Structural Racism and JAMA Network Open

Abstract

Like so many in our academic community, we were distressed by the February 2021 JAMA podcast and corresponding tweet suggesting that structural racism does not exist and that no physicians are racist. Although we have not written about this issue until now, these events have prompted a deep internal reexamination of how we engage constructively to acknowledge and reverse structural racism and of our own contributions to perpetuating it. We are challenging ourselves to consider how we can be truly antiracist in our roles as physicians, scientists, editors, and members of the communities in which we work and live.First, we, the editors of JAMA Network Open, affirm the entrenched history and ongoing harms of structural racism. In recent times, the horrific killings of George Floyd, Breonna Taylor, Philando Castile, and hundreds of other individuals who were members of racially/ethnically marginalized groups, such as Black and Latinx individuals, at the hands of police have forced critical and long overdue conversations about this centuries-old problem. Structural racism persists in essentially every social system in the US, including, but not confined to, housing, employment, education, health care, finance, transportation, law enforcement, the environment, criminal justice, and politics.Although not always visible, prejudice is embedded in all aspects of US life. Acknowledging the problem is necessary but insufficient. Structural racism requires active dismantling, not only to reverse the status quo but also to counteract ongoing efforts to worsen structural racism through active steps, such as legislation targeted at impeding voting rights.Second, structural racism has deeply and adversely affected health and health care specifically, as manifested by reduced life expectancy, 1,2 higher burden of various illnesses, 3 and higher infant and maternal mortality, 4,5 especially among Black and Hispanic or Latinx individuals. This stark disparity has become further exacerbated during the COVID-19 pandemic. Black and Hispanic or Latinx populations have experienced rates of hospitalizations and deaths due to COVID-19 that are 3-fold higher than White populations. 6,7 This discrepancy has led to a further widening the nearly 6-year lower in life expectancy among Black persons compared with White persons in the US. 8 This distressing trend is a direct manifestation of the disparities in the availability of and access to highquality health services, with associated inferior treatment and outcomes. Uneven access to highly effective vaccines risks deepening these disparities, which have been documented for decades, in many cases without any evidence of improvement over time. The disparate risks of infection with SARS-CoV-2 and subsequent death from COVID-19 among people of racial and ethnic minority backgrounds, such as Black and Hispanic or Latinx individuals, have appropriately attracted attention but must be viewed in the context of systems that have failed the communities in which people of racial and ethnic minority backg...

Use of hospitals in the New York City Metropolitan Region, by race: how separate? How equal in resources and quality?

“…We also build upon previous research by demonstrating the extent of racial and ethnic segregation in the most populous and one of the most ethnically and racially diverse metropolitan regions in the United States. Ongoing questions about the existence of structural racism throughout American medicine including within its most high profile publications underlie the importance of further quantifying and illustrating the extent of hospital segregation [ 48 ].…”

White supremacy culture and the assimilation trauma of medical training: ungaslighting the physician burnout discourse

“…Thanks to the overwhelmingly white cisheterosexual male leadership among national organizations, department chairs, and medical school deans, the white cisheteropatriarchy remains entrenched (Figure 1, Image 2). Testing practices, including the MCAT, and honorary societies like AOA cement the white supremacist professional taxonomy fabricated two centuries ago (Gaufberg et al 2010;Brooks 2015;Rivara et al 2021). As a result, in 2021, white male editors leading a top medical journal can still deny racism's existence (Rivara et al 2021).…”

“…Testing practices, including the MCAT, and honorary societies like AOA cement the white supremacist professional taxonomy fabricated two centuries ago (Gaufberg et al 2010;Brooks 2015;Rivara et al 2021). As a result, in 2021, white male editors leading a top medical journal can still deny racism's existence (Rivara et al 2021). Concepts like "professionalism" cloak the policing of minoritized individuals forced to suppress their distress while enduring the profession's pervasive whiteness (Sethuraman 2006;Gaufberg et al 2010).…”

“…Concepts like "professionalism" cloak the policing of minoritized individuals forced to suppress their distress while enduring the profession's pervasive whiteness (Sethuraman 2006;Gaufberg et al 2010). Medical education still promotes race and gender as biological, not social, realities, despite the resulting harm patients endure (Rivara et al 2021).…”

Improving Social Justice in COVID-19 Health Research: Interim Guidelines for Reporting Health Equity in Observational Studies

“…Structural and systemic inequities in opportunities for health shape vulnerability, defined as exposure to risk, susceptibility to disease, and capability of individuals and communities to respond [23]. For example, structural racism in medicine continues to have profound and adverse impacts on health equity [24,25]. Moreover, a distinction can be drawn between medical vulnerability (those infected individuals who experience poorer prognosis) and functional vulnerability (those individuals who are more susceptible to infection but do not necessarily have a worse prognosis [26].…”