Racism, and not race, is a social determinant of health, as leadership from the Ohio State University Wexner Medical Center and Health Sciences Colleges recently declared. Acknowledging this is a foundation for structural and systemic change. Indeed, academic medical centers and health care organizations not acting to eliminate racism are perpetuating its proliferation. Within and outside our walls, we must build a culture of health that empowers populations that have historically been made vulnerable and uproots the manifestations of racism that appear in health care.
Applying Anti-Racism To Our Own Systems First
As has been increasingly acknowledged, our nation is simultaneously experiencing two pandemics. The COVID-19 pandemic has led to devastating effects on communities of color impacted by disproportionately higher rates of disease, hospitalization, and death. The pandemic of racial injustice, a longstanding, persistent pandemic receiving more attention now due to high-profile cases of police and citizen brutality against Black people, is provoking the kind of outrage that creates space to elevate anti-racist platforms. For health care institutions and educators to effectively respond to both pandemics and their systematic causes, an anti-racism foundation is necessary, and anti-racism must become a core value.
First, however, we must do the important work of acknowledging and dismantling racism in our own systems—from maltreatment of Black patients to prejudice against Black colleagues, students, and trainees in research grants, admissions, promotion, rewards, compensation, and representation. Health care institutions and organizations need a culture shift to make anti-racism foundational to our core values and operations. This requires targeted education and engagement, funding, and new policies and practices, and must begin in health professions education, where we bear the responsibility of training the very clinicians who will treat maladies that are caused by and reinforce racial injustice.
The Miseducation On “Social Determinants”
The list of ways in which our systems have caused Blackness to equate to sickness is long and egregious. We call these “social determinants of health”—which, in a sense, is a kind of softening and euphemizing of language that shields the genuine root causes of poor health. While social determinants play a significant role in shaping everyone’s health and overall well-being, in communities of color, social determinants often equate to disparity, and are, in many cases, institutional expressions of racism, oppression, sexism, injustice, and inequity. And yet we teach around these issues every day.
We teach students that infant mortality, for example, is more than twice as high in Black than White infants, but fail to underscore that racism is a toxic prenatal stress for Black mothers at every income and educational level. Trainees need to be taught about redlining and discriminatory practices that have made Black populations more vulnerable to poor living conditions, limited food options, inaccessibility to walkable space, lower-paying jobs, inadequate educational opportunity, violence, economic deprivation, mass incarceration, and substandard health care.
By omitting dialogue around the real causes of poor health, health professions education has proliferated potentially life-threatening social categorization of Black patients through scientifically unfounded teaching. It’s no wonder, then, that Black patients are less likely to have their symptoms and pains given serious credence, less likely to receive evidence-based diagnostic testing and treatment, and more likely to be mislabeled and stereotyped by health care professionals due to implicit and explicit biases.
As medical professionals, we take an oath to do no harm. It is therefore our professional and ethical obligation to dismantle systems that have structurally been designed to harm. This does not mean talking around social determinants of health or talking about diversity; it means actively working against racism, by evaluating curricula, practices, training models, behaviors, and actions through a lens of anti-racism.
To this end, the Ohio State University Wexner Medical Center and Health Sciences Colleges have launched an Anti-Racism Action Plan and urgently call for other academic medical centers and health care serving institutions to follow suit. Some organizations are already moving in this direction; more must step up.
The Anatomy Of Our Anti-Racism Agenda
Our Anti-Racism Action Plan consists of four key pillars, with concrete steps and action teams associated with each priority area, as well as an oversight committee reporting to the chancellor to ensure accountability. Below, we share some of the activities being undertaken.
Elevate The Cause
The first pillar makes anti-racism foundational to enterprise efforts. The action teams focused on this pillar will work to raise awareness within and outside of our institution, focusing on educational and curricular reform, community engagement, and strategy.
One example of this work is the upcoming launch of our Roundtables On Actions Against Racism, to engage key stakeholders, including local and national experts, businesses, government agencies, community organizations, and individuals around action-oriented racism dialogues. The series will include facilitated discussions, policy recommendations, and dissemination of best practices. We are also auditing our curricula to ensure inclusion of the historical context of racism in health and health care, and a detailed understanding of social determinants of health. Lastly, we are reengineering and reforming our institution’s policies and creating an accountability framework through comprehensive evaluation and scorecards to facilitate broader engagement and alignment on this critical work with the institution’s strategic plan.
As we raise awareness about the roots and impact of racism, we are making efforts to engage employees, faculty, staff, students, and other learners and stakeholders in tactical solutions and activities to confront and mitigate racism. We have initiated a series of cross-departmental, inter-college, anti-racism town halls and listening sessions, and have provided leaders with practical tools, such as racism dialogue toolkits and anti-racism training resources, to create open and safe spaces for action-oriented dialogue.
