All of us have them — biases and prejudices informed by our lived experiences. Physicians and other health care workers are no different. Yet far too often, those of us in health care fail to recognize our biases and, when baked into organizational policies and practices that have been historically and largely defined by privileged white people (and usually men), the result can be serious and even deadly to the patients we serve.
As two physicians born into white privilege, we acknowledge our complicity in systemic racism in medicine and recognize that we have much work to do to become anti-racist.
Many nonwhite patients describe negative interactions with the health care system — pain assumed to be drug-seeking behavior, referrals for specialty care assumed to be unaffordable, complex prescriptions noted as unlikely to be understood and followed. Just recently, leaders at the American Medical Association (AMA) were appropriately called to task in response to a podcast that suggested doctors were not racist and that downplayed the effects of systemic racism in health care.
The organization's top physician quickly reached out to stakeholders to assure them the association, which advocates on behalf of physicians across the country, had made a big mistake.
"To be clear, structural racism exists in the U.S. and in medicine, genuinely affecting the health of all people, especially people of color and others historically marginalized in society," wrote Dr. James L. Madara, AMA CEO and executive vice president. "This is not opinion or conjecture, it is proven in numerous studies, through the science and in the evidence. As physicians, and as leaders in medicine, we have a responsibility to not only acknowledge and understand the impact of structural racism on the lives of our patients, but to speak out against racial injustices wherever they exist in health care and society."
This is why the Minnesota Medical Association (MMA) and UCare have teamed up and recently launched a two-year initiative to combat clinician biases in order to promote health and racial equity. It is long overdue. Minnesota, often cited as a shining example of superior health care to the rest of the country and world, has some of the worst health disparities in the country among Black, Indigenous, Latinx, Asian and Pacific Islander communities.
This initiative will focus on addressing physician and other health professional biases as a contributing factor in health outcomes and support the adoption of an anti-racist culture by Minnesota health care organizations. Its overriding goal is to begin dismantling some of the key elements of structural racism present in Minnesota's health care system.
This work comes at a time when Minnesotans from Black, Indigenous, Latinx, Asian and Pacific Islander communities are experiencing disproportionate morbidity and mortality from COVID-19, shorter life spans, and higher rates of infant mortality and diseases such as diabetes, heart disease and cancer than their white peers. Beyond this unacceptable toll on the lives and health of Minnesotans, these inequities have economic consequences on the workforce and the affordability of health insurance.
For example, a University of Minnesota Program in Health Disparities Research study found that preventable deaths caused by racial disparities cost the state from $1.2 billion to $2.9 billion each year.
Ultimately, we want to create anti-racist training for future generations of health care professionals as well as establish and facilitate cross-organizational communication and exchange of health equity initiatives, practices and policies. We want to explore and develop communitywide metrics for accountability, and identify opportunities for the use of restorative justice models to facilitate trust building between Black, Indigenous, Latinx, Asian and Pacific Islander communities and Minnesota health care organizations.
There is much to do and undo to create a more just and fair health care system for all Minnesotans. We need to begin today to dismantle structural racism in health care settings, reduce implicit bias among our colleagues and make demonstrable improvement in the health outcomes of Black, Indigenous, Latinx, Asian and Pacific Islander communities.
Marilyn Peitso is president of the Minnesota Medical Association. James Pacala is board chair at UCare.