The NEW ENGLA ND JOURNAL of MEDICINE

Perspective july 7, 2022

A Call for Antiracist Action

David A. Ansell, M.D., M.P.H., Brittani James, M.D., and Fernando G. De Maio, Ph.D.​​

O
A Call for Antiracist Action

n January 22, 2022, neo-Nazis marched providers must acknowledge how

on Boston’s Brigham and Women’s Hospi- racism has contributed to unequal
health outcomes; redress the dam-
tal, with a banner claiming that the hospi- age by providing restitution to
tal “kills Whites” and flyers featuring photos of the population that has been
harmed, which involves offering
Drs. Michelle Morse, a Black able, contending that only race- pathways for access to services
woman, and Bram Wispelwey, a explicit programs will directly and care that have historically
White man, who have led antira- address the underlying causes of been denied; and facilitate closure,
cism work at the hospital. The racial health inequities and miti- achieving reconciliation with the
group denounced the physicians gate the current impact of racism community that has been harmed
and the hospital for “creating in medicine. by the health care system and
preferential health care treatment With other colleagues, Wisp­el­ reaching agreement that the harm
policies for non-White patients.” wey and Morse uncovered racial has been redressed.
This was not the first time that inequities in the treatment of pa- The framework applies the
Morse and Wispelwey were at- tients with cardiac failure at the principles of applicative justice to
tacked for their work. Brigham.1 They found that Black racial health inequities at the lev-
On March 17, 2021, the two and Latinx patients were less el of the health system. It recog-
physicians published “An Antira- likely than White patients to be nizes the need for race-conscious
cist Agenda for Medicine” in the admitted to the cardiology ser- approaches in medicine. While it
Boston Review.1 The article described vice, which was associated with affirms that race is a sociopoliti-
the historical failure of color-eva- better outcomes. Wispelwey and cal construct with no biologic
sive (or what many term “color- Morse implemented changes to basis, a race-conscious approach
blind”) solutions to racial ineq- rectify these practices. Their ef- allows the identification and rec-
uity in health care and offered a forts to correct this disparity led tification of long-standing racial
race-conscious approach they them to rethink the approach to health inequities. This effort is not
named “The Healing ARC.” They racial justice in medicine. about race-preferential treatment,
called for a structural shift in ra- The Healing ARC has three as the neo-Nazis and others on
cial equity work toward holding components: acknowledgment, re- the political right have claimed,
health care institutions account- dress, and closure. Health care but about eliminating obstacles

n engl j med 387;1  nejm.org  july 7, 2022 e1(1)

The New England Journal of Medicine
Downloaded from nejm.org on July 20, 2022. For personal use only. No other uses without permission.
Copyright © 2022 Massachusetts Medical Society. All rights reserved.
PERS PE C T IV E A Call for Antiracist Action

Asian American, Latinx White American Indian Black

formerly enslaved people,2 ac-
Native Hawaiian, or Alaska Native knowledging that race-conscious
or Pacific Islander approaches are necessary in medi-
Vermont cine because colorblind approach-
Maine
Idaho
es have not closed racial gaps in
Hawaii health outcomes.
New Hampshire Predictably, there was back-
Massachusetts
lash. Fox News was the first ma-
Rhode Island
Connecticut jor U.S. news source to attack the
Oregon article and the authors in 2021.
Colorado
Extremist social media figures
New Mexico
Washington including an editor and support-
Alaska ers of Quillette — a known source
Wyoming of White supremacist hatred and
Arizona
Maryland discredited, racist “science” —
Virginia amplified the Fox attack. Morse
Delaware has been subjected to repeated
Florida
New York racial slurs, harmful rhetoric, and
Utah threats to her safety.
New Jersey In 2020, as racial gaps in Covid-
North Carolina
Minnesota related mortality and murders of
California Black people touched the national
Georgia conscience, more than 200 health
Indiana
Kansas care organizations, including the
Iowa American Medical Association
Pennsylvania (AMA), declared racism a public
Kentucky
South Carolina health crisis. They pledged to take
West Virginia steps to eliminate racial health
Texas inequities by removing systemic
Ohio
Alabama barriers that block people of color
Nevada from achieving better health out-
Illinois comes. This is a critical moment
Wisconsin
Missouri for health care leaders to publicly
Louisiana reaffirm their support through
Washington, DC organizational actions for antira-
Michigan
Tennessee cism in medicine. The AMA and
Nebraska the Massachusetts Medical Soci-
Arkansas ety have issued statements, and a
Montana
Oklahoma
group of physicians and health
North Dakota care workers have signed a peti-
South Dakota tion of support, but we believe
Mississippi
that more leaders of national
0 20 40 60 80 100 120 140 160 180 200 220
health care organizations should
Deaths per 100,000 Population publicly express their support for
Deaths from Conditions That Are Treatable with Timely Access to High-Quality Drs. Morse and Wispelwey and
Health Care. their antiracism efforts — and
Data are from Radley et al.5 Missing squares for a particular group indicate that there then put their words into actions.
are insufficient data for that state. States are arranged in rank order based on the high- The neo-Nazi protest in Boston
est death rate in each state. is a reflection of reactionary ef-
forts in both medicine and broad-
to care that harm systematically liam Darity, Jr., and A. Kirsten er society to deny that racism ex-
excluded populations. The Healing Mullen calling for federal repara- ists or invalidate antiracism efforts
ARC builds on the work of Wil- tions for Black descendants of as “anti-White.” A 2021 Common-

