This article comes from the winter 2020 edition of the Nonprofit Quarterly as part of an article series on “America’s healthcare crisis.”
The Nonprofit Quarterly recently sat down with Dr. Willarda V. Edwards, who has been helping to spearhead an effort inside the House of Delegates at the American Medical Association (AMA) to reorient the organization around antiracist principles. This has resulted in a policy platform, made public in mid-November 2020, that took on a wide variety of issues seen as needing systemic redress. The new policy,1 now approved by the AMA House of Delegates, will do the following:
- “Acknowledge that, although the primary drivers of racial health inequity are systemic and structural racism, racism and unconscious bias within medical research and health care delivery have caused and continue to cause harm to marginalized communities and society as a whole.
- “Recognize racism, in its systemic, cultural, interpersonal and other forms, as a serious threat to public health, to the advancement of health equity and a barrier to appropriate medical care.
- “Support the development of policy to combat racism and its effects.
- “Encourage governmental agencies and nongovernmental organizations to increase funding for research into the epidemiology of risks and damages related to racism and how to prevent or repair them.
- “Encourage the development, implementation and evaluation of undergraduate, graduate and continuing medical education programs and curricula that engender greater understanding of the causes, influences, and effects of systemic, cultural, institutional and interpersonal racism, as well as how to prevent and ameliorate the health effects of racism.
- “Identify a set of current best practices for health care institutions, physician practices and academic medical centers to recognize, address and mitigate the effects of racism on patients, providers, international medical graduates, and populations.
- “Work to prevent and combat the influences of racism and bias in innovative health technologies.”2
The platform also addresses related antiracist practices in education and research. One of the more interesting recommendations is the elimination from medicine of the notion of racial essentialism, or “the belief in a genetic or biological essence that defines all members of a racial category.”3 The AMA pledges to, among other things:
- “Recognize that the false conflation of race with inherent biological or genetic traits leads to inadequate examination of true underlying disease risk factors, which exacerbates existing health inequities.
- “Encourage characterizing race as a social construct, rather than an inherent biological trait.
- “Recognize that when race is described as a risk factor, it is more likely to be a proxy for influences including structural racism than a proxy for genetics.”4
“The AMA is dedicated to dismantling racist and discriminatory policies and practices across all of health care, and that includes the way we define race in medicine,” says AMA board member Dr. Michael Suk. “We believe it is not sufficient for medicine to be nonracist, which is why the AMA is committed to pushing for a shift in thinking from race as a biological risk factor to a deeper understanding of racism as a determinant of health.”5
Dr. Edwards tells us that the new, explicitly antiracist position has a two-decades-long history involving many internal and external stakeholders who have worked for years on issues of health equity.
Externally, she says, the AMA has worked with the National Medical Association—the African American physicians’ organization that was established in 1895 because the AMA was a whites-only organization6—and with the National Hispanic Medical Association. Internally, she says, groundwork for this recent advance had been laid out by the Commission to End Health Care Disparities, on which it collaborated with both organizations starting in the 1990s. In essence, the work they started then has continued, interrupted in 2016 by sunsetting the Commission and continuing its work in the already established Minority Affairs section of the AMA—a move that did not last long. As Dr. Edwards notes:
By the following year, in 2017, our House of Delegates was clear that we needed to bring the commission back—that there was a lot more work that needed to be done. In 2017, we developed recommendations to create a center on health equity within the AMA. The House [of Delegates] approved it in 2018. In 2019, we appointed Dr. Aletha Maybank to be head of our Center for Health Equity. And it wasn’t just another section or another part of AMA—it became embedded in all AMA business units. But then in June of this year, our AMA board of trustees acknowledged the health consequences of the violent police interactions, and denounced racism as an urgent threat to public health. And we proposed then and there to take action to confront systemic racism, racial injustice, and police brutality. And in November, when we had our usual fall meeting of our House of Delegates—which sets policy for the organization—this policy unanimously passed, and culminated with AMA recognition of racism as a public health threat.
That resolve, of course, was only hardened by the degree to which Black and Brown communities are disproportionately affected by COVID-19. Dr. Edwards points to the fact that the African American community makes up only 13 percent of the U.S. population, yet represents 25 percent of the COVID-19 deaths; and the Latinx community, if categorized monolithically as 18 percent of our population, represents 33 percent of the new COVID-19 cases. But the racial disparities that cause real differentials in health are so all-inclusive, Dr. Edwards says, that you have to back way up and ask what all the factors are that go into, say, a thirty-year difference in life expectancy between one zip code and another immediately bordering it, as you find in, for example, Chicago.7 For that, she says, you cannot just look at issues like better healthcare access, which is certainly a concern in that city, but must also look to the support of business ventures,