Page 8 - ASCO Cultural Competency Toolkit

racial groupings within which we currently group people and frame differences. For example, age- related macular degeneration, the leading cause of blindness in the elderly, is most prevalent in the White and European populations. Without further inquiry, one may draw the conclusion that the high prevalence may be associated with race but researchers have found genetic risk factors in variant alleles and factors that influence the ability to control inflammation to have a greater association (Fritsche, 2014, Johanna M, 2017). Along that line, sickle cell disease is found to have a higher prevalence in people of Middle Eastern, Indian, Mediterranean, and African heritage and is associated with geographic regions prone to malaria. It is not a condition found in African Americans as it has been described in the past (El-Hazmi M, et. al., 2011, Grosse SD, et. al, 2011, Power-Hays A et. al. 2020). It is common practice to disaggregate the prevalence of conditions by racial categories to uncover health disparities due to societal factors, but if we don't contextualize the information with root cause analyses and discussion about social determinants of health, students will be missing an important understanding of the trends in health inequities these statistics demonstrate. If we continue to present diseases by racial demographics we should ensure our students have a firm understanding of the social construction of race and subsequent racism that breeds disparity (Ruqaiijah Y, 2021).
Our society has created and perpetuated a social hierarchy based on the color of a person’s skin and other physical characteristics. Belief in the superiority of one race over another has led to a long history of racist actions and policies across all sectors of society, including medical training. The codification of racial superiority has resulted in injustices like segregated medical facilities, unequal access to care, abuse in medical experimentation and research, and the exclusion of racial groups from health professions and professional organizations (Nieblas-Bedolla E. et. al, 2020, Newkirk V, 2016, American Medical Association). Even when explicitly racist acts are outlawed, racist beliefs and practices can be built into societal and institutional systems and influence all aspects of the social determinants of health, including environmental, educational, and economic factors. Marginalized communities often have reduced access to health care, reduced access to healthy foods and healthy living environments, and experience greater social stress, all of which adversely affect health and healthcare outcomes. For example, individually, a doctor may create a different treatment plan for managing a patient’s pain based on their perception or implicit bias related to a belief that Black people have increased pain tolerance (Hoffman K, et. al. 2016). An example of structural racism can be seen in the historical exclusion of marginalized communities from professional organizations and institutions resulting in relatively few doctors of color across many professions, including optometry (Herbert K, 2020, Godoy M, 2020).
As clinicians, we need to learn about the roots of racism in the medical system if we are to critically evaluate our clinical processes to ensure racist practices and beliefs are challenged and eliminated. This analysis and change need to go beyond individual instances of racism driven by bias, prejudice, and discrimination, to facilitate change on a system and structural level. Since most health professions were influenced by the historical structures within a society that still grapples with the impacts of racism, we need to stay cognizant of the effect on our training, what we teach, and how we intentionally work to dismantle systems and practices that lead to unequal care in our daily clinical practice.
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