Academic Medicine’s Journey Toward Racial Equity Must Be Grounded in History: Recommendations for Becoming an Antiracist Academic Medical Center

Abstract

The harsh realities of racial inequities related to COVID-19 and civil unrest following police killings of unarmed Black men and women in the United States in 2020 heightened awareness of racial injustices around the world. Racism is deeply embedded in academic medicine, yet the nobility of medicine and nursing has helped health care professionals distance themselves from racism. Vanderbilt University Medical Center (VUMC), like many U.S. academic medical centers, affirmed its commitment to racial equity in summer 2020. A Racial Equity Task Force was charged with identifying barriers to achieving racial equity at the medical center and medical school and recommending key actions to rectify long-standing racial inequities. The task force, composed of students, staff, and faculty, produced more than 60 recommendations, and its work brought to light critical areas that need to be addressed in academic medicine broadly. To dismantle structural racism, academic medicine must: (1) confront medicine’s racist past, which has embedded racial inequities in the U.S. health care system; (2) develop and require health care professionals to possess core competencies in the health impacts of structural racism; (3) recognize race as a sociocultural and political construct, and commit to debiologizing its use; (4) invest in benefits and resources for health care workers in lower-paid roles, in which racial and ethnic minorities are often overrepresented; and (5) commit to antiracism at all levels, including changing institutional policies, starting at the executive leadership level with a vision, metrics, and accountability.

Reckoning with Our Racist Past: An Academic Health Center’s Engagement with History and Health

“…Initiatives taken by individual AHCs to address institutionalized racism include (a) a reexamination and acknowledgment of institutional history, (b) initiating open, safe, and ongoing dialogues around inequity in medical care, education, and research, (c) training to recognize implicit bias, and (d) community partnerships to address social needs of marginalized patients (Karanja et al, 2020;Mateo & Williams, 2020;Morse & Loscalzo, 2020;Peek et al, 2020;Wilkins et al, 2021). Indigenous, African American, and Hispanic/Latino persons are less represented in the health care workforce not by chance but due to long-standing formal and informal discrimination.…”

“…Indigenous, African American, and Hispanic/Latino persons are less represented in the health care workforce not by chance but due to long-standing formal and informal discrimination. As part of recognizing its history and supporting institutional selfexamination, Vanderbilt University Medical Center has begun to address institutional climate and barriers to upward mobility for all workers in the AHC (Wilkins et al, 2021). Likewise, Johns Hopkins Medicine, notorious for kidnapping black children for medical experiments and taking tissue cells from Henrietta Lacks without consent, is re-examining and acknowledging its past (Woodruff, 2016).…”

When I say … diversity, equity and inclusion (DEI)

“…While diversity is the presence of perceived differences, in medicine diversity is often based solely on visible demographics without consideration of the social construction and specific history of these categories 6,7 . Similarly, equity refers to the practice of promoting impartiality, fairness and access through processes and procedures 8 that ensure individuals have equal opportunities based on their needs regardless of the systemic disadvantages or barriers put in their way 9 .…”

“…4,5 While diversity is the presence of perceived differences, in medicine diversity is often based solely on visible demographics without consideration of the social construction and specific history of these categories. 6,7 Similarly, equity refers to the practice of promoting impartiality, fairness and access through processes and procedures 8 that ensure individuals have equal opportunities based on their needs regardless of the systemic disadvantages or barriers put in their way. 9 The existence of equity is extremely important for the success of underrepresented individuals and people with marginalised identities because it provides the support they need to be able to work within a social institution that was historically envisioned and nurtured for another type of worker.…”

For us by us: Instituting mentorship models that credit minoritized medical faculty expertise and lived experience

“…Additionally, the National Academy of Medicine, the American Medical Association, and the National Institutes of Health, as well as multiple scientific journals publicly affirmed the support for Black Lives Matter and the need for racial reckoning, highlighting urgent calls for equity in opportunity and representation among all ranks including the highest within each institution (3,4). These conversations echoed throughout academic medical centers around the country and prompted faculty members who are underrepresented in medicine (UIM) to build community around shared and lived experiences of isolation, and historic and ongoing aspects of internalized, interpersonal, and structural racism, while simultaneously rallying to create actionable steps to counter these visible and invisible practices of discrimination and denigration (5).…”