Dear Faculty, Staff and Students:
Undoubtedly by now you have witnessed the human tragedy that occurred in Minneapolis, and the ensuing unrest. While we should have no tolerance of the rioting occurring in Minneapolis and other major American cities over the past few days, we should also have no tolerance of the cruelty and injustice that triggered it. It should no longer be acceptable that we live in a country where black children see their unarmed fathers die at the hands of law enforcement officers sworn to serve and protect, nor where black fathers have to teach their teenage sons how to avoid being killed by the police.
In 1963, President John F. Kennedy introduced his Civil Rights legislation by declaring: “One hundred years of delay have passed since President Lincoln freed the slaves, yet their heirs, their grandsons, are not fully free. They are not yet freed from the bonds of injustice. They are not yet freed from social and economic oppression. And this Nation, for all its hopes and all its boasts, will not be fully free until all its citizens are free.” Sadly, 57 years later our nation is still wrestling with many of these same challenges. Recent events have yet again brought this lingering legacy of intolerance to the forefront of public discussion.
But racism is not just a sociological and economic issue—it is also a pervasive public health problem. Racial differences in health outcomes are well documented. African American women have a 2.5-fold greater risk of maternal mortality and a 50% higher rate of preterm birth than white women, while Black infants have twice the mortality rate of their white counterparts. Screening rates for various cancers are lower and mortality rates higher among African Americans. Hypertension, obesity, and diabetes are more common in African Americans as are deaths from heart disease and stroke. And Black Americans are less likely to obtain mental health treatment, less likely to be referred to specialists, and twice as likely not to have health insurance. Even the current pandemic mocks us: in Chicago about 70% of COVID-19 deaths occur in African Americans even though they account for 30% of the population.
While there are many proximate causes of these health disparities, they are all intertwined with this country’s shameful legacy of racism. Racial discrimination is reinforced through de facto segregation in our churches and neighborhoods, by inequities in education and the criminal justice system, and by chronic unemployment and underemployment. And finally, it is manifest in adverse health outcomes accruing poor nutrition, the chronic stress attendant these inequalities and limited access to high quality care. And when Black Americans finally access health care, they are often confronted by implicit bias and poor cross-cultural communication from providers.
To be fair, since President Kennedy’s call for racial justice, real progress has been made in many areas including health disparities, but it is time to finish the job. A full throated societal commitment to combat racism, and policy changes to combat housing, educational and economic inequality are necessary to tackle the underlying causes of racial injustice. But the health care community must play a critical role in this fight.
First, we must acknowledge that disparities exist and examine our own and our colleagues’ role in their perpetuation through, fortunately rare, expressions of explicit racial prejudice, and far more common and insidious forms of implicit bias. This means scrutinizing our own attitudes and actions, and the ways such cultural misconceptions interfere with clinical decision-making.
Second, we should work to carefully cultivate cross-culture forms of care and communication. There is clear empirical evidence that providers educated in cross-cultural practices are more effective working with patients from diverse backgrounds and achieve higher levels of patient satisfaction and adherence to therapy.
Third, we should ardently advocate for reforms to health policy that prioritize the just and equitable treatment of racial minorities, as well as others from historically disadvantaged groups. A civilized society is stronger and more productive when it properly maintains the health of all its citizens, permitting them to meaningfully contribute.
Finally, we must continue to train the next generation of health care professionals to practice inclusive behaviors and learn from the diverse experiences of others. Understanding cultural differences that impact health is not supplementary to health education; it is foundational to it.
There is no easy fix for racial bias and discrimination. As a great man once said, “hard things are hard.” An effective remedy for racial disparities in health care and other disparate societal outcomes has evaded multiple generations. But as a community committed to efficient, effective, and equitable health care, we at USF Health must keep trying, and when we find that our old treatments aren’t working, we need to be willing to change our prescription.
Sincerely,
Charly,
Dr. Charles Lockwood
Senior Vice President, USF Health
Dean, USF Health Morsani College of Medicine
