The effects of racism are interwoven in U.S. healthcare systems and structures, from practice and teaching of medicine to disease management. A powerful call to action from the American Academy of Pediatrics (AAP) demands critical self-evaluation and fundamental changes in the practice of medicine to end long-standing inequities in health care.
In the new policy statement, "Eliminating Race-Based Medicine," pre-published online May 2, 2022, in Pediatrics, the AAP observes that race is a historically derived social construct that has no place as a biologic proxy. Over the years, the medical field has inaccurately applied race correction or race adjustment factors in its work, resulting in differential approaches to disease management and disparate clinical outcomes.
"Before we can legitimately address systemic and structural inequities in health care we must first recognize that they exist and are a byproduct of deeply ingrained societal racism," said Chair of the AAP Board Committee on Equity, Joseph L. Wright, MD, MPH, lead author of the policy statement and Chief Health Equity Officer of the University of Maryland Medical System.
Social determinants of health
"The American Academy of Pediatrics is taking an important step toward dismantling race-based medicine. This effort calls for acknowledging the impact that differential lived experiences have on individual and population health outcomes through a race-conscious health equity lens rather than through approaches that have inappropriately identified skin color as an independent risk-adjusting variable," Dr. Wright said.
"Social determinants of health need to be carefully considered in the development of care delivery strategies including factors embedded in broad categories such as access, the physical environmental and community supports. Evidence informed incorporation of these factors is vital in all areas of medicine."
The policy statement reflects on the vigorous debate on the role of race and racism in medicine, and how perceptions of physiologic differences based solely on racial phenotypes have long been intertwined in the practice and teaching of medicine. The statement includes examples of race-based clinical algorithms or practice guidelines that are undergoing reexamination and reconsideration within pediatrics and across other medical specialties.
"Eliminating race-based medicine is necessary; it is challenging; and it is long overdue," AAP President Moira Szilagyi, MD, PhD, FAAP, said. "We are mindful that this work will make some uncomfortable, not only because it requires systemic change, but how we must approach this work as individuals. We welcome this challenge—and the discomfort that comes with it—and are encouraged by the steps we've already taken."
The AAP recommends:
The AAP will leverage its relationships with medical schools, academic health systems, schools of medicine and accrediting bodies to ensure health equity curricular content, including a specific focus on the elimination of race-based medicine. It will seek to proactively reframe appropriate social determinant of health measures.
The Academy will critically examine, deconstruct, retire, if necessary, and revise all practice guidelines and/or policies that include race assignment as a part of clinical decision-making.
The Academy will leverage its Words Matter document, to ensure that all authors, editors, presenters, media spokespersons, and other content contributors recognize race as a social construct only and desist from any use, or its reference, as a biologic proxy.
"The evolution of modern medicine has produced incredible advancements and accomplishments in health care," Dr. Wright said. "But we must acknowledge and address the stark inequities that persist in leaving vulnerable populations behind. We are better than this. Now is the time for change."