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In this episode of Clinical Problem Solvers: Anti-Racism in Medicine, we are joined by Aletha Maybank MD, MPH, the American Medical Association’s (AMA) inaugural Chief Health Equity Officer and director of the AMA’s Center for Health Equity, and Camara Jones MD, PhD, MPH, thought leader in the fields of health equity and public health and former president of the American Public Health Association (APHA). We discuss policy, professional organizations, and history as they relate to advancing health equity, and imagine what the anti-racist health system of the future looks like. 

Learning Objectives

After listening to this episode listeners will be able to…

• Recognize that racism is both structural and interpersonal, and that both aspects must be addressed simultaneously.
• Appreciate the importance of acknowledging history and sustaining institutional memory in advancing anti-racism efforts and achieving structural change.
• Understand that collective action and a focus on community, rather than individualism, are most effective in combating racism and achieving health equity.

Credits

• Written and produced by: Rohan Khazanchi, LaShyra Nolen, Naomi Fields, Dereck Paul, MS,  Utibe R. Essien, MD, MPH, Michelle Ogunwole, MD, Chioma Onuoha, Jazzmin Williams, and Jennifer Tsai MD, M.Ed
• Hosts: Rohan Khazanchi, LaShyra Nolen, Naomi Fields
• Infographic: Creative Edge Design
• Show Notes: Chioma Onuoha 
• Guests: Aletha Maybank MD, MPH, (@DrAlethaMaybank) and Camara Jones MD, PhD, MPH (@camarajones)

Download Transcript Here

Episode 5: Racism, Power, and Policy: Building the Antiracist Health Systems of the Future

Show Notes

Chioma Onuoha

Timestamps

00:00 Music/Intro

01:14 Guest Introductions

03:09 Framing Racism 

05:15 Allegory: Cement Dust in Our Lungs 

07:00 The AMA’s Declaration on Racism as a Public Health Threat 

13:28 History and the AMA and APHA Movements 

15:20 Barriers to Achieving Health Equity in Medicine 

20:55 Documenting, Centering, and Institutionalizing “The Work” 

23:30 The AMA’s Racist Past 

31:00 How Do We Create Sustainable Work? 

35:25 Creating and Maintaining Urgency 

39:00 Racism Saps the Strength of the Whole Society 

43:43 Building an Anti-Racism Health Care System from A Grassroots Level

52:15 Building an Anti-Racism Health Care System from A Governmental Level 

53:45 Health is Not Created with the Health Sector 

56:53 Why Must All Health Workers Practice Anti-racism? 

1:05:57 Outtakes 

Takeaways

1. Name Racism for What It Is

If we don’t explicitly say the word racism, and identify its historical context,  then we are complicit in its denial.  Racism denial is deeply ingrained in our society and it needs to be called out and recognized as a system in order to be addressed. Though the field of medicine often fails to think systematically, it is imperative that all healthcare workers learn to recognize racism, actively practice anti-racism, and acknowledge the many systems that impact people and community’s health.

Four Key Messages for Naming Racism: 

• Racism Exists
• Racism is a System
• Racism Saps the Strength of the Whole Society
• We can Act to Dismantle Racism

1. History and Documentation are Key 

Our country habitually denials racism by working to make its impacts invisible. Remembering history and collecting institutional memory avoids the danger of repeating work, wasting labor, and makes clear racism’s long standing effects. Part of this effort also includes learning the history of the organizations and institutions we are a part of. 

1. Focus on the Community 

While the health sector is where illness and ailments are often treated, a person’s health largely manifests outside of the health sector and is impacted by their community and environment. One of the biggest barriers to health equity is the narrow focus on the individual and a failure to see health as a widespread community issue. We must recognize that all policy is health policy and that which affects someone outside of the health sector may also affect their health. Our future should be grounded in our communities; our solutions cannot solely be declarative or institution-driven.

