This is the Wellbeing column. Why talk about Race? Because our wellbeing is necessarily tied to the wellbeing of our community.

Posted on Jul 7, 2020 in Uncategorized | 0 comments

Systematic Racism and Healthcare Disparities:

Lessons from the Black Lives Matter Movement as We Reckon with Healthcare Disparities.

In the wake of the recent widespread protests over police killings, San Francisco is discussing creating a new service of community responders who would be unarmed and properly trained to deal with issues the police should not be involved with, like homelessness, addiction and other non-violence problems.  People are demanding that we defund an expensive institution that is ill-suited to do much of what it does. We are now beginning to see some civic leadership proposing different solutions that reflect the demands of the people.

Many people across the nation are learning that being “not a racist” is not enough; we need to be actively “anti-racist” if we are to end racism that is weaved to into the fabric of our society.   For health care workers that means not just protesting and voting but taking a hard look in our own backyard.  I for one have become numb at times to the way we operate in a dysfunctional healthcare system that has albeit weak but important analogies to the criminal justice system. 

While distinct from criminal justice issues, health disparities are an important manifestation of and continued driver of systemic racism.  We all know how pervasive health inequities are and we see the end result of them daily as increased morbidity – in the African American community in particular. At ABSMC, probably a quarter of what we do should have never reached our doors and sadly, our solutions don’t get to the root of the problem. I treat an opioid dependent person and discharge them back to their tent and needles.  I offer no real program for our patients with COPD who still smoke. My diabetes patients are discharged back to shop at the dollar store for food since they are impoverished. Much of the follow-up care for those in the “safety net”, though provided by smart, dedicated people is shamefully underfunded. When I acknowledge that I have become complicit with this dysfunctional status quo- while receiving societal respect and a good salary – I am at moments ashamed. 

At the same time, I am truly proud of the work we do at ABSMC.  Beyond the excellent, compassionate care we provide, we now have an in-house diabetic education program, case managers funded by us in the ED and our FCHCs.  There is an asthma initiative in the ED and nascent inpatient addiction service now, too. We are working on a vegan diet our kidney patients who are disproportionally underserved. To target high users, we have the STAR program.  Wow, bold and inspiring work; thanks to Steve Lockhart, Meggie Woods, Michelle Tang, Manj Gunawardane, John Mouratoff, Sutter Enterprise, local physician and executive leadership and the many others of us involved in spearheading these efforts.

Yet, we have so much more work to do. Seeing the police officer kneeling on George Floyd’s neck caused anguish for many reasons: loss of life, cruelty, seeing the results of societal racism and dysfunction. To grieve publicly as a number of us did at our kneel-in acknowledged the pain and was moving but also inspiring.  Those of us there have a renewed clarity of our values as a medical center and sense of purpose. We must admit that the expensive and failed healthcare system is both a symptom and a source of societal problems.

 I have been around long enough to remember the slogan of the HIV movement: Silence=Death.  The same holds true today. True, we are all working so hard and the answers often lay beyond our skills set, but inaction is not a moral option.  What do we do? First, we need to acknowledge that inaction makes us complicit. Next, get educated about our own implicit biases.  Admitting them doesn’t make us a bad people.  It simply acknowledges we are human.  Then, we need to loudly advocate (and likely pay more taxes) for programs that lead to primary prevention for the problems we make a living off of. How to do that?  We all have to figure that out.  I have communicated with the president of my specialty organization, Society of Hospital Medicine, and asked them to advocate for programs that put dollars into primary prevention perhaps at the expense of hospital care. I have similarly messaged the CMA. I have written to Steve Lockhart, Sutter’s point person on health disparities asking how we can help him in his work.  As an institution, we need to be aware of how we are tracking the med center’s activities that are tied health disparities and follow the trends so we can better advocate for services.  Services here at the med center, in the broader medical safety net and more generally as anti-poverty programs for our community. I would suggest a quarterly report to the MEC about our institutional efforts that is then sent out to all medical staff.

And I am now asking our med center and my hospitalist leadership and YOU to think about ideas – maybe using a different toolkit – to address our community’s most vexing social and health problems.

Living with purpose and being anti-racist means acknowledging racism imbedded in our society and healthcare’s role in it.  It also means working toward solutions. So, what should happen? And what should we be doing?  Let’s talk! 

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