How Black students will answer the call for reform

The disproportionate impact of COVID-19 on Black people, coupled with the harrowing effects of police brutality, has once again laid bare institutional racism in America. This, along with growing support for the Black Lives Matter movement, necessitates that we work to eliminate racism in every space. In medicine, structural and social determinants of health in the Black community and gross injustices in health policy have produced inequities that are woven into the fabric of our society.

As members of the medical community — students, clinicians and educators — we must challenge this reality to fully honor the Hippocratic oath and begin to deliver on the promise of liberty and justice for all. To begin the multiplex work of confronting racism against Black people in our health care system, we must shore up the Black physician workforce, meaningfully address social determinants of health, close empathy gaps toward Black patients and recover the Black community’s trust in medical institutions.

How to reform 

Bolstering medical and research fields with Black leaders is a pivotal first step in improving Black health disparities. Systemic adversities that accompany being Black in America (toxified water, the biologization of race, a lack of health coverage, insufficient health literacy, and lower income and wealth) contribute to worse health outcomes.

External forces have an equal and internal reaction: Black patients treated by Black doctors are more likely to receive subsequent treatment, highlighting the role of race in access to optimal care. If we can activate an expansive network of Black health care leaders and pay health disparities the attention they require, Black patients will likely show greater trust in their care and better outcomes, too. This is best accomplished with investment in rigorous academic research that focuses on Black health. Well-endowed research institutes that seek to address social determinants and health disparities would result in tangible outcomes at every level of health care delivery. Improving care for Black individuals elevates the practice of medicine and will allow us to build more equitable policies for everyone.

A medical student on July 6, 2020, in Houston.
A medical student on July 6, 2020, in Houston.

Black people make up 13{50531db320f8e8a316d79d6a285e47c71b6e4f6739df32858cb86474d7e720e9} of the U.S. population but only 4{50531db320f8e8a316d79d6a285e47c71b6e4f6739df32858cb86474d7e720e9} of doctors.

This measure is even worse for Black men, the only demographic whose representation in medicine has dropped since 1978.

As our national shortage of doctors worsens, especially in minority communities, it is crucial that medical schools and residencies prioritize training underrepresented students through targeted programs so that the physician workforce better represents the people it serves. Research funding for medical schools should be contingent upon specific investments in underrepresented medical students — including representative mentorship, funding for elective learning opportunities, focused recruitment and retention efforts, and compensated representation in academic leadership and administration.

Further, Medicare should update the funding mechanism for graduate medical education based on the 2012 Institute of Medicine recommendations, which incentivize performance oriented toward health equity, particularly in underserved areas.

Health care and racial disparities: Black health matters. COVID has shown that improving care must be a national priority.

Ending racial bias in medicine

To mitigate health disparities, we must empower Black people with confidence to navigate our care systems through health literacy-based interventions. This approach must address Black distrust of the medical field, which stems from a history of deliberate discrimination ranging from eugenics, exploratory surgery without anesthesia, forced sterilization and other broadly unethical experiments on the Black body.

Today, implicit and explicit bias are pervasive in health care and impact health outcomes and disparities. As a result, discriminatory care has become a measurable and inherited element of health care delivery. This creates a tension in which lack of access is exacerbated by distrust and self-advocacy is dampened by bias.

In response, trauma-informed care and cultural humility should be ingrained in professional training. Substantive preclinical education should focus on histories of medical racism and the extent of disparities today, and no medical student should enter this career without a thorough education on how to pursue health equity in our work.

Trump and health care: Imagine a world with a COVID-19 pandemic and without the Affordable Care Act. Trump does.

The era of hollow words and racial allyship is over. Emphatic solidarity, rooted in tangible outcomes, is the new standard. We need results from stakeholders, and Black health care workers need to be elevated to well-resourced positions of leadership. Medical education needs to reflect the needs of every community, and taxpayer dollars should be reinvested in health education and advocacy for local residents. Importantly, each member of the health care system should hold health equity as the central and unshakable tenet of the mission of delivering care. Without it, we are failing to do our jobs and resigning ourselves to complicity in a racist paradigm. We are better. We can do better. We will do better.

Avery Ofoje is a 2020 graduate of Boston University and a prospective medical student. Follow her on Twitter: @averyofoje. Victor Agbafe is a dean’s and medical innovation scholar at the University of Michigan Medical School. Follow him on Twitter: @VictorAgbafe. Dr. Howard P. Forman is a professor of Public Health and Management at Yale University. Follow him on Twitter: @thehowie. Dr. Cecelia L. Calhoun is an assistant professor of Pediatrics at Washington University School of Medicine in St. Louis and a 2019 Pozen-Commonwealth Fund Fellow in Minority Health Leadership at Yale University.

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This article originally appeared on USA TODAY: Health care for Black Americans: How Black students will bring reform