Racial Equity: Fundamentals of Race and Racism

Race and racism have been foundational to medicine as an institution and the U.S. health system. This learning module traces the history of racism in medicine as a continuum, with deep roots in the institution of slavery, and shows how racism has affected African Americans’ health and health care practices. It documents the ways in which medical doctors, philosophers, and scientists throughout history have contributed to the creation and perpetuation of the mythology or racial inferiority and race-based stereotypes. These theories were taught in the U.S. medical schools in the 18th, 19th, and first part of the twentieth century. They demonstrate how this institutional practice throughout the United States, coupled with 246 years of slavery and biased education, led to what Byrd and Clayton (2001)  call “medical and scientific abuse, unethical experimentation, and overutilization of African Americans as subjects for teaching and training purposes.”

Race and racism have been foundational to medicine as an institution and to the U.S. health system. This learning module traces the history of racism in medicine as a continuum, with deep roots in the institution of slavery, and shows how racism has affected African Americans’ health and health care practices. It documents how medical doctors, philosophers, and scientists throughout history have contributed to the creation and perpetuation of racial inferiority and race-based stereotypes. These theories were first taught in the U.S. medical schools in the 18th, 19th, and first part of the 20th century. They demonstrate how this institutional practice throughout the United States, coupled with 246 years of slavery and biased education, led to what Byrd and Clayton (2001)  call “medical and scientific abuse, unethical experimentation, and overutilization of African Americans as subjects for teaching and training purposes.”

In 2020, the Robert E. Lee statue, the last of five major Confederate statues to be removed, on Richmond’s Monument Avenue became a symbol of the “Black Lives Matter” social movement (photo by Max Schlickenmeyer, VCU University Marketing)

 

Objectives

 

• Define race, racism and structural racism
• Describe how race and racism pervaded the institution of medicine
• Explain how structural racism impacts health and healthcare in the United States.

Although the conceptualization of race has moved from the biological to the social sphere over time, many medical fields still rely on and reproduce biological conceptions of race. Racism continues to be a factor that negatively impacts African Americans and other racial and ethnic minorities. As you read Race, Medicine, and Health Care in the United States: A Historical SurveyLinks to an external site., try to identify key figures in the history of western biomedical sciences and reflect on how racism in medicine has paralleled racism in society.

Let’s consider structural racism, or broader social, political, and economic factors that determine individual and community health. How have racist policies, laws, and institutions have resulted in racialized health and healthcare inequities and disparities in the United States? Read this brief essay to find out: How Structural Racism Works — Racist Policies as a Root Cause of US Racial Health Inequities | NEJM

Sociologist Dorothy Roberts uses a personal experience to dig deeper into the historical roots of race-based medicine practices. Where is race used to make false biological predictions? Roberts mentions diagnosis, measurements, treatments, prescriptions, and definitions of diseases. She explores race as a social construct and calls doctors to practice evidence-based medicine rather than continuing to treat patients by race. Further exploration leads us to address how race has been implemented as a shortcut around other relevant social factors that doctors don‘t address. She explores how race blinds physicians to these more important measures and leaves certain populations vulnerable due to stereotypes of tolerance and addiction levels. She further examines how drugs are marketed to black patients, how race stands in as a proxy for unknown genetic factors, and the resulting wariness black people have to use drugs targeted to blacks due to the history of medicine. Lastly, she digs into how racial discrimination has a staggering biological impact as a result of social inequality that no pill can fix in her TED Talk. Watch:

This event was presented as part of the History and Health: Racial Equity Speaker Series. The VCU Humanities Research Center. co-sponsors this event with the VCU Office of Health Equity.

VCU Health Sciences and the VCU Health System, like most medical institutions, have engaged in and benefited from slavery, segregation, and racism. Join panelists Dr. Meera Pahuja (VCU Health), Melanie Rouse (Virginia Department of Health), Rev. Benjamin Campbell (St. Paul’s Episcopal), Theresa Riley-Teekah (African-American Breast Cancer Support Group), and Sheryl Garland (VCU Health) as they share their stories and experiences, reflecting on how race and racism have been foundational to the institution of medicine and how structural racism impacts health and health care. The panel is moderated by Jason Callahan (VCU).

This event was presented as part of the History and Health: Racial Equity Speaker Series. The VCU Humanities Research Center. co-sponsors this event with the VCU Office of Health Equity.

These first two documents below (reading lists) are extensive, and offer some really helpful information and much more comprehensive overviews of Racism, Anti-Racism, Health, and Medicine:

Syllabus: A History of Anti-Black Racism in MedicineLinks to an external site.

Racism and Health: A Reading ListLinks to an external site.

Recommended readings of general interest:

“Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” at NAP.eduLinks to an external site.

Race and Racism in Health Care | Harvey Cushing/John Hay Whitney Medical LibraryLinks to an external site.

Metzl JM, Petty J, Olowojoba OV. Using a structural competency framework to teach structural racism in pre-health educationLinks to an external site.. Soc Sci Med. 2018 Feb;199:189-201. doi: 10.1016/j.socscimed.2017.06.029. Epub 2017 Jun 22. PMID: 28689630.

Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventionsLinks to an external site.. Lancet. 2017 Apr 8.389(10077):1453-1463. doi: 10.1016/S0140-6736(17)30569-X. PMID: 28402827.

History and Health events and educational content is created in collaboration with the Health Humanities Lab at the Humanities Research Center. This module was authored by Jason Callahan, MDiv, instructor in the Department of Patient Counseling, College of Health Professions, and chaplain for the Thomas Palliative Care Unit in VCU Massey Cancer Center and  Cristina Stanciu, Ph.D.,  Associate Professor of English and Director, Humanities Research Center. All modules undergo a rigorous curriculum peer reviewal process.