e1(2) n engl j med 387;1 nejm.org july 7, 2022

The New England Journal of Medicine

Downloaded from nejm.org on July 20, 2022. For personal use only. No other uses without permission.
Copyright © 2022 Massachusetts Medical Society. All rights reserved.
PE R S PE C T IV E
wealth Fund survey found that
53% of Americans do not believe
racism is a problem in the United
States.3 Yet one out of three Black
or Latinx survey respondents re-
ported experiencing discrimina-
tion in health care during the
previous year.3
Efforts to embed racial justice
in medicine and advance health
equity have been launched — and
critiqued. There have been concert-
ed attacks on critical race theory,
whose precepts are central to
health equity work: critical race
theory acknowledges that race is
a social construct, identifies the
mechanisms by which racism is
embedded throughout society’s
systems and policies, and opposes
colorblind solutions to racial in-
equities. Most recently, the main-
stream media has promulgated
attacks on the language of health
equity, contributing to an envi-
ronment in which extremism can
thrive. In the days leading up to
the neo-Nazi protest, right-wing
media mischaracterized tenets of
race-conscious medicine, claiming
that efforts to overcome inequities
would result in White people being
denied medical care.
Since the first scientific study
of poor health outcomes among
Black Americans was published
by W.E.B. Du Bois in 1899 (The
Philadelphia Negro: A Social Study),4
deep and persistent inequities in
health outcomes between Black
Americans and White Americans
have been well documented. To-
day, the toll of structural racism
on the life expectancy of Black
Americans is revealed in devas-
tating statistics, with large ineq-
uities in the leading causes of
death, including heart disease and
cancer. The racial and ethnic dis-
proportionality in hospitalizations
and deaths during the Covid pan-
demic has highlighted the long-
n engl j med 387;1  nejm.org  july 7, 2022
The New England Journal of Medicine
Downloaded from nejm.org on July 20, 2022. For personal use only. No other uses without permission.
Copyright © 2022 Massachusetts Medical Society. All rights reserved.
standing structural and social
fault lines that have always di-
vided our nation.
The Commonwealth Fund re-
cently reiterated the persistent re-
ality that in most states where data
are available, Black people, Ameri-
can Indians, and Alaska Natives
are more likely than White people
to die early in life from conditions
that are treatable with timely ac-
cess to high-quality health care
(see graph).5 A large body of lit-
erature demonstrates that these
gaps in health according to race
and ethnicity reflect racism, rath-
er than genetic or biologic differ-
ences. Even analyses that control
for socioeconomic status confirm
that Black people in the United
States have worse health outcomes
than their White counterparts. A
race-conscious approach to elim-
inating health care inequities is
thus required across all our health
care institutions.
White supremacism has proved
resistant to eradication over centu-
ries. It appears in different forms
— as denial of structural racism,
in simplistic narratives of individ-
ualism and meritocracy, in stories
that lay the blame for health in-
equities on the beliefs, behavior,
or biology of historically margin-
alized people. And yes, White su-
premacism appears in the swas-
tikas and uniforms of “freedom”
protests against vaccination man-
dates and antiracist doctors.
Martin Luther King, Jr., noted
that, “In the end, we will remem-
ber not the words of our enemies
but the silence of our friends.” The
neo-Nazi march on the Brigham
and our physician colleagues and
the attacks on health equity inter-
ventions are stark reminders of
the obligation of physicians, par-
ticularly White physician leaders
of our national health care orga-
nizations, to denounce White su-
A Call for Antiracist Action
premacism and reaffirm race-
conscious antiracism efforts. We
recommend three immediate ac-
tions: publicly defending Drs.
Morse and Wispelwey and others
who have become targets of hatred
and rancor because of their anti-
racism work; implementing and
evaluating race-conscious, inter-
sectional interventions such as the
Healing ARC, especially given that
colorblind approaches have failed
to achieve meaningful gains in
health equity; and publicly report-
ing progress toward achieving ra-
cial equity in health outcomes.
Inaction in the face of White su-
premacism must not be an option.
The views expressed are those of the au-
thors and do not necessarily represent
American Medical Association policy.
Disclosure forms provided by the au-
thors are available at NEJM.org.
From Rush University Medical Center
(D.A.A.), the Inner-City Muslim Action Net-
work Health Center (B.J.), the American
Medical Association (F.G.D.M.), and De-
Paul University (F.G.D.M.) — all in Chicago.
This article was published on February 16,
2022, at NEJM.org.
1. Wispelwey B, Morse M. An antiracist
agenda for medicine. Boston Review. March
17, 2021 (https://bostonreview​.­net/​­articles/​
­michelle​-­morsebram​-­wispelwey​-­what​-­we
​-­owe​-­patients​-­case​-­medical​-­reparations/​­).
2. Darity WA, Mullen AK. From here to
equality: reparations for Black Americans in
the 21st century. Chapel Hill:​University of
North Carolina Press, 2020.
3. Commonwealth Fund. Confronting rac-
ism in health care delivery: an imperative to
improve the public’s health. Boston:​Har-
vard T.H. Chan School of Public Health
September 28, 2021 (https://theforum​ .­
sph​
.­harvard​.­edu/​­events/​­confronting​-­racism​-­in​
-­health​-­care​-­delivery/​­).
4. Du Bois WEB. The Philadelphia Negro: a
social study. Philadelphia:​University of
Pennsylvania Press, 1995.
5. Radley DC, Baumgartner JC, Collins SR,
Zephyrin L, Schneider EC. Achieving racial
and ethnic equity in U.S. health care: a
scorecard of state performance. New York:​
Commonwealth Fund, November 18, 2021
(https://www​.­commonwealthfund​.­org/​
­publications/​­scorecard/​­2021/​­nov/​­achieving​
-­racial​-­ethnic​-­equity​-­us​-­health​-­care​-­state​
-­performance).
DOI: 10.1056/NEJMp2201950
Copyright © 2022 Massachusetts Medical Society.
A Call for Antiracist Action
e1(3)