The Hypocrisy of the Diversity, Inclusion, and Equity Movement in Medicine and Its Exclusion of Black People
The last twelve months have been some of the most complicated and challenging in world history. Amid a global pandemic and contentious American presidential campaign, a worldwide social movement of unprecedented scale was born. On May 25, 2020, the world watched as Mr. George Floyd, a Black man, was brutally murdered while being pinned under the knee of a Minneapolis police officer. This ignited a worldwide movement of Black Lives Matter (BLM) protests against police brutality. And because the medical community is a microcosm of society, these protests did not stop at the hospital doors.
Members of healthcare organizations and academic institutions peacefully marched in support of BLM proclaiming widespread change–trading institutional and systemic racism for a more just system. Our televisions and social media accounts were flooded with pictures of doctors genuflecting while donning BLM swag with Black power fists in the air, outside of their institutions. This sparked a glimmer of hope that maybe, just maybe medicine would change its oppressive systems. So, what has happened in the post-BLM protest era? Is medicine truly ready and willing to have a system of equity, diversity, and inclusion for Black people? Here are several recent examples that are antithetical to the institutional pledges made last summer.
Medicine and the American Caste System
“Looking at castes is like holding the country’s x-ray up to the light.” Recently, the medical profession’s x-ray was examined.
Although it is not commonly characterized this way, America is a caste system. One in which the social construct of race is used as a vehicle to maintain the prevailing hierarchy with Black people in the subordinate caste. In the book Caste: The Origins of Our Discontents, Isabel Wilkerson writes, “Caste is the operating system for economic, political, and social interaction in the United States since the time of its gestation.” And because medicine is a microcosm of the greater society, it is not immune. Furthermore, “Looking at castes is like holding the country’s x-ray up to the light.” Recently, the medical profession’s x-ray was examined. A recent tweet by Dr. David L. Brown, cardiologist and Professor of Medicine at Washington University in St. Louis, casually suggested that a moratorium be placed on white male leadership for 20 years until the playing field is leveled for underrepresented minorities. The collective outrage on social media was profound and eye-opening. The mere suggestion of temporary cessation of the caste system sent #MedTwitter into a frenzy with every justification as to why this was not actionable; some even claiming it was racist. And it was not just the dominant caste expressing its grievance, privilege, and invoking things such as meritocracy; the middle caste was also vocal in their panic of being leaped over as they attempt to assimilate and ascend to the dominant caste. Although his suggestion was more a thought experiment than a call to action, Dr. Brown’s tweet metaphorically held our profession’s x-ray up to the light; thereby, revealing who we really are and that medicine is not ready to be inclusive of Black people.
How the Pandemic Has Exposed America’s Hypocrisy
Despite being a vulnerable population that is disproportionately affected by the pandemic, Black people from Los Angeles to Boston are experiencing vaccine inequity.
What about the effects of the COVID-19 pandemic? When discussing the disparities and the cost of inequality associated with the pandemic during a broadcast on MSNBC, Rev. Dr. William J. Barber II said, “The virus spreads through the breakages in society.” If the virus spreads through the breakages, shouldn’t we be focusing all of our attention on those most vulnerable with vaccination? I mean, there must be equality and equity in the post-BLM protests era, right? The ugly truth is as expected. Despite being a vulnerable population that is disproportionately affected by the pandemic, Black people from Los Angeles to Boston are experiencing vaccine inequity. Government officials and pundits want to implore vaccine hesitancy as a sole reason. In actuality, another reason is vaccine apartheid–the economic and social privilege of the dominant caste are allowing them to be swiftly escorted, around the fence of inequality and inequity, to the front of the vaccination line. So, not unlike natural disasters such as Hurricane Katrina, the pandemic has revealed how Black people continue to be excluded and bear the brunt of America’s hypocrisy.
The Skepticism of Systemic Racism in Medicine
“No physician is racist, so how can there be structural racism in healthcare?”
A recent tweet on February 24, 2021, posed a question, “No physician is racist, so how can there be structural racism in healthcare?” This was from the account of the Journal of the American Medical Association (JAMA) with a link to a recent podcast by host Dr. Edward Livingston, Surgeon and Deputy Editor for Clinical Reviews and Education for JAMA, discussing his disbelief in the concept of structural racism. The podcast centered around his skepticism of the topic because of two main reasons: 1) his upbringing as a descendent of Jewish ancestors that fled persecution helped instill anti-racist values and 2) laws were passed in the 1960s that prohibited such things. His position can most easily be described as “white fragility.” A term coined by author Robin DiAngelo to describe the disbelieving defensiveness that white people exhibit when their ideas about race and racism are challenged. His position most certainly came from an authentic place; however, it also reflected his fragility, myopia, and privilege that just because something is not a problem to you, does not mean it is not a problem. Again, the social media backlash was swift and both the tweet and podcast were taken down with a letter of apology issued by Dr. Howard Bauchner (Editor-in-Chief of JAMA and the JAMA Network) taking full responsibility and pledging another podcast on the subject. A statement by Dr. James L. Madara (CEO and Executive Vice President of the AMA) announced the resignation of Dr. Livingston and a more actionable plan for addressing structural racism at JAMA.
Equality and the Zero-Sum Mindset
Finally, “When you’re accustomed to privilege, equality feels like oppression.” In a recent article written by John Blake, he interviews author Heather McGhee about her new book The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together. She discusses the concept of zero-sum politics in the post-civil rights movement in which there is a perception that whatever helps Black people must hurt white people. Again, medicine is not impervious. Approximately 5% of Doctors in the United States identify as Black or African-American and that dearth is greater in cardiology. Thus, diversity, inclusion, and equity should be paramount. When I was hired as a young Black cardiologist for my first job out of fellowship training, I came to learn later that colleagues were apprehensive in letting me interpret and bill for cardiac ultrasound studies. Why? A perceived fear that it would affect the productivity of the other physicians. In other words, instead of embracing the new partnership, diversity, inclusion, equity, and what they may gain, they operated from a place of deficit and what they might lose in the process. Was this a zero-sum mindset that whatever helps Black people must hurt white people? Would this happen when hiring a white cardiologist? Or would the perceived benefits of the addition outweigh the risks in their mind? One can only wonder.
The struggle for a more just and equitable system will not be easy but nothing worth having ever is. However, the lives of Black people depend on it, literally.
In conclusion, the pledges by the medical community to create a more diverse, inclusive, and equitable environment in the era of the post-BLM protests is a work in progress. As detailed above, we have seen what happens with the mere suggestion of disruption of the caste system, how Black people are experiencing vaccine apartheid with the vaccination rollout, and how leaders, influencers, and academics are dubious about the very existence of institutional racism. How are we to move forward when people are not willing to temporarily suspend the caste system–even for a potentially lifesaving therapy like a vaccine? How will we move forward when we can’t reconcile with our past and acknowledge the problem even exists? The struggle for a more just and equitable system will not be easy but nothing worth having ever is. However, the lives of Black people depend on it, literally.