“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.”
-Martin Luther King Jr., 1966
Taking a day off can be challenging for physicians. As a junior faculty, community hospitalist, I usually spend my days off catching up on projects, papers, groceries, and errands. But when I get a holiday off, I try to put my computer and to-do lists away. And while I still look forward to the chance to catch up on sleep or sneak in some academic work, on this particular holiday, January 18, 2021, I was looking forward to the opportunity to reflect. Martin Luther King, Jr. Day has always been a day of reflection and service, but with the twin pandemics of COVID-19 and racism ravaging the U.S., the need to truly reflect and address the injustice of our health care system felt more important than ever.
In January’s issue of the Journal of Hospital Medicine, we had the fortune of publishing two perspectives dealing with racism and health disparities in medicine. Yale medical student Max Jordan Nguemeni Taiko, along with Yale health policy professor Dr. Howard Forman and Dr. Marcella Nunez-Smith, co-chair of President Biden’s COVID-19 advisory board, wrote about how the COVID-19 pandemic has highlighted “long-standing inequities in health along racial/ethnic lines in the United States” in their piece “Racial Health Disparities, COVID-19, and a Way Forward for US Health Systems.” Additionally, health disparities researchers Dr. Utibe Essien, investigator at the Center for Health Equity Research and Promotion at the University of Pittsburgh School of Medicine and Dr. Giselle Corbie-Smith, director of UNC Center for Health Equity Research, outlined strategies for increasing health equity on a large scale in “Opportunities for Improving Population Health in the Post-COVID-19 Era.” Both articles demonstrate how we can leverage the knowledge, exposure, and momentum gained for improving health systems during the pandemic and to press towards a more equitable health system.
For January’s #JHMChat, “Leveraging the Pandemic to Address Health Disparities,” we invited the authors of these perspectives to share the hour on MLK Day, reflecting on health disparities and racism in medicine. We were joined by 88 participants who shared 425 tweets, leading to 4.2 million Twitter impressions.
Below are some of the thoughts and insights our community shared:
1. Racism in medicine and health disparities are not new problems deepening everyday with the pandemic:
A2. The pandemic and #BLMprotest has highlighted the role of racism in health inequalities. Disparities we have seen in risk of infection, access to testing, morbidity and mortality, and now vaccine hesitancy is the result of >400 years of structural racism. #JHMChat
— Giselle Corbie-Smith (@gcsmd) January 19, 2021
Yes, could not agree more. I almost feel like the COVID pandemic made EVERYONE stop and pay attention to what has been happening for centuries. #JHMChat
— Ndidi Unaka MD, MEd (@NdidiUnaka) January 19, 2021
It’s been a year of reckoning that’s long overdue. Shouldn’t have taken a pandemic. Unsurprisingly sad to see that inequity is being perpetuated in vaccine distribution…this is the system that’s been built. #JHMChat
— Brian McGillen, MD (@BMcGillenMD) January 19, 2021
T2: Covid has highlighted racial disparities that have already been existing. It’s great to see that there are leaders now calling racism a public health crisis but this has been in effect for centuries and even beyond. #JHMChat
— April Moreno PhD MPA (@aprilm2011) January 19, 2021
2. The pandemic has helped bring previously unrecognized or undervalued efforts in addressing health disparities to the forefront:
A2. I think the mainstream media has highlighted, so it has forced medical organizations & hospitals to take some action to address disparities. It’s also helping to highlight the amazing work that many of our colleagues have been doing with little/no acknowledgement #JHMChat
— Anika Kumar, MD (@freckledpedidoc) January 19, 2021
Recognition for #DEI work is key. Remains to be seen if new DEI Chairs will be empowered to make change, but at least this is now recognized and supported time #JHMChat
— Matt Sakumoto (@MattSakumoto) January 19, 2021
One powerful moment of the pandemic for me was getting on a Zoom back in April with almost 30 @SocietyGIM #HealthEquity mentors to talk about how we were going to take on these disparities that were coming out.
And we haven’t stopped fighting to address them ever since. #JHMChat
— Utibe R. Essien, MD MPH (@UREssien) January 19, 2021
3. With so much work to do, where do we go from here? What can we do? Here are some suggestions:
A3. Listening. I find most of the time that I am learning from my trainees in this realm. Being comfortable with uncomfortable conversations and calling out inequities in our system. #JHMChat
— Jen Readlynn, MD, FHM (she/her) (@jenreadlynn) January 19, 2021
A3: Education is foundational but not enough. To truly improve child health and eliminate health inequities will take 1) a complete change in the way we operate in medicine and 2) partnership with sectors outside of healthcare to combat other SDH #JHMChat
— Ndidi Unaka MD, MEd (@NdidiUnaka) January 19, 2021
A4. We have to measure these differences to address them. Steps forward include asking if differences exist in our own local data. #JHMChat. Btw…They do!
— ShantaZimmer (@ShantaZimmer) January 19, 2021
A3. To address racism with our trainees and colleagues:
1. Listen (to our patients)
2. Learn (the history of racism in medicine)
3. Lead (by example. Many in leadership in medicine are usually not from the backgrounds traditionally affected by these racial biases). #JHMChat https://t.co/c4yHkwTiAt— Utibe R. Essien, MD MPH (@UREssien) January 19, 2021
I was grateful to end Martin Luther King, Jr. Day this year with the community-driven passion for change evident in our #JHMChat. One thought was tweeted over and over again in a variety of ways: we must find a way to continue this momentum for both the improvement of health disparities and the end of racism in medicine even after the pandemic has faded.
If you want to reflect and learn with us and continue this conversation, join us monthly for our #JHMChat, where we tackle topics from high value care to racism in medicine, all during a lively Monday night Twitter chat.
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