July 1, 2020

Since my last blog about racism as a public health crisis, I’ve had a number of conversations with colleagues from around the state about this topic. To a person, everyone was supportive and in agreement with the sentiments expressed. But most of us, even if acutely aware of racism and racial disparities in medicine, feel ill-equipped to tackle this problem. It feels either too big, or too pervasive, or too difficult, and we don’t even know where to start.

At the end of my last blog, I walked through some potential next steps. But the NH physicians I spoke with are all looking for discrete, actionable steps that they can take now, in the context of busy practices and busy lives, along with the specter of COVID looming persistently over all of us.

I think the first step is to acknowledge that there is a problem. Racism is real, and it affects the health of black and brown people, and healthcare is no more immune to institutional racism than any other segment of American society. That acknowledgement and the open discussion of racism as a public health crisis validates that lived experience of those who have dealt with this first hand, and prioritizes action to address these inequities.

For a white male like me, I think that the flip side of recognizing that racism is affecting health is to understand that I essentially live in a privileged class in this country, and that it’s possible that not everything I have earned in life was based on merit alone. By virtue of where I grew up, learned, lived, played  and worked, which was made possible in part due to the color of my skin, I had advantages and opportunities, with respect to my health as well as other aspects of my life, that I would not have had if I had dark skin. So we need to approach this problem with humility and understand that we won’t have all the answers.  And we’ll most certainly make mistakes along the way. But we need to find a way toward health equity.

With that understanding, the next step could be to understand our own implicit biases. Also known as social cognition, implicit biases are unconscious constructs that we all have deeply embedded that cause us to have certain feelings or reactions to people based on race, sex, ethnicity, age, or appearance. Everyone has implicit biases, and so the challenge is to try to identify them and therefore understand them, and if necessary start to change them. There are specific programs and trainings available to do this type of work, and as individual physicians we can participate in these trainings and encourage our organizations to sponsor them.

From there, we need to educate ourselves about the effects of racism on health. We can read medical journals which are increasingly highlighting racial health disparities, and choose CME that addresses racism and racial disparities and the social determinants of health, to develop a broader and more accurate understanding of the issues. For example, when we learned in medical school that African Americans have higher rates of diabetes or hypertension than whites, was there also a concurrent discussion that much, if not all, of this difference is due to the conditions in which African Americans live – their housing, education, available food choices, economic opportunities, all adversely affected by the stress of institutional and systemic racism? No, there wasn’t. Well, certainly not when I was in medical school. I was taught that these were genetic differences. It turns out the truth is a lot more complicated. We are now seeing these structural inequities play out in real time with the well documented disparities in COVID hospitalizations and mortality in black and brown communities.

And when we are caring for patients with black or brown skin, we can ask ourselves a question as suggested by Nwando Eze, MD, MPH, in a recent article, Equality Is Our Last Hope in the NEJM Catalyst: “If this patient were white, would I treat them differently?” As she describes it, if the answer is no, it means we are practicing equality in our care. But if the answer is yes, acknowledging that fact provides us an opportunity to improve our care, make it more equitable, and do better with the next patient.

The Medical Society is actively working to support these steps for Granite State physicians. So here is my pledge to you. We will strive to build a coalition of medical providers in the state who can work together to start to address racism as a public health crisis in New Hampshire. We will also work to develop implicit bias training and CME content around racial disparities in health and in healthcare. And our annual conference this year will focus on the social determinants of health, with special emphasis on the effects of racism.

We will endeavor to help NH physicians in this process. But you will have to take the first step. We’ll meet you there – I’ll meet you there – and together we can find a way toward more equitable care and better health in New Hampshire, which will make it a better place for us all.

In health,

John Klunk, MD
NHMS President

Please send comments or questions to john.klunk@nhms.org.