Identifying racism and the damage it causes are essential to addressing health inequalities

April 09, 2021

3 min read

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Maybank A. Keynote: Operationalization of Racial Justice. Presented at: National Kidney Foundation Spring Clinical Meetings (virtual meeting); April 6-10, 2021.

Disclosure:
Maybank does not report any relevant financial information.

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Recognition of racism as a leading cause of health inequalities is necessary if the medical community is to work to address these gaps, according to the AMA’s chief health equity officer.

Aletha Maybank

Aletha Maybank, MD, MPH, The AMA’s senior vice president claimed that digital transformations had given people across the country an opportunity to better understand racism and feel more comfortable naming it. She gave the example of the murder of George Floyd, which she suggested shows that racism poses a threat to public health; Lately, according to Maybank, it has become less taboo to acknowledge the role of racism and the harm it does.

racism

“It was a tremendous opportunity to know that we can name racism and we need to name racism to create these inequalities that have existed in our country for centuries,” she said during her virtual presentation at the National Kidney’s Spring Clinical Meetings Foundation. “The critical questions now are: How do we go beyond declarative advocacy or just the conversation and the words? What must organized medicine do? What do associations have to do? What do policy makers need to do? “

Before Maybank started the technical steps, he stressed the importance of starting from the ground up to consider how “we value people, how we value society, and what stories we have about people and communities that relate to them The decisions we make and how we affect ourselves show in our strength and responsibility. “

Harm and trauma

Here she pointed out the trauma and harm caused by all forms of systemic oppression (including oppression based on race, gender, class, and LGBTQ +). This damage, she argued, not only harms communities but also harms the health of the individual body. According to Maybank, those affected by various types of oppression are more likely to develop chronic stress.

“The trauma shapes our genes over time,” she said. “It is an environmental stressor that increases allostatic and stress loads in our bodies and leads to inflammation over time.”

To further illustrate this point, Maybank quoted Ta-Nehisi Coates’ Between the World and Me, in which he wrote: “You must always remember that the sociology, the history, the economy, the graphs, the charts, the All land regressions are with great violence on the body. “

According to Maybank, it is important to reflect on the damage that has caused marginalized groups to “die early and unfairly”.

“It’s not just about the graphs, the numbers and the charts,” she said. “It’s about people’s experiences. It’s about the experiences of families. It’s about children’s experiences and what they will pass on from generation to generation. “

Responsibility and opportunity

As individuals working in the healthcare sector, Maybank reminded audiences that their code of ethics requires them to “do no harm”. Since this is a fundamental responsibility for medical professionals, she argued that thinking about the damage caused – and the myths that might influence beliefs in certain communities – is a central piece of work. Some of these myths relate to “individualism,” which incorrectly suggests that individual patients are solely responsible for “right or wrong decisions about lifestyle choices” and are therefore responsible for poor health outcomes (this mindset has come to the fore over time COVID-19 pandemic, she said). Rather than accepting these myths, they must be challenged and the medical community must recognize the political, structural, and social determinants of health that create health inequalities. According to Maybank, this will lead to understanding the root and causes of differences in health outcomes.

“I have a lot of experience with what it means to do organizational change work to promote justice,” she said. “It’s this inside-outside strategy that I think is critical. We cannot say that we are doing justice outside of the company unless we have focused and challenged how we think and how we understand how our decisions can potentially worsen or improve inequalities and fill the gaps. If there is one thing that can be used to move away from the presentation, it is this: we all have the power and we all have the responsibility. This is not the burden of blacks and browns or a marginalized group. This is work for everyone. ”

Maybank said this is an opportune moment for change, as indicated by the federal government’s regulation on promoting racial justice and helping underserved communities.

“We have never been at this time,” she said. “We have never been at a time when the federal government has promoted racial justice.”

Concluding her talk, Maybank urged the medical community to seize the opportunity to do work that promotes health equity.

“This is the moment when we need to take advantage of the open doors,” she said. “In my experience, I’ve learned that these doors open and close. And the doors are open now and we have to push as fast and as far as possible. ”

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National Kidney Foundation Spring Clinical Meeting