Infectious Disease

Combating institutional racism in academia

March 10, 2023

8 min read


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Mehta reports being a Medical Research Council-GlaxoSmithKline EMINENT clinical training fellow with project funding unrelated to this paper.


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An “undercurrent of racism” runs throughout academic medicine, resulting in not only “disillusionment and attrition,” but also internalized racism among underrepresented groups, according to a letter published in The Lancet.

“The undercurrent of racism in academic medicine is pervasive — preferential treatment, failure to acknowledge intellectual contributions, stealth othering, and denial of opportunity and sponsorship,” Puja Mehta, MD, of the Center for Inflammation and Tissue Repair, in the division of medicine at the University College London, and Christopher D. Buckley, MD, of the Kennedy Institute for Rheumatology at the University of Oxford, both in the United Kingdom, wrote. “This manifests in differential attainment, disillusionment and attrition.

Mehta quote

An “undercurrent of racism” runs throughout academic medicine, resulting in not only “disillusionment and attrition,” wrote Puja Mehta, MD, and Christopher D. Buckley, MD.

“Minoritized pioneers have been deleted from history with deliberate exclusion from success metrics such as grants and publications,” they added. “Gate-keepers, including funding bodies and peer-reviewed journals, have conceded their role in colluding with the status quo. Dismantling barriers is the appropriate top priority, but the taboo topic of internalized racism has received less attention. This refers to ‘conscious/unconscious acceptance of racial hierarchies by minoritized people.’ Self-subordination and over-assimilation propagate the problem.”

In their letter, Mehta and Buckley address how people from underrepresented groups have accepted certain racial hierarchies and internalized subordinate positions. The letter additionally calls for these groups to empower themselves to speak out on their own behalf when facing discrimination while assessing workplace safety. They are also encouraged to address the feeling that they must over-achieve to gain acceptance.

“Finding our voice is critical to advocate for self and others, liberating authentic self-expression required to drive innovation, creativity, and progress,” Mehta and Buckley wrote. “Instead of proving our worth, we should focus on knowing our worth. This will deliver dividends for all of us. Eliminating internalized racism is critical in reclaiming our power and making academia truly collaborative and inclusive.”

Healio sat down with Mehta to discuss some the consequences of ongoing institutional racism and the benefits — both societal and scientific — of a more just and equal academic environment.

Healio: In one passage of the paper, you wrote, “People of color need to self-examine and phagocytose the locus of control.” What do you mean by that?

Mehta: There are structural barriers that have impeded the progression and promotion of people of color in academia. Dismantling those barriers is the appropriate first step and we do not want to victim-blame.

However, another important anti-racism aspect that has been largely neglected is to empower people of color to break down their own internal barriers that may be holding themselves back. Allyship is really important, but people of color need to internalize the locus of control rather than being purely dependent on others. We need to empower people of color, to help them find their voice and advocate for themselves and others.

Healio: In the letter, you also discuss the concept of “intersectionality.” Can you briefly explain what that refers to?

Mehta: Intersectionality refers to a framework of overlapping variables that may influence perceived power, privilege and discrimination. They include gender, race, wealth, social class, sexuality and age, among others. All of us have variables that increase — such as male gender — or decrease — such as darker skin color — perceived power and privilege.

Healio: How do we acknowledge the complex layers of intersectionality in real-world settings?

Mehta: We need to be mindful of these variables in all working relationships, such as when mentoring and when communicating with each other. We need to see the world from each other’s perspectives and be open to the different challenges someone else may be facing, which we are immune and potentially blind to. We should also always check our own privilege when entering these difficult conversations and try to find ways to level the playing field.

Healio: The letter additionally describes the ‘shame and fear stereotyping’ experienced by underrepresented groups. Can you expand on this?

Mehta: Internalized racism is a term given to conscious and unconscious acceptance of a lower position in any hierarchy based on one’s race. One reason people of color do not speak up on their own behalf is because they feel ashamed or fear being stereotyped as playing the so-called ‘race card.’ For women of color, there is fear of being seen as the ‘angry Black woman.’ There is often a risk in speaking up.

Healio: Is it possible to overcome these stereotypes, as well as this shame and fear?

Mehta: The shame aspect is interesting. People of color tend to over-assimilate. Meaning, they eradicate parts of their racial identity in order to fit in with a white dominant group. But what this really amounts to is shame of their own ethnicity. We need to have pride in our duality and privilege. Rather than hiding our differences, we should be celebrating them. The more we can celebrate our own identity and accept ourselves, the more others will accept us.

Healio: How do these perceptions of superiority and privilege manifest?

Mehta: If people of color can have the confidence and courage to speak up when boundaries are being traversed, it will be a step toward leveling the playing field and chipping away at a potential perception that white culture is superior. It could also help eliminating the conscious and subconscious biases that we all have. It is very important to emphasize that all people and races have biases. None of us are exempt, including people of color. We need to be more comfortable at openly expressing, addressing and challenging our own and each other’s biases.

Healio: In terms of having these difficult conversations, you use the term “Goldilocks level of discomfort.” Could you explain what this means?

Mehta: The edge of our comfort zone is a growth zone. Growth requires some degree of discomfort. If the conversations are too easy, there will not be any growth. If there is too much discomfort, people can shut down. So there is a sweet spot. Both sides need to be mutually open to having these uncomfortable conversations.

Healio: Who decides what is an appropriate level of discomfort for these conversations?

