This is from Boston Review:
An Antiracist Agenda for Medicine
Colorblind solutions have failed to achieve racial equity in health care. We need both federal reparations and real institutional accountability.
We are experienced physicians. But in the early days of the pandemic, when we felt like fresh interns nervously awaiting a flood of disease presentations we had never seen before, we had a nagging sense of déjà vu: it seemed that a disproportionate number of COVID-19 patients admitted to our Boston hospital were people of color. We asked around; our colleagues corroborated. The trend was confirmed by data coming out of Milwaukee first, then sporadically elsewhere. Now it is a well-known and tragic fact of the pandemic.
The experience was doubly jarring, however, because we had noted an analogous pattern in hospital admissions six years ago. In 2015 some of us wondered why Black and Latinx patients with heart failure—our hospital’s most common diagnosis—seemed more likely than white patients to end up on our general medicine service rather than on our cardiology service, where patients have better outcomes (along with a more comfortable experience, including private rooms and better amenities). Our effort to understand and correct this disparity has led us to rethink the nature of the fight for racial justice in medicine.
After analyzing ten years of hospital data, we concluded that the trend we observed was painfully robust: white patients at Brigham and Women’s Hospital—a prominent, predominantly white Harvard teaching hospital—were indeed more likely to be admitted to the cardiology service. We also found that the discrepancy, like many other racial health inequities, wasn’t fully accounted for by insurance status, established links to care, other medical conditions, or an index reflecting the socioeconomic status of a patient’s neighborhood. In a follow-up study we found that patient self-advocacy may play a role in these disparities: white patients were perceived to advocate for cardiology admission more often and more intensely, and providers acknowledged such behavior impacted their decision making.
Recognizing this problem, public health scholars Chandra Ford and Collins Airhihenbuwa brought CRT’s legal approach to the public health realm in 2010 with their landmark proposal of a Public Health Critical Race Framework. Following their lead, we have sought to implement that framework in our own advocacy and clinical work on equitable heart failure admissions. Together with a coalition of fellow practitioners and hospital leaders, we have developed what we hope will be a replicable pilot program for direct redress of many racial health care inequities—one that takes seriously the limitations of colorblind solutions and empowers institutions in variety of contexts to take decisive action to achieve racial equity.
Sensitive to these injustices, we have taken redress in our particular initiative to mean providing precisely what was denied for at least a decade: a preferential admission option for Black and Latinx heart failure patients to our specialty cardiology service.
Offering preferential care based on race or ethnicity may elicit legal challenges from our system of colorblind law. But given the ample current evidence that our health, judicial, and other systems already unfairly preference people who are white, we believe—following the ethical framework of Zack and others—that our approach is corrective and therefore mandated. We encourage other institutions to proceed confidently on behalf of equity and racial justice, with backing provided by recent White House executive orders.
This is zero-sum thinking. It always ends with the unfavored group having their access limited.
So under this plan, presumably, a white man with chest pains and shortness of breath is going to have to take a back seat waiting for the hospital cardiologist or be given a Tums and told to do home.
Never in the history of this sort of action has the outcome been to improve people. The Soviet peasants weren’t able to grow more food, the Kulaks who did grow the food had their land taken away and everyone starved. The Chinese repeated that half a century later. Then the Cubans, Zimbabweans, and Cambodians after that.
They never build up, they only tear down. These people cannot achieve equity by reducing the mortality rate for black patients, they will just increase the mortality rate for white patients until parity is achieved.
Dancing doctors and nurses on TikTok will be a drop in the bucket of animosity directed to the medical community if they embark on a plan to make white people feel like they can’t trust that if they go to the hospital they will be given the best care because of the color of their skin.
Go Woke, go broke is an absolute rule and it will break our hospitals too. They will doom medical care in this country by going woke.
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