Such important and interesting questions.
Yes, the question of how to acknowledge the reality of the lived experience of racism and its impact on health and health care without reinforcing harmful narratives about race or causing harm is really challenging.
To take your second question first, the question of how to engage with racial categorization in the clinical context is an active one. One issue is that race has real clinical and biological outcomes because of biological embedding related to the experience of racism - as we will discuss next week. This is why, for example, CAD/CHF occurs at younger ages among Black patients, and why it makes sense to include race in the ASCVD calculator. However, doing so also has the potential to reinforce biological interpretations of race for people who are not aware of this context. As you point out, recognizing the role of race also can raise awareness of the potential for racism/bias in the clinical context and aid with attempts to impact that. However, this is complicated because of the milieu of structural racism that discussion of race by necessity occurs in, and so it is not as simple as having good intentions about why racial categorization is being done. I am working with a group led by Dr. Bibbins-Domingo to organize a series of symposia addressing exactly this issue – how to be “race-conscious” in clinical care, medical education and research using principles of anti-racism. The specific issue it will address is as follows:
Over the past few years, there has been increasing attention and discourse focusing on social determinants of health, root causes of health inequities, and the role of structural racism in these inequities. In these conversations, how medicine considers and engages with the construct of race has surfaced as an area of controversy. Those in academic medicine have grappled with questions such as:
• What is the history of race and racism in the health sciences, and how does they operate in clinical practice, health research, and medical education today?
• How does inclusion of race in diagnostic and therapeutic algorithms reconcile with thinking about social determinants of health and how they produce and perpetuate health inequities?
• How does the current approach to considering race and racism in medicine relate to and potentially contribute to ongoing societal narratives about racial differences and racial inequities?
• How does the conversation about the use of race and racism in medicine relate to the growing attention to genetic ancestry and population-based variation in genetic polymorphisms?
So stay tuned, and keep asking these good questions!
And for your first question – yes, it is complicated. I don’t have any simple answers, other than self-reflection, emotional intelligence and patient-centered care being critical - I welcome others' thoughts. There is also the concept of structural competency which is increasingly being integrated into medical education as an approach to train medical students to engage with these issues. The paper is attached here.
Thanks for reaching out!
Yes, the question of how to acknowledge the reality of the lived experience of racism and its impact on health and health care without reinforcing harmful narratives about race or causing harm is really challenging.
To take your second question first, the question of how to engage with racial categorization in the clinical context is an active one. One issue is that race has real clinical and biological outcomes because of biological embedding related to the experience of racism - as we will discuss next week. This is why, for example, CAD/CHF occurs at younger ages among Black patients, and why it makes sense to include race in the ASCVD calculator. However, doing so also has the potential to reinforce biological interpretations of race for people who are not aware of this context. As you point out, recognizing the role of race also can raise awareness of the potential for racism/bias in the clinical context and aid with attempts to impact that. However, this is complicated because of the milieu of structural racism that discussion of race by necessity occurs in, and so it is not as simple as having good intentions about why racial categorization is being done. I am working with a group led by Dr. Bibbins-Domingo to organize a series of symposia addressing exactly this issue – how to be “race-conscious” in clinical care, medical education and research using principles of anti-racism. The specific issue it will address is as follows:
Over the past few years, there has been increasing attention and discourse focusing on social determinants of health, root causes of health inequities, and the role of structural racism in these inequities. In these conversations, how medicine considers and engages with the construct of race has surfaced as an area of controversy. Those in academic medicine have grappled with questions such as:
• What is the history of race and racism in the health sciences, and how does they operate in clinical practice, health research, and medical education today?
• How does inclusion of race in diagnostic and therapeutic algorithms reconcile with thinking about social determinants of health and how they produce and perpetuate health inequities?
• How does the current approach to considering race and racism in medicine relate to and potentially contribute to ongoing societal narratives about racial differences and racial inequities?
• How does the conversation about the use of race and racism in medicine relate to the growing attention to genetic ancestry and population-based variation in genetic polymorphisms?
So stay tuned, and keep asking these good questions!
And for your first question – yes, it is complicated. I don’t have any simple answers, other than self-reflection, emotional intelligence and patient-centered care being critical - I welcome others' thoughts. There is also the concept of structural competency which is increasingly being integrated into medical education as an approach to train medical students to engage with these issues. The paper is attached here.
Thanks for reaching out!