We are students of medicine and public health at the Joint Medical Program of the University of California, San Francisco’s School of Medicine and University of California, Berkeley. We each bring a background in racial and social justice work and research to our current studies. Our unique dual-degree program affords us the opportunity to build upon these backgrounds, providing instruction and opportunity to question many of the accepted norms of our clinical education.
Dorothy Roberts, a foremost critical race theory scholar (and hero), says in her seminal 2015 TEDMED talk, “Race is not a biological category that naturally produces these health disparities because of genetic difference. Race is a social category that has staggering biological consequences, but because of the impact of social inequality on people’s health.”1
In other words, racism, not race, causes health disparities. This truth guides our work. We are united by a common goal: to place justice and challenging anti-Black racism at the center of our practice of medicine to ensure the care and well-being of all communities, especially those that have been historically marginalized and disenfranchised.
As learners of both medicine and critical race theory, we regularly engage in discussions about critical race theory as we study racial disparities in health. We are able to see both at once, in ways that many fellow learners can’t yet see. We also care for underserved patients of color at community clinics and safety net hospitals throughout the Bay Area. These opportunities have allowed us to put theory into practice, and the results are shocking. There are critical, deadly errors in traditional clinical textbooks, research, and practice that contribute to root causes of racial health disparities:
In our textbooks, we are taught that race can serve as a risk factor for disease. Yet we know that race is a social construct, not a biological risk factor.
In clinical research, we are told that disparities in disease among Black and brown communities are due to culturally determined individual behaviors. Yet we know that structural barriers to food and stress-free lives, as well as targeted discrimination, prevent many people of color from achieving health and well-being.
In clinical practice, we are mentored by clinicians who blindly follow guidelines that instruct them to prescribe based on race rather than overall effectiveness. Yet we know that these guidelines are built on a deep history of biological racism and othering within medicine and health care.
We have found these scenarios to be commonplace and largely unchallenged throughout our medical education and training. Racist, outdated notions are taught in clinical education, solidified in research and perpetuated in practice.
We are astounded, outraged, and driven to make a call to action.
This action is personal, political, and technical. We follow the tradition of women of color scholar-activists, like Dorothy Roberts, Cherríe Moraga, Gloria Anzaldúa, and countless others, who embrace that the way we move through the world, our “personal” lives, are inherently political—a “theory in the flesh.”2 As physicians-in-training, our world is furthermore inherently technical as we learn the algorithms of diagnoses, and those diagnoses are sometimes visibly and sometimes invisibly political. It is all connected. Therefore, this work presented here is unapologetically personal, political, and technical. These are the lives we live and the lens we bring to building a just, antiracist field of medicine.
Our politics, purpose, and intentions to further advance an antiracist, people-centered medicine are inspired by abolitionist frameworks of those who seek the end-of-the-prison industrial complex.3 Central to the abolitionist framework is the understanding that all cages that restrict autonomy and expose people to harm—physical, mental, emotional, psychological, and structural—are connected. So, too, in medicine are all the forms of racism connected, and much like abolitionism, in order to fight them, we must see them in their entirety and then work to eradicate them all. The current medical and health-care system in the United States harms Black and brown bodies and souls. To build a medical system in which all people are valued and healed as whole persons, we must challenge the current understanding of what is “normal” and what is “just reality.” We hope that this paper contributes to the abolition of outdated, oppressive “normal ways of doing medicine” that have exploited Black and brown bodies. Ultimately, by deconstructing current limitations, we will collectively generate new imaginations of whole-person healing for communities that have been neglected and ignored. Through this work, we aim to abolish the biomedical oppressions that have put forth more harm than healing in order to reimagine ways to bring healing back to our people.
We are not the first to make this call. We are led by womxn of color; scholars and activists who have been making this same call for far too long. Yet our experiences as trainees reflect how racism continues to be deeply ingrained in health care. Medicine, and health care more broadly, has yet to heed their call. We have found many practicing clinicians and professors to be unfamiliar with the historical context and harm of their practices. Some are simply ignorant of the impact of their actions. We hope this paper may provide them with the education and language to pause, reflect on their complicity, and begin to question and to shift their practice. Others do not care. We hope this paper begins critical dialogue and change that one day will change their practice as well because we know how deeply historical scars run in medicine.