As a large academic health center, our stakeholders also include the communities we serve and the generations that will ultimately populate and lead our institutions. Therefore, we are expanding efforts to create pathways for excellence that reach deeper into the pipeline and further upstream to provide tools, mentoring, and resources for Black students from elementary school onward to aspire for and achieve goals in the health professions.
Equip Communities, Employees, And Learners
We cannot drive an anti-racist agenda—nor expect others to do the same—without material support and resources. Our third pillar is about investing in scholarships, funding, training, toolkits, people, positions, and pathways that support anti-racism initiatives. The journey toward anti-racism should not be another minority tax on underrepresented groups within organizations. All faculty, students, and staff must work toward creating a culture of anti-racism within their institutions.
To do this effectively, we are educating our entire faculty, staff, students, and other learners, along with our communities, to equip them with the tools and resources they need to deliver on anti-racism goals, including but not limited to training on implicit bias, microaggressions, and discrimination. For example, all faculty, staff, students, and trainees will be required to participate in system-sponsored interactive workshops that incorporate a health equity perspective into clinical decision making. The costs of such programs will be borne by the institution, not the individuals, with resources dedicated to support staff and a dedicated project manager for anti-racism initiatives.
Recognizing that racism appears in many other sectors of society, including housing, employment, and education, we are committed to rectifying disparities through alignment with community partners and investing in housing and employment. Additionally, as health care delivery has shifted during the COVID-19 pandemic, with increased attention to digital health care, we are focused on initiatives to improve telehealth literacy and access, including advocating for affordable broadband for underserved communities and blunting the digital divide through activities such as building awareness of health risks and technology needs in partnership with community organizations and local libraries, as well as optimizing the use of community health workers.
Empower Those Who Are Marginalized Or Oppressed
We recognize our own faults in allowing racism to fester in our learning environment, as well as our unique opportunity to empower those who have been marginalized or oppressed. Action groups focused on this pillar will ensure that we empower patients, communities, and employees with an anti-racist culture that encourages individuals to speak out against racism, invests in the voices of the unheard, and leads comprehensive evaluation efforts to demonstrate impact.
One example is the new Stop the Line initiative, modeled after the Toyota company’s approach to risk mitigation and response that provides a safe environment for anyone to speak out if a problem is detected. When that happens, all production is halted. In health care, this has been critical as a lean strategy when applied to patient safety. We will leverage this framework as a zero-tolerance strategy to build a culture of trust, safety, and accountability on issues such as racism, bigotry, and discrimination. Such a model will empower all employees, learners, partners, and patients to Stop the Line as needed, and encourage and protect those reporting offensive, racist, sexist, discriminatory behaviors, actions, inactions, or comments.
An academic health center cannot be anti-racist without committing to meaningful advocacy and community investments. In addition to learning from and engaging communities, we aspire to be a place where marginalized groups feel welcome to advocate. To that end, we are using our position in one of the nation’s largest cities and Ohio’s state capital as a resource for community advocacy efforts, partnering with local, county, state, and national anti-racism efforts to align, elevate, and evaluate efforts with public health and community organizations focused on mitigating racism.
Some examples include launching an enterprisewide non-partisan voter registration campaign in concert with a community partner, as well as examining our vendor relationships and procurement policies through an anti-racist lens. We aim to use our social and financial capital to uplift and partner with Black and minority-owned businesses, other community partners, and organizations committed to social reform. Specifically, departments across the institution have been asked to support initiatives, companies, and vendors who empower Black and minority-owned businesses.
Evaluation And Accountability Are Key
Our anti-racism plan functions on both the institutional and individual level, creating a continuous feedback loop that supports ongoing change and regular reflection on progress toward anti-racist policies, protocols, and reporting.
But these efforts cannot happen without rigorous, regular evaluation, transparency, and accountability. To accompany the action plan, we are developing an anti-racism scorecard and real-time tracking dashboard led by our analytics action group. The scorecard, for instance, will capture anti-racism targets that align with our goals in domains such as talent and culture, research, wellness, advancement, and clinical care. Maintaining a laser focus on goals and progress is important to motivate ongoing action, inspire redirection where needed, and create a climate of innovation around anti-racism activity.
The Time For Action Is Now
Academic health centers are often regarded as sources of truth and leadership in the communities they serve. However, that status cannot be assumed; it must be earned and renewed. As we renew the social contract that academic health centers have with their students, learners, faculty, staff, patients, and communities, we must explicitly condemn racism. We cannot be content with teaching future health care professionals about caring for the downstream consequences of racism without addressing its upstream roots. We must challenge the very systems that have propagated racism and acknowledge that racism makes us all sicker. We call on all involved in health care to translate their anti-racist affirmations into their core values, which would then inspire actions that improve education, engagement, policies, practices, and funding within their organization and the lives of those they serve.