affect their health. Our future should be grounded in our communities; our solutions cannot solely be declarative or institution-driven.
Barriers to Achieving Health Equity
- Narrow focus on the individual – makes systems and structures invisible or irrelevant
- We as a nation are ahistorical – we need to bring history into the fold
- Our endorsement of the myth of meritocracy – the uneven playing field
- White supremacist ideology
To learn more, read about Dr. Jones’ Seven Values Targets for Anti-Racism Action
A movement can disappear as quickly as it arose if it is not institutionally ingrained. This means that anti-racism must be embedded into practice, performance standards and institutional culture. All policies, decisions, and behaviors should occur through the lens of anti-racism in order for its impact to be longstanding and effective.
The Power of Collective Action
“When we acknowledge each other’s work we acknowledge the power of collective action”
– Dr. Camara Jones
Addressing structural racism is a collective effort and is more effective when we shift from “what can I do” to “what can we do”. When we lift up our peers and validate/center the work of people on the margins, we recognize the power of collective action and ensure that efforts are not erased or lost. This includes recognizing the experts that have come before us and reaching out to younger generations.
Addressing Structures and Values
Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks. In order to address racism, we must address both the structures and the values. Structures include the ways that racism is institutionalized and systematically reinforced, and values include the way that racism manifests in our shared consciousness. Addressing values will require us to make clear that “racism saps the strength of the whole society” and to highlight the urgency of anti-racism efforts. Additionally, we should equip educators, parents, and those who will guide the next generations with the tools to operate within the framework of anti-racism. Because structural racism often operates through inaction and complacency, the work to combat it must be persistent and collective. Racism hurts all people and achieving anti-racism will require active “fellows in the struggle” not just feeling allies.
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Jones, C. Camara Jones, APHA executive director citation award acceptance speech. [Video]. YouTube. https://youtu.be/BGmIXV859YQ. Published December 2, 2020. Accessed December 9, 2020.
Jones, CP. (2020). Seeing the Water: Seven Values Targets for Anti-Racism Action. Harvard Medical School Primary Care Blog. Retrieved from http://info.primarycare.hms.harvard.edu/blog/seven-values-targets-anti-racism-action
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- Jones, C. Camara Jones, APHA executive director citation award acceptance speech. [Video]. YouTube. https://youtu.be/BGmIXV859YQ. Published December 2, 2020. Accessed December 9, 2020.
- Jones, CP [@CamaraJones]. (2020, Nov 28). My map with the 28 states (in red) with at least one city/county/state-level body declaring “Racism is a public health crisis.” Each state name is followed by the number of jurisdictions making these declarations. State name is in CAPS if there is a state-level declaration. [Tweet]. Twitter. https://twitter.com/CamaraJones/status/1332729107952627712?s=20
- Maybank A. A Historic Day For Black Women, A Historic Day For The American Medical Association. Essence. Published November 18, 2020. Accessed December 7, 2020. https://www.essence.com/lifestyle/health-wellness/black-women-american-medical-association-racism/
- Maybank A. The Pandemic’s Missing Data. The New York Times. https://www.nytimes.com/2020/04/07/opinion/coronavirus-blacks.html. Published April 7, 2020. Accessed December 7, 2020.
- Metzl JM, Maybank A, De Maio F. Responding to the COVID-19 Pandemic: The Need for a Structurally Competent Health Care System. JAMA. 2020;324(3):231-232. doi:10.1001/jama.2020.9289
- O’Reilly KB. AMA: Racism is a threat to public health. American Medical Association. Published November 16, 2020. Accessed December 7, 2020. https://www.ama-assn.org/delivering-care/health-equity/ama-racism-threat-public-health
- Prioritizing Equity video series. American Medical Association. Accessed December 7, 2020. https://www.ama-assn.org/delivering-care/health-equity/prioritizing-equity-video-series
Dr. Maybank is the AMA’s Chief Health Equity Officer and director of the Center for Health Equity. Mr. Khazanchi is a member of the American Medical Association’s Council on Medical Education. The views presented herein represent their own and not necessarily those of the AMA. The hosts and guests report no other relevant financial disclosures.
Jones CP, Maybank A, Nolen L, Fields N, Ogunwole M, Onuoha C, Williams J, Tsai J, Paul D, Essien UR, Khazanchi, R. “Episode 5: Racism, Power, and Policy: Building the Antiracist Health Systems of the Future.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. January 19, 2021.