Pearls 

Barriers to Achieving Health Equity 

• Narrow focus on the individual – makes systems and structures invisible or irrelevant
• We as a nation are ahistorical – we need to bring history into the fold 
• Our endorsement of the myth of meritocracy – the uneven playing field 
• White supremacist ideology 

To learn more, read about  Dr. Jones’ Seven Values Targets for Anti-Racism Action

Institutionalizing Anti-Racism 

A movement can disappear as quickly as it arose if it is not institutionally ingrained. This means that anti-racism must be embedded into practice, performance standards and institutional culture. All policies, decisions, and behaviors should occur through the lens of anti-racism in order for its impact to be longstanding and effective. 

The Power of Collective Action 

“When we acknowledge each other’s work we acknowledge the power of collective action” 

– Dr. Camara Jones 

Addressing structural racism is a collective effort and is more effective when we shift from “what can I do” to “what can we do”. When we lift up our peers and validate/center the work of people on the margins, we recognize the power of collective action and ensure that efforts are not erased or lost. This includes recognizing the experts that have come before us and reaching out to younger generations.

Addressing Structures and Values 

Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks. In order to address racism, we must address both the structures and the values. Structures include the ways that racism is institutionalized and systematically reinforced, and values include the way that racism manifests in our shared consciousness. Addressing values will require us to make clear that “racism saps the strength of the whole society” and to highlight the urgency of anti-racism efforts. Additionally, we should equip educators, parents, and those who will guide the next generations with the tools to operate within the framework of anti-racism. Because structural racism often operates through inaction and complacency, the work to combat it must be persistent and collective. Racism hurts all people and achieving anti-racism will require active “fellows in the struggle” not just feeling allies. 

References Mentioned

01:55

Jones, C. Camara Jones, Allegories on race and racism | Camara Jones | TEDxEmory. [Video]. YouTube. https://www.youtube.com/watch?v=GNhcY6fTyBM&ab_channel=TEDxTalks. Published June 10, 2014. Accessed January 11, 2021.

03:55

Jones, C. Camara Jones, APHA executive director citation award acceptance speech. [Video]. YouTube. https://youtu.be/BGmIXV859YQ. Published December 2, 2020. Accessed December 9, 2020.

16:20

Jones, CP. (2020). Seeing the Water: Seven Values Targets for Anti-Racism Action. Harvard Medical School Primary Care Blog. Retrieved from http://info.primarycare.hms.harvard.edu/blog/seven-values-targets-anti-racism-action 

27:17

Berney, B., & Friedman, R. (Producers), & Burnett, C., Loewenthal, D. (Directors). (2018). Power to Heal: Medicare and the Civil Rights Revolution. Retrieved from https://www.blbfilmproductions.com/ 

28:55

Baker, RB., et al. Creating a segregated medical profession: African American physicians and organized medicine, 1846-1910. J Natl Med Assoc. 2009 Jun;101(6):501-12. doi: 10.1016/s0027-9684(15)30935-4. PMID: 19585918.

Washington, HA., et al. Segregation, civil rights, and health disparities: the legacy of African American physicians and organized medicine, 1910-1968. J Natl Med Assoc. 2009 Jun;101(6):513-27. doi: 10.1016/s0027-9684(15)30936-6. PMID: 19585919.

