A Case for Race Consciousness in Medicine: How Color Blindness Won’t Cure Racial Health Disparities
By Nialena Ali and Deborah Cohen
February, 2022
In recent years the healthcare industry has experienced a racial reckoning as evidenced by the American Medical Association’s 2020 pledge to take action against racism and the American Psychology Association’s 2021 apology for perpetuating racism.
In their quest to redress past harms, many practitioners have identified and eliminated unnecessary race-based practices. For example, in 2021 the National Kidney Foundation and the American Society of Nephrology formed a joint task force to develop a new race-free calculation for estimating eGFR (estimated glomerular filtration rate tests which measure kidney function). Previously, patients were grouped into two categories: Black or non-Black based on false, archaic assumptions that Black people have higher muscle mass, and thus higher kidney function.
Eliminating race-consciousness from some areas of medicine is an important measure to counter the effects of outdated, eugenics-based practices that consider race biological. However, promoting widespread, race-neutral practices in all areas of medicine is not the solution to addressing racial health disparities.
As President of the National Kidney Foundation, Dr. Paul M. Palevsky stated, “The use of race in clinical algorithms, such as for the estimation of GFR, normalizes and reinforces the misconception of race as a biological determinant of health and disease. This is not to say that clinicians should ignore race and ethnicity. Doing so would blind us to the disparities and inequities present in health and healthcare.”
While a color-blind assessment may be valuable for measuring kidney function, race neutrality will not rectify other racial disparities seen among patients with kidney disease (such as lower transplant rates and higher death rates for Black patients). Furthermore, race neutrality in medicine is not an attainable goal as we all have implicit bias. The medical industry is not immune from this facet of human behavior; numerous studies have shown that implicit bias affects the quality of care patients of color receive.
Moving away from thinking of race as a biological construct is important and recognizing racism as the true determinant of health is necessary. As AMA Board Member, Dr. Michael Suk stated, “It is not sufficient for medicine to be non-racist…By acknowledging that race is a social construct and not an inherent risk factor for disease, we can truly make progress toward our goal of attaining health equity for all patients.”
To assist your organization’s efforts to promote racial health equity, Human In Common has compiled a list of examples of health disparities that require race-conscious action to redress.
- Pulse oximeters are less effective on dark skin. (1)(2)
- People of color are often underrepresented in clinical trials. (3)(4)
- Albuterol is less effective for Black and Puerto Rican patients. (5)
- Black mothers are more likely to be tested for illicit drug use during pregnancy & delivery. (6)
- People of color are underrepresented in medical school textbooks (7) (8) however, Black skin is more commonly used to depict sexually transmitted diseases. (9)
- Patients of color are often underdiagnosed and undertreated for pain. (10)
- Medical professionals often hold false, even fantastical beliefs, about Black patients. (11)
- Black and Latinx patients are more likely to be amputated compared to White patients. (12)
- Despite worse baseline knee pain and function, Black patients are less likely to receive total knee replacements (13)
- Black (14) and Native American women (15) are more likely to die from maternity-related causes.
- Black newborns are more likely to die when cared for by White physicians. (16)
- Black people receive later diagnosis and have lower survival rates for many cancers. (17)
- Medical institutions as well as medical eponyms are based on White men. (18)
SOURCES
1. Pulse Oximeter Accuracy and Limitations: FDA Safety Communication, U.S. Food & Drug Administration. (2021)
2. Racial Bias in Pulse Oximetry Measurement. The New England Journal of Medicine. (2020)
3. Disparity of Race Reporting and Representation in Clinical Trials Leading to Cancer Drug Approvals From 2008 to 2018. Journal of the American Medical Association. (2019)
4. More Minorities Needed in Clinical Trials to Make Research Relevant to All. Association of American Medical Colleges. (2016)
5. Genomic Analysis Reveals Why Asthma Inhalers Fail Minority Children. University of California San Francisco. (2018)
6. 1151 Racial disparities in urine drug testing on labor & delivery. American Journal of Obstetrics and Gynecology. (2021)
7. Representations of race and skin tone in medical textbook imagery. National Library of Medicine. (2018)
8. Equitable Imagery in the Preclinical Medical School Curriculum: Findings From One Medical School. National Library of Medicine. (2016)
9. Dermatology faces a reckoning: Lack of darker skin in textbooks and journals harms care for patients of color. Stat. (2020)
10. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America. (2016)
11. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America. (2016)
12. Explaining Racial Disparities in Amputation Rates for the Treatment of Peripheral Artery Disease (PAD) Using Decomposition Methods. Journal of Racial and Ethnic Health Disparities. (2017)
13. Racial Variation in Total Knee Replacement in a Diverse Nationwide Clinical Trial. US National Library of Medicine. (2019)
14. Working Together to Reduce Black Maternal Mortality. Centers for Disease Control and Prevention. (2021)
15. Maternal Mortality Among American Indian/Alaska Native Women: A Scoping Review. Journal of Women’s Health. (2021)
16. Physician–patient racial concordance and disparities in birthing mortality for newborns. Proceedings of the National Academy of Sciences of the United States of America. (2020)
17. Cancer Facts & Figures for African Americans 2019-2021. American Cancer Society. (2021)
18. Should eponyms be abandoned? Yes. US National Library of Medicine. (2007)
