Racism as a public health crisis

Dr Noon Altijani

A panel of experts of colour in medicine and public health from the UK and US discussed racism’s historic and pervasive effects on population health, and how racist structures embedded into social systems and medical practice can be remedied.

Watch the discussion:

Green Templeton’s Imogen Malpas, MSc Medical Anthropology, writes the following report of the event that took place on Wednesday 8 July 2020:

Among the multiple diverse health crises that have faced communities worldwide across time and space, one that has made itself disturbingly and pervasively known in recent times is racism. As the UK and US grapple with historical legacies of white power and privilege that seep into the medical sphere, leaving black women five times more likely than their white counterparts to die in childbirth and black people facing a COVID-19 mortality rate four times higher than white people, a panel of black experts from both countries came together to discuss how we got here – and what needs to be done.

Together, the panel charted a course through the histories of medical racism, the present-day institutional discrimination that blights health organisations, and the fatal microaggressions of modern medicine. Dr Monica Vela, Professor of Medicine and Associate Dean for Multicultural Affairs at the University of Chicago Pritzker School of Medicine, began by exposing the racist legacies ingrained into powerful stalwarts of medicine: such as the American Medical Institution, which excluded and denied career rights to African-American physicians until the 1960s. Demonstrating how conditions that affect those of African heritage – like sickle cell disease – are underfunded and underresearched thanks to this systemic disadvantagement of African-American researchers and resources, Dr Vela called for a radical rethink of the medical education system in response to the profound failures of ethics still perpetuated against the African-American community long after the Civil Rights movement had led many to consider racism a thing of the past.

Following with a perspective from across the pond, Dr Adwoa Danso – GP, resident doctor on GN Radio UK and award-winning writer and community health advocate – drew a parallel between institutional discrimination in the US and the UK, urging the audience to accept the existence of racism within the NHS. Pointing out that BAME workers in the NHS are less likely to be promoted or to complain about workplace safety due to fears of sanctions and docked pay – and that 1 in 4 black women in the NHS experience racial harassment or bullying from managers – Dr Danso explained how the hugely damaging effects of racism extend to medical staff as well as patients, highlighting how the disproportionate lack of black people at the ‘table’ of healthcare must be addressed at a systemic level. As she so profoundly stated, ‘racism can’t go hand in hand with good leadership’: to keep patient care a priority, the BAME staff of the NHS need allies willing to speak up against discrimination in all its forms.

Next up, Professor Helena Hansen, joint-appointed Associate Professor of anthropology and psychiatry at the New York University Grossman School of Medicine, took us back through the intertwined histories of American drug policy, biotechnology and pharma marketing to bring to light the murky, racialised context of the US opioid crisis. Professor Hansen demonstrated how the remarkable racialisation of powerful narcotics in US policy – normally associated with black populations, for whom the euphemism most commonly used is ‘suburban’, but newly marketed to white groups as ethical pain relievers – has led to a lethal social acceptability of opioids for white users, driving white consumers to pay inflated prices for patented opioids, black consumers to be economically and socially forced into consumption of illegal opioids, and both to pay with their lives in the form of lethal doses. Underlying the entire system, Professor Hansen warned, is racial capitalism: the primary driver of biotech and pharma industries both in the US and abroad, since new medical technologies on the market are almost exclusively targeted at white clientele with purchasing power. A logic underlying the inflated death rates for black populations of COVID-19, racial capitalism must be challenged in order for patients – especially BAME patients – to become the priority in any healthcare system.

Rounding off the panel with a macro-level public health perspective was Adebusuyi (Ade) Adeyemi, director of the Chatham House African Public Health Leaders Fellowship and founder and managing director of GlobalHealthJobs.com. Ade addressed the event’s topic from a unique perspective, asking what myths we tell about our society and its structures that keep us from seeing the structural inequalities that exist amongst us in plain sight. The problem with racism, Ade explained, is that it doesn’t fall into the ‘hero vs. villain’ structure that Hollywood has made us all so comfortable with. Rather, racism follows far more deeply nuanced and subtle patterns that allow it to insert itself into daily interactions through actors who may well be blind to their own problematic actions. Who, then, is the person responsible for fixing the systemic evil of racism? The answer, of course, is nobody – it’s not one person’s problem, but everyone’s, and in particular white people as allies to the BAME community must take action to address creeping instances of discrimination where we find them.

What followed was a discussion as lively as it was complex, facilitated by Green Templeton’s Dr Noon Altijani: a physician, DPhil candidate and population health expert studying maternal mortality in Sudan. From strategies on how to combat racist bias inherent in medical algorithms, to the need for more images of disease presentations on darker skin tones, to the value of the acronym BAME to describe discrimination that often disproportionately affects black groups specifically, the 200-strong audience engaged with these challenging topics with sensitivity and a true desire to learn. The large turnout to this groundbreaking event gives us all at Green Templeton the sincere hope that, as we keep making room for these vital conversations to take place and for marginalised voices to be heard, more and more people will come to listen.

Created: 13 August 2020