Systemic racism

We often wonder if there is indeed such a thing called ‘systemic racism’ or if it can even be proven. We often reconcile to the fact that it may be ingrained in people from early childhood and hence becomes ‘systemic’.

Scientifically speaking, there were two papers published in Journal of American Medical Association (one in Internal Medicine and other in Oncology), which provide a stunning definition of how systemic racism works.

JAMA Internal medicine – On Jul 11, 2022, Eric Gottlieb et al published a research paper in JAMA Internal medicine titled “Assessment of racial and ethnic differences in oxygen supplementation among patients in the intensive care unit”. This work used the data between 2008 and 2019 in a Boston hospital available publically as MIMIC-IV dataset. In this cohort study of 3069 patients in the ICU, asian, black and hispanic patients had a higher adjusted time-weighted average pulse oxymetry reading and were administered significantly less supplemental oxygen for a given average hemoglobin oxygen saturation compared to white patients.

JAMA Oncology – On Jul 14, 2022, Manali Patel et al published a paper in JAMA oncology titled “Racial and Ethnic disparities in cancer care during the covid-19 pandemic”. In the survey study of 1240 US adults with cancer, black and latinx adults reported experiencing higher rates of delayed cancer care and more adverse social and economic effects than white adults. This study suggests that the covid-19 pandemic is associated with disparities in the receipt of timely cancer care. Could be due to limited or overburdened resources, but the systemic nature of racism manifests.

Both these studies nail the systemic racism that exists, even in healthcare. These are not one-off incidences. These are systematically administered biases over a long period of time over many individuals. Human race, have a long way to go to be equitable!

Last year, Zinzi Bailey et al published in New England Journal of Medicine (here) an article on how structural racism works, with racist policies as a root cause of US racial health inequities.

It concludes by saying structural racism reaches back to the beginnings of U.S. history, stretches across its institutions and economy, and dwells within our culture. Its durability contributes to the perception that Black disadvantage is intrinsic, permanent, and therefore normal. But considering structural racism as a root cause is not a modern analogue of the theory that disease is caused by “miasmas” — something that’s “in the air,” amorphous and undifferentiated. The article suggests four ways of moving forward by:

1. embracing the intellectual project of documenting the health impact of racism.
2. making available data that include race and ethnicity must improve, and efforts to develop and improve measurement of structural racism need to be supported, particularly those using available administrative databases.
3. self-introspecting - the medical and public health communities need to turn a lens on themselves, both as individuals and as institutions. Faculty and students need a more complete view both of U.S. history and of the ways in which medicine and public health have participated and continue to participate in racist practices.
4. acknowledging that structural racism has been challenged, perhaps most successfully, by mass social movements