Dismantling structural racism in health care

U of M health professionals speak out on needed system reforms

On June 10, the New England Journal of Medicine published “Stolen Breaths,” a commentary on the state of Black American health from Rachel Hardeman, University of Minnesota School of Public Health associate professor; Eduardo Medina, Park Nicollet primary care physician and University of Minnesota Medical School adjunct assistant professor; and pediatrician Rhea Boyd.

The commentary lays bare the threats to the health and well-being of Black Americans, including being consigned through redlining to toxic residential environments, a 15% greater risk of dying from COVID-19 than White people, and Black maternal and infant death rates that are twice as high as those of their White peers.

What we need to protect the health of Black Americans, write the authors, is for the nation to address the “social, economic, political, legal, educational, and healthcare systems that maintain structural racism.”

Focusing on healthcare systems, they offer five practices that these systems can enact to dismantle structural racism and improve the health and well-being of Black Americans. They are:

Divest from racial health inequities. For example, the U.S. health insurance market enables a sometimes racially segregated healthcare delivery structure that provides different quality of care to different populations.

• Make “mastering the health effects of structural racism” a professional medical competency.  Desegregate the healthcare workforce. Mandate and measure equitable outcomes.
• Protect and serve. “Police violence and structural racism are public health crises that are making individuals and communities sick,” says Hardeman.
• “Healthcare systems must play a critical role in protecting, serving, and advocating for their patient populations.”

As the authors write, “The choice before the healthcare system now is to show, not tell, that Black Lives Matter.”