Mehta: There needs to be work on both sides of the table, and there will be discomfort on both sides. Expressing your needs is very hard. It is also difficult not to evoke defensiveness when boundaries have been traversed. It may be equally hard for non-minoritized people to listen and acknowledge where they may have actively or passively contributed to inequity. It is difficult to have discussions that both parties may not have had before. Both parties need to grow a muscle that they have never used before. Both sides need to come to the table with the intention to learn, understand and work together.

Healio: Could you talk about the implications of such conversations in both academic and clinical settings?

Mehta: In terms of practical application, most universities and institutions have policies regarding DEI — diversity, equity and inclusion — or EDI — equity, diversity and inclusion — as it is known in the United Kingdom. It is very important to have policies in place that are formalized. But mentorship, leadership and sponsorship opportunities are critical to one’s success in the field of science, and they should be equitable. To that end, there needs to be training for seniors, mentors and leaders in the field about potential biases and microaggressions — all of these topics that minoritized people deal with every day.

Healio: Do you have experience with these conversations?

Mehta: As the clinical chair of the early career research, I have organized a research culture seminar series program on microaggressions, ethical allyship and colonialism in academic medicine.

I was very uncomfortable the first time I chaired the session, although I think that as a woman of color, people expected me to be comfortable with these topics. I gave people permission to express their discomfort and ask questions and we ended up having some very fruitful conversations. We need to get comfortable with uncomfortable topics. The more we talk about this the easier it will be. They will become less taboo and it will minimize the shame surrounding them.

Another point is that we need to stop talking about these conversations as being “courageous.” I have had a lot of feedback that I was very brave to chair these sessions and have these conversations, and to write this article in The Lancet. I understand that there is a real risk to career and reputation whenever you talk about race because people feel vulnerable. But I would like this topic to reach a point where it is so comfortable that there is no risk. People should feel empowered to express their feelings on these topics. And seniors and mentors should be comfortable enough to listen.

Healio: Given the potential real-world consequences of potentially losing opportunities, is there not some risk to having these conversations that requires some courage to have them?

Mehta: Right now, yes, there is definitely a risk in speaking up. The truth can be triggering and can provoke retaliation rather than reflection. Anyone who thinks there is no risk is not paying attention, does not understand the issues or is speaking from their privilege. There is always a risk.

I was nervous to publish this paper for fear of risk to my reputation and career. There is always a group of people that is resistant to change because the current status quo benefits them. People who challenge the status quo risk being vilified as disruptors. This is where I think it is necessary for all of us to perform a risk assessment before we speak or act. We should ask ourselves some questions: What outcome are you trying to achieve? Is the person you are speaking to able to understand? Is their intention to understand or defend? Do they want to grow? What is the risk of retaliation?

Healio: What other advice do you have for people who wish to speak up about topics pertaining to race?

Mehta: Having an advocate or ally in a position of authority can be helpful. Also, there is safety in numbers. But you also have to recognize that you sometimes need to pick your battles. Sometimes, the best step is to walk away. There is no shame in being silent if the risks far outweigh the possible benefits. We should never berate ourselves or others in being silent. Prioritizing self-care and safety is imperative.

Healio: One other term in the letter that seems worthy of exploration is “workplace tribalism.” What is it and how can it impact the workplace?

Mehta: Some people enjoy living in an echo chamber. They feel safe and comfortable if they surround themselves with people who look like them and reinforce their own beliefs, so they recruit in their own image. But this creates an ‘in’ group and an ‘out’ group. A homogeneous group is very unlikely to have cognitive diversity. A lack of diversity will stifle productivity, growth and creativity in a department.

Again, seniors and mentors in academia should recognize that diversity can lead to new ideas and forward thinking and, ultimately, better scientific advancement. Disruption is a good thing!

Healio: Can you discuss how underrepresented people can fall into a cycle of performing extra administrative tasks and other activities that take them away from their areas of expertise?

Mehta: There is a ubiquitous expression from immigrant parents that you have to work twice as hard — or sometimes 10 times as hard — to get half as far. This is ingrained in many people of color from birth, that you must perform extra tasks that we have called a “gratitude tax.” Minoritized people often feel they have to prove their worth, or that they owe something to the people who have given them a job or opportunity, so they volunteer for the tasks that do not contribute to their career progression.

Healio: How do you break that cycle?

Mehta: Minoritized people need to recognize it in themselves. If they feel that administrative roles are inequitably distributed, and if they feel they are not being valued, they need to either speak up, or stop and walk away.

The second part is that non-minoritized people need to ensure that tasks are being equitably distributed, rather than just being satisfied that the task is being completed. Again, it is about both sides of the table. The inequitable distribution of these administrative tasks does both groups a disservice, as the minoritized may not feel valued and non-minoritized may feel entitled without knowing it. Some leaders need to realize that they are unknowingly contributing to inequity.

Healio: What are the benefits of creating an environment that recognizes the need for equity, and where underrepresented people feel comfortable advocating on their own behalf?

Mehta: Equity and diversity in science is beneficial not only for working relationships, but for the work itself. Having multiple voices speaking up and speaking out improves the quality of our conversations by interrogating the argument, our science and research.

There seems to be an over-focus on diversity, but actually the goal should be equity and meritocracy. I am hopeful that lots of people are working hard to level the playing field. We need to ensure that everyone — including people of color — value themselves and their contributions are valued by others to make academia truly collaborative and inclusive.


Mehta P, Buckley CD. Lancet. 2022;doi:10.1016/S0140-6736(22)02486-2.


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