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Published On May 6, 2021

POLICY

Is Health Care’s Racism Treatable?

In the wake of a landmark year of activism, medical schools, hospitals and the research establishment are seeking to excise racial discrimination. How well have they done?

In April, the Centers for Disease Control and Prevention declared racism “a serious public health threat” and director Rochelle Walensky outlined steps the agency would take to address it, including $2.25 billion that has been earmarked to address COVID-19-related health disparities. The agency is also launching a web portal, “Racism and Health,” as a hub for their wider efforts. This initiative came months after the American Medical Association, in November, officially recognized racism as a threat to public health and implored its physician members to find ways to counter its negative impact on quality of care and patient health.

Those were some of the largest efforts to respond to the past year’s crisis and activism, sparked by the death of George Floyd and others. Similar efforts have become remarkably widespread, with hundreds of health care institutions seizing the moment to enact meaningful change. “I don’t think we’ve had this kind of opportunity since the Civil Rights movement of the 1960s,” says David Acosta, chief diversity and inclusion officer for the Association of American Medical Colleges, which represents 155 U.S. medical schools and more than 400 teaching hospitals and health systems. While most of those institutions have embraced anti-bias training and other diversity initiatives for years, many problems have seemed entrenched. Student bodies and faculties of medical schools, for instance, remain overwhelmingly white, and the needle on many diversity measures seems stuck. “Our phone has been ringing off the hook with our members asking for help,” says Acosta. “I think everyone now realizes racism is embedded in the system in many ways—and we need to create system-based solutions.”

Younger people—medical students and residents—are shaping much of this conversation. “This new generation is bringing these issues to the forefront,” Acosta says, calling on medical schools and hospitals to root out racial bias in educational materials and clinical training, among other measures.

Hospitals have a major front for such efforts, and in many ways represent the crux of the problem. In a 2020 survey of 600 hospitals by the American Hospital Association, 96% of the executives who responded said they considered it a moderate or high priority to foster diversity and inclusion strategies in their organizations. Yet more than half of the hospitals didn’t have a comprehensive plan for implementing changes. And while minority populations account for more than a third of patients, fewer than one in five hospital board positions and just 16% of executive leadership positions are held by people of color.

“Hospitals and health systems are in varying stages of development on equity,” says Joy Lewis, AHA senior vice president of health equity strategies. “But the past year has pushed the importance of health equity and workforce diversity front and center. We’re at a pivotal moment.”

Improving those numbers was a priority for two-thirds of respondents to the AHA survey, with many hospitals hiring executives tasked specifically with managing diversity and inclusion initiatives. “New hires for such positions are being announced almost weekly,” Lewis says. The AHA, supported by funding from the Robert Wood Johnson Foundation, is developing what it calls an equity roadmap for system-wide interventions, and in the meantime is supporting member institutions with case studies, training materials and help in creating community partnerships.

Some of those hospitals are pushing forward with broad changes. At Massachusetts General Hospital, initiatives had, for several years, been looking at equity issues, and employees were required to take bias awareness training. Last year, the institution announced a new 10-point plan, looking to root out biases in how the organization conducts research and delivers care. They set out a plan to review all policies and created new ways to report and address acts of racism. Patient protocols at the hospital have been revised as well, and leadership has put new emphasis on retaining and promoting diverse employees.

“Diversity has become a more significant issue than I’ve seen in my 20 years in this kind of work,” says Joseph Betancourt, senior vice president for equity and community health at MGH. “Our leaders understand the urgency.”

Discrimination in research funding is another major issue, with surveys showing a stark racial bias in grantmaking by the National Institutes of Health, among other funding organizations. In March, NIH director Francis Collins posted a statement on the agency’s website apologizing for inequities in biomedical research and other imbalances that imply racial bias. Now UNITE, a new effort led by committees of experts from across all 27 NIH institutes, will look to identify problems and suggest improvements. It will seek to follow the example of the behavioral and social sciences, which from 2003 through 2017 were able to double the proportion of underrepresented minorities in their scientific workforces from 11% to 22%, according to a recent National Science Foundation report.

Time will tell which of these changes will bear fruit. Finding objective measures of progress are a major part of the task, one that most efforts are incorporating into their planning process. While most parties are hopeful about the opportunity for change, they are realistic about the sustained efforts needed to carry them out. In describing the efforts at NIH, Collins wrote that “identifying and dismantling racist components of a system that has been hundreds of years in the making is no easy task.”