These 'concrete steps' could help fight racism in health care

医生, 医院和医学院应采取具体行动，与威胁数百万美国人健康的结构性种族主义作斗争, according to a new report meant to help guide the medical establishment.

建议包括, 这是2020年美国心脏协会和美国心脏病学会专业与道德共识会议报告的一部分:

-医学院应要求一年级学生选修一门关于社会正义的课程, 种族和种族主义, and trainees should spend time immersed in the communities they serve.

-国民教育, 与种族和种族主义有关的地方和机构历史应该成为医学院课程和继续教育计划的一部分.

-卫生保健机构应进行年度审查，询问"种族主义是如何在这里运作的?"

都是a的一部分 更广泛的报告, 该研究于周二同时发表在美国心脏协会的《线上电子游戏飞禽走兽》杂志和美国心脏病学会杂志上. 该报告为医学院、医生和其他卫生保健专业人员提供了指导.

此前，几个专业协会和疾病控制与预防中心发表声明，承认种族主义如何威胁公众健康. But the report does more than just note the problem, said Dr. 卡马拉P. Jones, who co-wrote the section on social justice and racism.

“这些都是具体的行动步骤，可以让那些试图采取行动的人知道我们首先要做什么,琼斯说。, 家庭医生, epidemiologist and past president of the American Public Health Association.

一个人健康的大多数方面是由卫生保健环境之外的因素决定的, 她说. Our health is "created by the conditions of our lives – by schooling, 通过住房, and by access to fresh fruits and vegetables, and by living in a clean environment, 还有收入和财富." In America, racism heavily influences all those conditions.

Dr. 威利E. 劳伦斯小., a cardiologist and co-chair of the task force that wrote the recommendations, said addressing racism is crucial to addressing all kinds of health problems, such as high blood pressure.

“作为一个医疗机构，如果培训医生为更广泛的人群提供更好的护理是你的目标, 你必须认识到的一件事是不仅仅是你在药理学课上学到的东西才能更好地控制高血压,劳伦斯说, medical director for health equity at Spectrum Health in Michigan.

Factors such as the ones Jones listed, known as the social determinants of health, 可能会对你能否控制病人的血压产生更大的影响, whether you get that patient to actually take that pill."

Building community is one of the cornerstones of fighting racism, 琼斯说, 这就是为什么让医学实习生进行家访或在社区环境中工作是必要的.

劳伦斯对此表示赞同，他说医生需要知道如何到达病人所在的地方. 这适用于所有背景的医学专业人士，他以自己为例.

劳伦斯, 在进入哈佛大学和约翰霍普金斯医院接受培训之前，他主要在克利夫兰东部的一个单亲家庭长大, 他说，任何富裕的医生都很容易忽视贫穷带来的挑战, 当一些简单的事情，比如4美元的共同支付药费，就能让你负担不起.

There can be "an assumption that somehow because I'm Black, I automatically understand my poor Black patients,他说. "Well, that's not necessarily a safe assumption. Because the fact is, there are some things I was never taught in medical school."

He didn't learn about the infamous 塔斯基吉梅毒研究 until he was well into adulthood, 例如, and was never taught about the history of discrimination against Asian Americans.

The knowledge of such things, he said, "makes us more compassionate. And I think it makes us better physicians."

That's the idea, 琼斯说.

The report's recommendation to require history lessons, 她说, 她最近做的工作对参与其中的学校和医院系统来说是“启示性的”. 对于参与者, knowing the history of their workplaces – how the location was chosen, who wasn't allowed as patients, 或者谁被允许或不被允许成为医生——“让他们看到”种族主义是如何运作的.

She and 劳伦斯 acknowledged the challenges ahead.

"I think that race is a very difficult subject to talk about," 劳伦斯 said. "And if you want to quiet down a room, you walk in and you start talking about some issue related to race. 它不舒服."

But the recommendations are not radical, he said. They would have "a significant impact" on medical school curriculum. 但在他们的核心, 他们希望培养盟友关系的理念——与遭受结构性种族主义或其他系统性歧视的人合作——并加深对患者的理解.

"They're not really lofty goals,他说. "They're basic goals related to achieving health equity."

成功, 琼斯说, 这将需要各级医疗机构的支持和培训. “因为我们当然不希望下一代长大后仍然没有能力处理这些更广泛的问题”，或者缺乏对反种族主义是他们作为医生工作的核心部分的理解.

“所以我要说的是, 我们都在播种”，这些种子最终将在卫生保健领域和整个社会结出果实, 她说. "This is not the end of the story. 这是开始."

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