Advancing and Strengthening Racial Equity, Diversity, and Inclusion in the Biomedical Research Workforce and Advancing Health Disparities and Health Equity Research(response to rfi not-od-21-066)
The Beyond Flexner Alliance community is deeply heartbroken by the loss of George Floyd, Tony McDade, Ahmaud Arbery, and Breonna Taylor – and so many others in America’s black communities - who have suffered discrimination and inexcusable losses because of racism, violence and injustice. Racism pervades all sectors of society. Healthcare and education is no exception. The Beyond Flexner Alliance is built on the principle of dismantling racism and injustices in health professions education, health systems, and society. We are committed to continuing our work to integrate anti-racist curricula; support and advance health workforce diversity; and provide multidimensional, sustained professional learning experiences for providers, educators, and administrators that advance the health of all racial and ethnic groups. Let us highlight the final words of the Beyond Flexner Alliance’s founder, Dr. Fitzhugh Mullan, as he reflected on his life as a civil rights doctor and the need for medical schools – and all health professions schools – to reform.
"The civil rights doctor and many others have spent careers in pursuit of what we now call health equity, but the world has not moved as far as he would have wanted. Racism is still very much with us, as are massive and growing disparities in health and wealth. These disheartening realities account for tens of thousands of deaths and uncounted days of unnecessary pain and suffering every year. The civil rights doctor’s mission turned out to be changing the culture of medicine, making the idea of health equity central to the character of medicine, and positioning medicine as an agent of social as well as individual healing. Choices physicians make about where and how to practice can bring more compassion to the system but, ultimately, it is the U.S. medical education community that can do the most. Large, resourceful, and distributed, the nation’s medical schools and teaching hospitals have early and strong leverage to change the culture of medicine. The civil rights doctor may have worked hard and with purpose but it is only with a forceful, enduring, and community-wide commitment to social mission that medical education will realize its full 21st century capabilities to build a healing profession."
Fitzhugh Mullan, MD
The Civil Rights Doctor Revisited (Dec. 17, 2019). Academic Medicine
Racial and ethnic minorities continue to be subjected to a sustained pattern of disparate treatment in health care with no panacea for the confluence of contributing factors. In the 2003 provocative landmark report, Unequal Treatment; Confronting Racial and Ethnic Disparities in Health Care, the Institute of Medicine (IOM) exposed a painful truth about the health care system. When racial and ethnic minorities enter the clinical arena, they are less likely to receive routine medical procedures, appropriate cardiac medications, or essential clinical services. The differences in how minorities are treated in health care contribute to their higher rate of disability and mortality.
Since the 2003 IOM report, the tendency for racial and ethnic minorities to receive an inferior level of care has not abated. A 2007 systematic review conducted by the Department of Veterans Affairs (VA) found that African American male veterans received less aggressive pain management for osteoarthritis, providers gave them less information about cancer, and clinical decision making varied based on the veteran’s race. More recently, the Agency for Healthcare Research and Quality revealed in the 2016 National Healthcare Quality and Disparities Report that “most disparities have not changed significantly for any racial and ethnic groups…especially among people in poor and low-income households, uninsured people, Hispanics, and Blacks.” Although the gap in health insurance coverage between minorities and whites has narrowed, differences have actually widened for quality indicators such as annual foot exams and prevention of lower extremity amputations among diabetics. Indeed, the persistence of health care disparities, which the Institute of Medicine defined as “differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness or intervention,” is alarming and depicts a dismal reality for ethnic and racial groups.