Additional References 

1. Boyd RW, Krieger N, Jones CP. In the 2020 US election, we can choose a just future. Lancet. 2020;396(10260):1377-1380. doi:10.1016/S0140-6736(20)32140-1
2. Crear-Perry J, Maybank A, Keeys M, Mitchell N, Godbolt D. Moving towards anti-racist praxis in medicine. Lancet. 2020;396(10249):451-453. doi:10.1016/S0140-6736(20)31543-9
3. Ford CL, Airhihenbuwa CO. The public health critical race methodology: praxis for antiracism research. Soc Sci Med. 2010 Oct;71(8):1390-8. doi: 10.1016/j.socscimed.2010.07.030. Epub 2010 Aug 11. PMID: 20822840.
4. Jaffe S. Aletha Maybank: AMA’s Chief Health Equity Officer. The Lancet. 2020;395(10242):1963. doi:10.1016/S0140-6736(20)31408-2
5. Jones CP, Holden KB, Belton A. Strategies for Achieving Health Equity: Concern about the Whole Plus Concern about the Hole. Ethn Dis. 2019;29(Suppl 2):345-348. doi:10.18865/ed.29.S2.345
6. Jones CP, Jones CY, Perry GS, Barclay G, Jones CA. Addressing the social determinants of children’s health: a cliff analogy. J Health Care Poor Underserved. 2009;20(4 Suppl):1-12. doi:10.1353/hpu.0.0228
7. Jones CP. Allegories on “Race,” Racism, and Antiracism. 2019. Accessed December 7, 2020. https://www.radcliffe.harvard.edu/video/allegories-race-racism-and-antiracism-camara-phyllis-jones
8. Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22. 
9. Jones CP. Overcoming Helplessness, Overcoming Fear, Overcoming Inaction in the Face of Need. Am J Public Health. 2016;106(10):1717. doi:10.2105/AJPH.2016.303406
10. Jones CP. Systems of Power, Axes of Inequity: Parallels, Intersections, Braiding the Strands. Medical Care. 2014;52:S71. doi:10.1097/MLR.0000000000000216
11. Jones CP. Toward the Science and Practice of Anti-Racism: Launching a National Campaign Against Racism. Ethn Dis. 2018;28(Suppl 1):231-234. doi:10.18865/ed.28.S1.231
12. Jones, C. Camara Jones, APHA executive director citation award acceptance speech. [Video]. YouTube. https://youtu.be/BGmIXV859YQ. Published December 2, 2020. Accessed December 9, 2020.
13. Jones, CP [@CamaraJones]. (2020, Nov 28). My map with the 28 states (in red) with at least one city/county/state-level body declaring “Racism is a public health crisis.” Each state name is followed by the number of jurisdictions making these declarations. State name is in CAPS if there is a state-level declaration. [Tweet]. Twitter. https://twitter.com/CamaraJones/status/1332729107952627712?s=20
14. Maybank A. A Historic Day For Black Women, A Historic Day For The American Medical Association. Essence. Published November 18, 2020. Accessed December 7, 2020. https://www.essence.com/lifestyle/health-wellness/black-women-american-medical-association-racism/
15. Maybank A. The Pandemic’s Missing Data. The New York Times. https://www.nytimes.com/2020/04/07/opinion/coronavirus-blacks.html. Published April 7, 2020. Accessed December 7, 2020.
16. Metzl JM, Maybank A, De Maio F. Responding to the COVID-19 Pandemic: The Need for a Structurally Competent Health Care System. JAMA. 2020;324(3):231-232. doi:10.1001/jama.2020.9289
17. O’Reilly KB. AMA: Racism is a threat to public health. American Medical Association. Published November 16, 2020. Accessed December 7, 2020. https://www.ama-assn.org/delivering-care/health-equity/ama-racism-threat-public-health
18. Prioritizing Equity video series. American Medical Association. Accessed December 7, 2020. https://www.ama-assn.org/delivering-care/health-equity/prioritizing-equity-video-series

Disclosures

Dr. Maybank is the AMA’s Chief Health Equity Officer and director of the Center for Health Equity. Mr. Khazanchi is a member of the American Medical Association’s Council on Medical Education. The views presented herein represent their own and not necessarily those of the AMA. The hosts and guests report no other relevant financial disclosures.

Citation

Jones CP, Maybank A, Nolen L, Fields N, Ogunwole M, Onuoha C, Williams J, Tsai J, Paul D,  Essien UR, Khazanchi, R. “Episode 5: Racism, Power, and Policy: Building the Antiracist Health Systems of the Future.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. January 19, 2021.