This is our action. As members of the health-care workforce, we find the current state of racism in medicine untenable. We refuse to be part of a system that perpetuates harmful, deadly practices against Black people and people of color. We aim to use our unique positionality and experiences as medical and graduate students to offer a way forward for our current and future instructors, colleagues, and mentees. We are inspired by the growing body of research and commentary by clinicians and learners challenging both the normalized uses of biological race and the unacknowledged racism in clinical research, education, and practice. Our aim is to amplify existing voices in this movement and to further bridge the gap between critical race theory and medicine.
Our responsibilities to patients, to communities, and to justice demand we make this call to action.
Who Is This Work For?
In thinking about our intended audience for this paper, we are inspired by Michelle Alexander’s preface to The New Jim Crow.4, 5 Our paper is intended for a similarly specific audience—our fellow clinicians in training and current providers of all types, who care about practicing antiracist medicine but who, for a number of reasons, may not yet appreciate the magnitude of the violent history and current clinical manifestations of the flawed assumption about biological race that pervades medicine. We have spoken to countless medical students and current providers who struggle to challenge their teachers and supervisors who perpetuate racist ideologies, due to unfair power dynamics and a lack of readily available facts and data to back up their claims. In part, we have written this resource because we wish it existed for us.
We also write this paper for patients. Our desire to support patients in feeling happy, healthy, and strong, rather than pathologized, is why we do this work. However, while we do our best to make both technical medical language and critical race theory accessible for all, we realize that may not be accessible for all our patients. Know that when you say that medicine is hostile, we hear you. We hope for future resources more specifically directed at patients to supplement our work, and more importantly, we hope for medicine to transform into a welcoming practice.
We hope this resource is used as educational and action-generating. Although not exhaustive as an educational resource, we are bridging existing work on critical race theory with our firsthand knowledge of clinical education, research, and practice. Please see the appendix for further resources.
Yet it is not enough to simply read and learn; we must also act. Reflecting on the tenth anniversary of publishing The New Jim Crow, Michelle Alexander notes that this work is necessarily personal, moral, and spiritual. We echo that call and add that it is necessarily political.6 We live lives that are personal, political, and medical, so our action must be all three as well. We live in a world structured by racism, meaning in order to make the changes necessary to support the health of all communities, we have to continue to unpack the unquestioned uses of race and do the work to reprogram ourselves away from racialized algorithms. We must do the work to build systems that are just and antiracist. Our final section includes our calls to action and a few ideas of where to start. But this is where you must take up your own action so that together we build the health system we wish to live and practice in.
- 1. Dorothy E. Roberts, “The Problem with Race-Based Medicine, ” TEDMED, video (2015), https://www.ted.com/talks/dorothy_roberts_the_problem_with_race_based_me....
- 2. Cherrie Moraga and Gloria Anzaldúa, This Bridge Called My Back: Writings by Radical Women of Color, fourth edition (Albany: State University of New York Press, 2015).
- 3. Dorothy E. Roberts, “Constructing a Criminal Justice System Free of Racial Bias: An Abolitionist Framework,” Columbia Human Rights Law Review 26 (2008).
- 4. “This book is not for everyone. I have a specific audience in mind—people who care deeply about racial justice but who, for any number of reasons, do not yet appreciate the magnitude of the crisis faced by communities of color as a result of mass incarceration. In other words, I am writing this book for people like me—the person I was ten years ago. I am also writing it for another audience—those who have been struggling to persuade their friends, neighbors, relatives, teachers, co-workers, or political representatives that something is eerily familiar about the way our criminal justice system operates, something that looks and feels a lot like an era we supposedly left behind, but who have lacked the facts and data to back up their claims. It is my hope and prayer that this book empowers you and allows you to speak your truth with greater conviction, credibility, and courage. Last, but definitely not least, I am writing this book for all those trapped within America’s latest caste system. You may be locked up or locked out of mainstream society, but you are not forgotten.” Excerpt from Michelle Alexander, The New Jim Crow, on Apple Books.
- 5. Michelle Alexander and Cornel West. The New Jim Crow: Mass Incarceration in the Age of Colorblindness (New York: The New Press, 2012).
- 6. David Remnick, “Ten Years After ‘The New Jim Crow,’” The New Yorker (January 17, 2020), https://www.newyorker.com/news/the-new-yorker-interview/ten-years-after-....