Ensuring racial justice and health equity in ob/gyn

August 3, 2020

“In the past 55 years since I became a physician, progress has been made but we still have so much more to do and a long way to go.”

We are in a cultural moment of awareness and change because of moral outrage by people of all colors. As was said at George Floyd’s eulogy, “What happened to Mr. Floyd happens every day in this country, in education, in health services, and in every area of American life, it’s time for us to stand up in Mr. Floyd’s name and say get your knee off our necks.”

Use your platform! In obstetrics and gynecology, it’s way past the time to provide better and improved health care for all, not just for the haves but for the vulnerable in our communities as well.

Systematic and institutional racism result in many if not all of the Social Determinants of Health (SDoH) our patients face. The SDoH play a major role in numerous health disparities in our specialty and poorer outcomes that we see, whether in the death of pregnant mothers or infants or rates of cancer, heart disease, or worse outcomes in black and brown individuals with COVID-19.

This is as a result of long-standing racism that is interpersonal, systemic, institutional, structural, and exemplary of racial bias and which adversely affects healthcare.

Physicians and healthcare workers (us) see this every day. We know racial bias and racism when we encounter it and that over the years, it leads to poorer health status and outcomes.

The COVID-19 pandemic disproportionately affects and targets black and brown people more than whites because of racism. This is no surprise to us in healthcare. The coronavirus has placed a bright spotlight on the long-existing poor health in black and brown people and the worse outcomes when they get COVID-19.

Clearly, there are demonstrated disparities in outcomes based solely on implicit bias and racism. A midwife said to me on rounds that there is no reason for a black or brown pregnant woman to die or be very sick more so than her white counterpart other than long-standing and present racism. Think about that. She is right. There is no genetic or biological reason for this tragedy!

We can eliminate racial disparity by eliminating racial inequity.

Racism is an insidious cultural disease with many manifestations. Privilege is one and has to be admitted. Access to healthcare and healthcare injustice are others. Not getting a deserved promotion is another. Being assigned an insurance plan that does not provide for needed services is another. And so on. You know them.

Around the country, medical students, physicians, nurses, and their families have recently knelt in remembrance of George Floyd’s death to say “yes” we know there is racism in the provision of healthcare services and “yes” we admit it and “yes” now let’s use our platforms and do something about it.

This is a great start but that alone is not enough! Letters and events of support are meaningful, but the systemic racism continues.

All of us providing healthcare services have a role and must speak out. What should empower you to speak out? Better outcomes for your patients.

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Dr. Hill is a Maternal-Fetal Medicine specialist with CenterPlace Health and Sarasota Memorial Hospital and has been an obstetrician-gynecologist for 55 years, almost 30 in Sarasota, Fla., within the Sarasota Memorial Health Care System. He can be reached at dr.washingtonhill@gmail.com

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Steps to advance and address racial justice and healthy equity in ob/gyn

So where do we go from here? What can you as a clinician or administrator do? Everyone is asking that question.

  • Cultivate within your organization diversity and inclusion among your learners, faculty, staff, and most importantly the leadership within your organization. Change starts from the top. Is your “med exec” group truly diverse and reflective of your medical staff or group?
  • Communicate. Have those difficult and sometimes uncomfortable, real, open conversations about racism and racial equity at your institution and their effects locally and within policies and practices in your organization.
  • Understand and teach the importance of SDoH and structural racism in health services as part of the curriculum for trainees.
  • Advocate for more diversity of staff, employees, management, faculty, and leadership. These people need your help. Use your platform and speak out wherever and whenever you can.
  • Increase health equity knowledge and advocacy where you work. Remember that equality is not equity. The service may be available to all; i.e., “equality,” but are all really able to access it, i.e., “equity?”
  • Check yourself. Examine your own group, clinic or office. Is it really diverse? Who is at the front desk and who is doing the procedures? Any blacks or Latinos?
  • Use your meetings, mouth, ears, devices, and contacts to advocate and speak out for a more accountable, diverse and inclusive “healthcare system.” Compliment when you see something done well and hold those accountable when it needs to improve.
  • Encourage your leadership, staff, and employees to use their influence and push forward with diversity and inclusion initiatives. Encourage them to partner with community organizations, suppliers, businesses, and diverse communities, not just those that look like them.
  • Ask questions like, “How diverse is our workforce and management?” “What do the data show?” Look at the metrics over time. You know the importance of data. Eenie, Meenie, Minie, Mo...What Do the Data Really Show?
  • Examine your own institution. Does it appear that your hospital is welcoming to all forms of promoting diversity? What more can be done? Speak up if you see an injustice committed. Your organizations should encourage and support their staff to confront overt racism and implement efforts to address the implicit biases of coworkers and senior staff members.
  • Speak up. We can no longer remain silent and not speak up. That’s complicity. Your voice has power!

For those of you who choose to do it, this is not easy work. There will be lots of resistance and lots of words. It will take a lot of energy, but do not become dismayed or give up. It can be very frustrating.

We have come a ways in including diversity, inclusion, and equity in our healthcare organizations but we still have a very long way to go in really being diverse. Healthcare organizations cannot rest on their laurels.

Your hospital should be just as proud of being one of the top diverse hospitals in your area or country as it is about being a top cardiovascular center putting in valves. Use your platform to get there.

In the past 55 years since I became a physician, progress has been made but we still have so much more to do and a long way to go. Those gatherings in front of medical schools, hospitals, and clinics kneeling to remember George Floyd in support of the Black Lives Matter movement will make sure of that.

They are not going away nor is the community.

We are not going back.

An Associated Press wire story, dated March 26, 1966, contains the first known published reference to Dr. Martin Luther King’s famous quotation regarding injustice in health care, “Of all the forms of inequality, injustice in health care is the most shocking and inhuman.”

Dr. King’s remarks were made at a Chicago press conference held the day before in connection with the annual meeting of the Medical Committee for Human Rights. These words still ring true today.

I graduated from medical school in 1965 and remember marching the next summer for racial equity. It is now the summer of 2020 and people of color are still marching for racial equity. There is something wrong with that picture and many of you have pointed that out.

Some things but far too little—has changed. We must all do, expect, and demand better of ourselves and those in power who provide healthcare services and teach about it.

We have a lot of work and a long way to go to get the knee up and improve healthcare services for all of our patients, but we can do it if we really want to.

A change has to come! I hope that this commentary rings clear as a clarion call touse our platforms, work together, stronger and better to eliminate racial inequity in our specialty and all of healthcare.

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