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While industry stakeholders have issued statements and commitments about combatting racism in healthcare, few have provided clear guidance on curtailing the effects of bigotry.
In a JAMA Network report published this week, the U.S. Preventive Services Task Force detailed steps to stop medical racism and ways to abate its impact when discrimination does happen.
“Racism increases exposure to risk factors, reduces life expectancy, and increases the burden of disease,” said Dr. Chyke Doubeni, leader of the race and racism work group for USPSTF. “What we also know is that it can be addressed. Racism is actually physiological.”
The task force is committed to developing a framework to improve clinical preventive services and health outcomes as it pertains to health equity, as first announced earlier this year.
These are best practices for providers to make inroads, according to USPSTF.
1. Identifying the problems: The first step is to understand how racism and language contribute to the health and treatment of patients of color, said Jennifer Lin, director of Kaiser Permanente’s Evidence-based Practice Center.
“We can only begin to mitigate and eliminate health disparities if we know what the underlying mechanisms are that are causing it,” Lin said.
She said the center was contracted by USPSTF to produce an overview of how best to incorporate health equity into clinical practice guidelines, looking at how people see and define race, ethnicity and racism.
Part of this includes acknowledging that racism can cause biological consequences, and using correct terminology for different races that does not alienate or degrade any community.
It also requires that providers understand how racism affects one’s health, through reduced access to employment, housing and healthcare, exposure to risk factors, adverse effects of chronic adversity or stress on physiological systems and organs, and physical injury as a result of racially motivated violence, among other things.
2. Conducting research: Lack of research hinders progress in addressing racism, Doubeni said.
Few studies objectively assess clinicians’ cultural sensitivity when interacting with patients and studies that provide evidence for healthcare improvement often exclude minority racial and ethnic groups.
So, the USPSTF enlisted help to scan existing literature and data for the differences between ethnic and racial groups and whether there is evidence that interventions can reduce those, Doubeni said.
The task force then could conduct studies to assess evidence for separate populations and ask for public comments throughout the process to gain insight on how it can improve its methods for overcoming health inequity, he said.
3. Creating a health equity framework: In constructing anit-racism guidelines, certain considerations must be made to ensure inequities are being mitigated.
The task force report warns that providers should expect differences in the success of some interventions in populations or settings that have trouble accessing care due to racism.
4. Joining forces: “It’s going to take everybody playing a role in their various areas of work to make sure that healthcare is accessible,” Doubeni said.
He said the task force is currently calling on its partners, including the National Medical Association, Department of Health and Human Services’ Office of Minority Health and National Institutes of Health, to work in tandem to find ways to deliver high quality preventative, primary and special care.
5. Implementing solutions: The task force now will focus on how to integrate approaches to address systemic racism in healthcare settings and communicate these guidelines nationally, Doubeni said.
Through a series of pilot studies, the task force will test how its framework can be applied, starting with recommendations in areas of screening, behavioral counseling, and disease medications as well as pediatric and maternal health, he said.
Different solutions could include culturally tailored lifestyle and self-management interventions, the use of community health workers and patient navigators, patient outreach, improving access to care through service integration, care pathways, information and communication technology or specialized clinician training.
“It’s important for healthcare organizations to think outside of their traditional medical model and traditional purview by working closer with the community, the public and the patients that they serve,” Lin said.
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