'All policy is health policy': 5 practices healthcare systems can do to dismantle structural racism

There are five practices healthcare organizations should implement to dismantle structural racism and improve the health of the black community, according to a perspective article published June 10 in The New England Journal of Medicine. 

As illustrated by the COVID-19 pandemic, "all policy is health policy," the authors write. The response to the pandemic has also made it clear that systemic change in healthcare can in fact happen overnight.

Black communities bear the physical burdens of centuries of injustice, toxic exposures and racism. Therefore, solutions to racial health inequities must be rooted in such material conditions, the authors write. 

The authors recommend healthcare systems engage in at least these five practices to dismantle structural racism: 

1. Divest from racial health inequities. "Racial health inequities are not signs of a system malfunction: they are the by-product of healthcare systems functioning as intended," the authors write. For example, the tiered health insurance market enables a sometimes racially segregated healthcare delivery structure, meaning different quality of care is provided to different patient populations. 

2. Desegregate the healthcare workforce. The healthcare workforce is predominantly white, from student to CEO. The authors claim this lack of diversity must be viewed as a form of racial exclusion that affects economic mobility and therefore the health of nonwhite groups. For example, healthcare systems are often the largest employers in their communities. Extending employment opportunities to nonwhite communities can extend the employer-based insurance pool, raise median wage, support the local tax base and counter residential segregation that often surrounds major medical centers.

3. Make "mastering the health effects of structural racism" a professional medical competency. Medical schools and training programs should teach every clinician in every role to address racism, the authors write. Licensing, accreditation and qualifying procedures should test this knowledge as an essential professional competency.

4. Mandate and measure equitable outcomes. Just as healthcare systems are required to meet rigorous safety and quality performance standards for accreditation, they should be required to meet standards for addressing structural racism and achieving equity in outcomes.

5. Protect and serve. Healthcare systems must work to protect and advocate for their patients, the perspective piece claims. Victims of state-sanctioned brutality are also patients. Healthcare systems should advocate for an end to police brutality as a cause of preventable death in the U.S. They should take a clear position that the disproportionate killing of black, indigenous and Latinx people at the hands of police counters their commitment to ensure the safety and well-being of patients.


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