An Oct. 4 online forum hosted by the Chicago-based American Medical Association (AMA) addressed critical race theory (CRT) and its applications for equity in healthcare settings.
CRT has achieved notoriety among right-wing elements recently as a means to proselytize anti-white discrimination among young people. But experts maintain that CRT as referred to by conservatives is, in fact, a caricature of liberal concerns that is far removed from the actual CRT, which to this point has existed mainly as a component of law school curricula.
"[CRT] has evolved as a way of looking at structures of racism in the United States," said AMA Chief Equity Officer Aletha Maybank, MD, who moderated the panel, and added that CRT "allows healthcare professionals to confront and dismantle racial injustice and is thus vital to the pursuit of health equity."
Maybank noted that in the past year 26 states have introduced legislation restricting the instruction of CRT in public schools.
Dennis Chin, director of strategic initiatives for the New York City-based advocacy Race Forward, explained that the term "Critical Race Theory" is now being used colloquially "as an umbrella for ultra-left views" by conservatives, but that the genuine theory emerged from "an academic field that simply demonstrates how racism is embedded in our laws and in our institutions. … It is a graduate level course."
Chin noted that CRT will be a vital subject for health researchers and physicians to study, since race is still a useful predictor for life outcomes. But differentiators between white patients and patients of color result mainly from systemic and structural inequities in service-delivery, among numerous other socio-economic realms.
Applying notions from CRT within a healthcare setting could one day eliminate many inequities in healthcare service delivery, suggested Bran Wispelwy, MD, associate physician in the Division of Global Health Equity at Brigham and Women's Hospital in Boston. He added, CRT "gives us a set of rigorous tools to analyze why we have these racist outcomes in our health systems healthcare delivery models."
Wispelwey noticed during his residency that Black patients with heart issues were less likely to be placed in his hospital's cardiology department, often staying in its general care department instead. He and colleagues began examining why that was happening; their research ultimately led to a larger initiative to "name racism and how it's operating in that setting, and how we have to strategize and organize it."
CRT is especially useful since its advocates have moved beyond documenting inequities and are discussing eliminating them, Wispelwy said. In the case of his hospital, he and colleagues utilized a restorative justice approach to tackle the inequities in care they noticed.
"We talked with a number of experts outside the world of medicine, and tried to get their opinions, as lawyers, historians and political scientists who've all worked on racism," he said.
Ultimately, his cohort developed a model called Healing ARC (Acknowledgement Redress Closure). A subsequent article Wispelway co-wrote with a Black colleague about the program that mentioned CRT attracted a major backlash from the Right.
"Many people don't realize the harm that has come to people from many fields, as it comes to speaking up about racism and racism work, especially as it relates to CRT," said Maybank.
"Backlash is not new," continued Chin. "Every time that this country makes progress, there is a backlash spurred by a political and economic elite that wants to stop that progress."
Malika Sharma, MD, assistant professor in the Department of Medicine at University of Toronto, discussed resistance to CRT in Canada. Canadian culture, she noted, often dismisses racism as a uniquely United States problem, which ignores both a history of slavery and an undercurrent of inequity in Canada. With CRT, "We can't pretend we do not know and we can't pretend it doesn't exist," she said.
Sharma added that instructing physicians requires an examination of their beliefs about race, noting that Western culture has developed a series of misperceptions of genetic difference tied to race. In one study she noted, several medical students believed Black patients perceived pain to a lesser extent, "which has obvious implications, for example, in the administration of pain medications in the E.R. or medical wards."
Rahel Zewude, MD, an internal medicine resident at the University of British Columbia in Vancouver, discussed how she, working in tandem with Sharma, integrated concepts from CRT into her work and research.
"It was exciting for me as a Black woman training, finding this framework that really empowered the advocacy work that we'd been doing in recruiting Black learners in the field of medicine," Zewude said. The research ultimately inspired her to form an organization, Black Physicians of British Columbia.
She added, "As care providers, ultimately we are [working] in a system that has been built with roots in colonialism and indigenous people. [This system] still has pervasive racism against Black and indigenous people, and other socialized groups."
Another complication is that, even as younger physicians and medical students become aware of racial equity, they are nevertheless working within entrenched power hierarchies resistant to change.
"In making space for the voices of the most marginalized people, it can certainly be challenging when the system of medicine is built in [such a way] that you have to value the voice of the most senior person in the room … That has been a big challenge," Zewude added.
Chin said that stakeholders should not expect an immediate results when they set out to dismantle institutional racism. "But we can do some good. … [We] are in a moment of possibility, of urgency, because of Black and indigenous organizers, and immigrant organizers, who've taken this to the streets. Institutions that we are part of are taking notice, and looking at each other and asking, 'How do we change?'"