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American Medical Association confronts its racist past with plan for a more equal future

BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1314 (Published 21 May 2021) Cite this as: BMJ 2021;373:n1314
  1. Janice Hopkins Tanne
  1. New York, USA

The American Medical Association (AMA) has set out a plan to dismantle structural racism, starting within the organisation, and to work towards a future of health equity.1

The AMA, which has among its members 240 000 doctors and more than 190 state and specialty medical societies, said that race is social, not biological. “Race is a socially constructed way of grouping people, based on skin colour and other apparent physical differences. It has been defined by an arbitrarily organised combination of physical traits, geographic ancestry, language, religion, and a variety of other cultural features.”

The plan began three years ago when the AMA’s annual House of Delegates meeting considered a report defining “health equity” and outlining the association’s role in tackling inequities in healthcare. It recommended that the organisation set up a centre to initiate, coordinate, and track its health equity activities.

The plan presents what the AMA calls an “overarching, aspirational vision of a nation in which all people live in thriving communities where resources work well; systems are equitable and do not create or exacerbate harm; everyone has the power, conditions, resources, and opportunities to achieve optimal health; and all physicians are equipped with the consciousness, tools, and resources to confront inequities.”

It comes just two months after the editor in chief of the association’s flagship journal JAMA, Howard Bauchner, was placed on administrative leave after deputy editor Ed Livingston downplayed the existence of racism in medicine in a controversial podcast.2

The plan notes that it “comes amid the worst pandemic of our lifetime; a divisive presidential election, punctuated by its violent aftermath; a year of sustained protests in response to police brutality and the exposure of the historical harm imposed on Black people for generations; escalating hate crimes towards Asian communities; deliberate and ongoing family separation at the US border under the Zero Tolerance Policy causing irreparable harm to children; persistent gun violence; and, most recently, our own journal’s egregious, harmful error and failure in posting a podcast denying structural racism,2 keeping old wounds open while new ones form.”

The Center for Health Equity was established in April 2019 and headed by Aletha Maybank, a senior vice president of the AMA. The report recognises that “our current state was built on the labours of others” such as African American, indigenous, Hispanic, Asian, LGBTQ+ people, and people with disabilities, “in ways that violated the fundamental principles of equity.” The report acknowledges and lists past national and AMA actions that harmed these groups as well as women.

The AMA president elect Gerald Harmon said that the association must commit to eliminating “systemic, preventable, and unjust differences in the health of our patients.” Pushing towards a more equitable future, he said, also means “reversing the historic harms we caused and forging paths towards truth, reconciliation, racial healing, and transformation.”

The plan outlines five approaches:

  • *Embed equity and racial justice throughout the AMA

  • *Build alliances with marginalised physicians and other healthcare leaders

  • *Push to the origins to tackle determinants of health and root causes of inequities

  • *Ensure equitable structures and opportunities in innovation in existing AMA efforts to advance digital health

  • *Foster pathways for truth, racial healing, reconciliation, and transformation of the AMA’s past.

Maybank said, “Achieving equitable solutions requires disruption and dismantling of existing norms and taking collective action. It also requires a sense of urgency and ambition, and the time is now.”

Health inequities are linked to social inequities such as poor housing; lack of markets providing fresh, nutritious food; and other factors. The report calls for working together with public health authorities.

Among the beliefs that must be countered, the report says, is meritocracy, the idea that people are successful purely by their own efforts—and this belief is embedded in medical education. Other forces of inequity include gender, gender identity, sexual orientation, disability, age, class and socioeconomic status, citizenship status, and language. The report said the AMA would work through its “Ed Hub,” a resource that supports medical education and training, to tackle these matters.

The AMA management team has organised efforts for change among its own 1100 staff by establishing diversity, inclusion, and equity workgroups. The report says that over the past two years there has been tremendous progress with training activities, building an internal accountability infrastructure to ensure the organisation does what it says it sets out to do, and creating and increasing the spaces for truth telling and psychological safety supports.

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