Antiracism Practices Promote Health Equity in Clinical Care

Megha Shankar, MD

A new qualitative study from California suggested that antiracism practices from outside the health care sector could offer innovative strategies to promote health equity by addressing personally mediated, institutional, and internalized racism in clinical care.

The 3 levels of racism (personally mediated, institutional, and internalized) were first described in an article published in 2000 in the American Journal of Public Health. Investigators from the present study used these levels as a framework to examine health inequities and shape antiracism efforts.

The team, led by Megha Shankar, MD, Divisions of General Internal Medicine at the University of California, noted that whole this framework is over 2 decades old, organizations have only recently begun to acknowledge institutional/structural racism in health care.

Shankar and colleagues utilized the levels of racism framework to describe personally mediated, institutional, and internalized antiracism practices that could be applicable to medicine.

The Methods

The study utilized a human-centered design approach that drew on the experiences of individuals in analogous professions to learn about transdisciplinary antiracism communication practices, as well as how they could be applied to health care.

Additionally, the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guideline checklist was completed to ensure the quality of qualitative research was upheld.

Race and ethnicity-concordant interviewers were used often to elicit the best-quality data from participants, and all data received 3 rounds of coding to encourage correct interpretation.

Among the 10 interview team members, there were 3 Black or African American individuals, 3 East Asian, Southeast Asian, or South Asian individuals (30.0%), 2 individuals with Hispanic, Latinx, or Spanish origin (20.0%), and 2 White individuals.

Nearly all (90%) team members were women.

Convenience and purposive sampling were used to recruit 40 participants via email, social media, and electronic files. A semi-structured interview guide was developed and featured open-ended questions focused on workplace experiences with anti-Black racism and specific antiracism communication practices.

The Findings

Personally mediated antiracism practices included dialogue and humble inquiry, building trust, and allyship and shared humanity. Investigators believed that clinicians could adopt these practices through focusing on patient successes, avoiding stigmatizing language in the electronic health record, and using specific phrases to address racism in the moment.

Regarding institutional racism, practices included education, representation, and mentorship.

In a health care setting, the team hypothesized that clinicians could develop staff affiliate groups focusing on improving racial health equity outcomes, and conduct antiracism trainings.

Finally, internalized antiracism practices revolved around authenticity, with the team noted that clinicians could be able to write positionality statements reflecting their identity and expertise that they bring to clinical encounters.

Investigators concluded that applying transdisciplinary antiracism communication practices to medicine could promote transformative change in the world of medicine.

“Future implementation and evaluation of these antiracism practices should continue to use human-centered design approaches, employing a patient-centered approach to ensure that Black voices are lifted and heard,” the team wrote. “From individual clinicians to health care systems at large, medicine has the power and responsibility to make actionable change across all levels of antiracism.”

The study, "Nonmedical Transdisciplinary Perspectives of Black and Racially and Ethnically Diverse Individuals About Antiracism Practices: A Qualitative Study," was published online in JAMA Open Network.