Tackling racism in health takes more than data alone, say experts
The COVID-19 crisis has magnified and exacerbated inequities in healthcare, with communities of color disproportionately affected by the disease and its economic fallout. But such disparities date back to long before the pandemic began to spread across the country this spring.
"Structural racism," said American Medical Association Chief Health Equity Officer Dr. Aletha Maybank, "permeates the healthcare system."
Given that reality, "How do we combat bias that's decades-old in our country as we move forward today?" she asked.
Maybank was among the experts at the HLTH VRTL 2020 conference this week who weighed in on the best strategies to confront the ways racism in the healthcare industry: from medical education content to training, to research study designs, to technological responses.
"Technology in itself can be a great equalizer," said Doctor on Demand Chief Medical Officer Dr. Ian Tong. However, he cautioned, technology can also replicate the bias of its creators. He noted, for example, that tools relying on artificial intelligence to flag potentially harmful skin lesions may misdiagnose or overlook signs of disease on darker skin tones.
Still, he said, "I have that belief we can use technology in the right way."
For instance, he said, AI could be used to alert doctors that some patients may be at higher risk for certain diagnoses, due to social determinants of health.
Tong said that developers should understand that technology is akin to medication in that it can be helpful, but it can also be harmful when used inappropriately.
"We need the tools, and I would ask that developers know that and consult us or involve us in the process early," Tong said.
Maybank noted that there remain enormous gaps in health data regarding people of color and the disparities they face.
"As COVID has highlighted, a lot of folks don't have systems set up to collect race and ethnicity data," she said. By not collecting information accurately, "we're not finding out what's happening to all folks in this country.
"We're not understanding what is impacting people that is creating those differences," she continued.
It's also important, she noted, for researchers and clinicians to move beyond what she called "the deficit model."
"What are the strengths of people? What are the networks?" she asked. "Those are the things we have to consider as it relates to race."
Other experts stressed that the pandemic has highlighted – and worsened – existing inequities.
"It's not enough just to be not racist. We have to be anti-racist," said Dr. Laurie Glimcher, president and CEO of the Dana-Farber Cancer Institute. "I think there's a nationwide recognition of how much we have left to do."
Dr. Ivor B. Horn, who moderated the panel with Maybank and Tong, noted that "technology is moving much faster than policy or practice." So how, she asked, do we train a new group of leaders in asking critical questions about addressing racism in healthcare?
"I want [leaders] to put their money where their mouth is," said Tong. "I want them to engage and fund and direct their business to companies that have true representation across the company and at the leadership level."
Maybank agreed, but also noted that doing so is difficult for those who don't know the root causes of the problems.
"My call to action is to learn more!" she said.
"Be humble, and be willing to be a learner, and seek out others who do have knowledge and companies who are doing the work in the trenches, and support them," Horn agreed.
"Racism is a cultural issue – broadly in this country, and more specifically, in medicine. It’s going to take more than talk to drive meaningful change. Change must start at the top – with leadership [members] who recognize the problem head-on, and commit to balancing the scales," Tong said in a statement to Healthcare IT News.