Four Steps to Addressing Racism in Health Care

By J. Matthew Austin, PhD

The killings of Black Americans such as George Floyd, Ahmaud Arbery and Breonna Taylor have reminded us of the systemic racism that permeates our society and the institutional biases that Black Americans and other people of color face in relation to policing, the criminal justice system, health and economic opportunity. 

The deaths of these individuals have sparked a movement across the United States, calling on society to demonstrate that Black lives matter, forcing the country to confront its own history with racism, and for many individuals, having to reckon with their own biases and privileges.

Historically in the United States, health outcomes have not been equal for all patients, with Black Americans often having worse outcomes than Americans of other races. For example, disproportionately high maternal mortality rates in Black women have only recently received significant national attention – 41 Black women still die from pregnancy-related causes per 100,000 live births as compared to 13 white women. Non-Hispanic Blacks are 24% more likely to die from heart disease than non-Hispanic whites, and that gap appears to be widening, not shrinking. 

Racism has a long history in health care, from researchers withholding syphilis treatment from Black men in the Tuskegee Study, to clinician scientists experimenting with Henrietta Lacks’s cells without her family’s permission, to the practice of eugenics and the forced sterilization of thousands of Native American women by the U.S. government in the 1970s.

If society is committed to ending racism, one necessary step is to ensure that people of color and other vulnerable populations consistently receive the same high-quality, person-centered, safe care as other patients. 

Health system leaders are uniquely positioned to lead on the issue of health care disparities.  They are at an inflection point, where they can choose to either continue the status quo or pivot their organizations toward new paths to confront and eliminate disparities in health care.

In the April 2021 issue of The Joint Commission Journal on Quality and Patient Safety, my colleagues and I outline four key steps health system leaders should take to identify and eliminate health care disparities:

1. Recognizing that health care disparities are a gap in the quality of care delivered, exist in every health system and are system failures that occur at many levels. 
2.  Declaring from the highest levels of their organization, including the board of directors, that this work is important, and that leadership will be held accountable. 
3. Ensuring that any disparities are made transparent and reported as part of the standard set of quality metrics.
4. Committing to increasing the diversity of their senior leadership ranks and those on the frontline caring for patients. 

We believe these four steps will move us a considerable way toward better understanding health care disparities and starting to eliminate them. Addressing disparities will require creative thinking and problem solving on the part of health system leaders, community partners and policy makers. But if disparities are viewed as a quality gap, health systems are the natural leaders.

J. Matthew Austin, PhD, is an assistant professor at Johns Hopkins Armstrong Institute for Patient Safety and Quality in Baltimore, and an assistant professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore. Dr. Austin’s research interests focus on health care performance measures.