Reconceptualizing Race for the Sake of Health and Humanity

As we celebrate Black History Month (also known as American history), we must step back and reckon with the truth about race and the root causes of stark racial disparities in health outcomes.

Race is a socialpolitical construct rooted in an 18th century classification system designed to marginalize Black Americans and preclude them from access to social, economic, and political conditions that influence health. And while the Civil Rights Act was passed in 1964, slavery and segregation were institutionalized in the DNA of America for centuries beforehand.

The consequential effects of these inequities must not be ignored and cannot be eradicated overnight.

From redlining to discriminatory housing lending practices, unjust practices have resulted in contemporary manifestations of intergenerational trauma, toxic stress, and persistent disinvestment in communities of color. Typically confounded by race as a causal factor, social and environmental conditions can have a profound and deleterious effect on health and well-being. Examples include advanced aging or weathering of DNA telomeres, exposure to cancer causing agents, limited access to healthy, affordable foods, and a dearth of medical providers with culturally sensitive environments that foster meaningful connections with patients.

Because of eugenics and the racist origins of race, race has been pathologized and operationalized as a key variable in shaping clinical algorithms, informing treatment protocols, and instilling inequities in patient experiences. With the proliferation of artificial intelligence and innovations in machine learning technology, algorithms are likely to be racially biased due to a history of discrimination and institutionalized biological fallacies. Critical audits are needed to vet algorithms and developing technologies with a racial equity lens.

What are other ways systemic racism show up in healthcare?

There are numerous examples, but one of my most salient memories was when I was giving a presentation to a Board of Directors of a large healthcare system with multiple hospitals. The overwhelming majority of the board was white males. After my presentation, I had to meet with an ER physician at one the system’s hospitals. When I walked in, I saw an overcrowded sea of black and brown people in need of care. I recall thinking . . . the board I just presented to is responsible for making healthcare decisions for a community of voices that are not included in decisionmaking; a community so far removed from their privileged identity. Moreover, the environment was visibly white, hetero-normative, and completely void of intersectionality. It was my ah ha moment. All I could think of is this is the reason black and brown people do not embrace the institutions of medicine and healthcare. This is one of the many reasons premature mortality rates are higher in Black Americans because chronic disease conditions are detected when it’s just too late. The environment of care is one of the many reasons patients rely on the ER as a last resort. We must do better.

What about a paradigm shift?

Equality is a founding value of American culture. However, the premise of equality negates equity and assumes everyone started off with the same amount of opportunity and resources. For more than 400 years, black and brown people were and continue to be marginalized, disenfranchised from the political process, and on the receiving end of bias and injustice. These conditions compromise health and help us understand disparities.

Systemic racism recognizes that racism has been an inherent condition of the American experiment.?Finger pointing would not be a productive exercise. Instead, it is incumbent for the healthcare system, and actors in the broader ecosystem to recognize the harm, practice atonement, and critically audit the institutions and structures that govern society as well as how they interact. For example, healthcare needs to be reconceptualized because clinical care only represents approximately 20% of an individual's or population's total health. Systemic racism must be recognized as a root cause of racial disparities in health, and furthermore, the inequities exist within and beyond the walls of the medical establishment.

But we have work to do. Borne out of Louis Pasteur’s work, healthcare is biomedically postured, which means it does not take into account the social, environmental, and ecological conditions that shape health. Correction warrants revolutionized systems of care rooted in a biopsychosocial approach. For example, if a patient is experiencing food insecurity, it would not make sense to prescribe a medication that needs to be taken on a full stomach. In this instance, the medical provider should have a partnership with a community-based organization that provides medically tailored meals.

According to the evidence, behavioral health services and seamless wraparound support services are some of the best ways to meet the needs of patients in historically underserved Black communities – particularly those that have been intentionally left behind. However, this cannot be accomplished without significant investments in community infrastructure, coupled with flexible forms of health insurance coverage.?

What happens if we ignore the past and deny the imperative?

Currently, the country spends approximately $4.5T on medical care annually, almost two times more per capita when compared with other industrialized countries, yet our age expectancy is among the lowest. In a study conducted in 2018, the economic burden of health inequities for racial and minority populations was $421B, resulting in roughly $42B in loss productivity.

As the country becomes more racially and ethnically diverse, a sick country is not a productive country. A sick United States of America that cannot rid itself from the vestiges of racism will ultimately lose its position in the global market.

For the sake of life, liberty and the pursuit of happiness, take action. Let’s do our part, be bold, and operationalize diversity as an asset and vehicle for solving some of the world's most seemingly intractable problems.

Valuing all people and their intersectionalities is key to achieving optimal health and well-being – for all.?

It’s in everyone’s best interest.