As med students push for change, the AMA calls out racism in health

Is it a new day at the American Medical Association?

The influential AMA and more than 600 members of its House of Delegates — a diverse body representing state and specialty medical societies — have officially recognized racism as a public health threat and race as a social construct instead of a biological one. The new policies could be a game-changer for an organization that has deep roots in racism.

But some activist medical students say the statement, issued in mid-November, is late and empty. They want to see more action by the AMA to address systemic racism.

Aletha Maybank, a physician who is the association’s first chief health equity officer and group vice president, called the new policies a historic step in the organization’s journey to address racial disparities and its own shameful record on race. “After the 2018 adoption of policy to define health equity and my hiring as the AMA’s inaugural chief health equity officer, in June 2020 the AMA Board of Trustees denounced racism as an urgent threat to public health and pledged action to confront systemic racism, racial injustice and police brutality,” she said in response to an inquiry from the Center for Health Journalism.

Writing in Essence, Maybank acknowledged the AMA’s racist past and the pernicious effects of racism on Black health. “It is racism, not race that produces higher death rates among Black women during childbirth, and of the babies that they bear. Years of institutional and structural racism has produced the highest rates of heart disease and high blood pressure for Blacks. Racism has produced the highest rates of getting and dying from COVID-19.”

The past is prologue

The American Medical Association was founded in 1847, when slavery was thriving in the South. After the Civil War ended, Black doctors were barred from joining local medical societies, a prerequisite to membership in the national association. The AMA never advocated for their admission and disqualified them from joining the national group directly. It didn’t drop this practice until civil rights era-legislation in the 1960s outlawed discrimination based on race, religion, sex and national origin.

The AMA had tremendous pull over the medical community and health policy for more than a century and used its power to enforce and perpetuate white supremacy and systemic racism. The association commissioned the infamous Flexner Report, which assessed medical education in the United States and resulted in the closure of nearly all Black medical schools — even as Black students continued to be excluded from white medical schools. The association also fought President Truman’s plan for health insurance for all Americans, a proposal that would have benefited millions of descendants of slavery.

Although its membership and clout have dwindled in recent decades, the AMA remains the nation’s largest organization of physicians and an influential voice in medicine. The group has been trying to make amends for past sins while keeping up with the changing times. 

At a meeting of the National Medical Association (think AMA for Black doctors) in 2008, Ronald M. Davis, then the AMA's immediate past president, apologized for AMA policies that led Black doctors to be excluded from medical societies. Davis pledged that the AMA would "do everything in our power to right the wrongs that were done by our organization to African American physicians and their families and their patients." 

Eventually his remarks led to an official apology from the AMA for discriminating against Black doctors.

In 2018, the AMA elected Patrice Harris, an Atlanta psychiatrist, as its first Black woman president. In July, after the police killing of George Floyd triggered massive protests, the AMA spoke out against police brutality and urged Congress to find a path toward “effective and equitable policing reforms.”

Shift change

The changes at AMA comes as a surge of medical students have called for racial justice and challenged their schools to rewrite curriculums to include more teaching and dialogue around race and discrimination. Their mission is to dismantle racism in medicine by teaching students that race is not a biological construct but a social one. White Coats 4 Black Lives (WC4BL), run by medical students, was formed in 2014 after the deaths of Michael Brown and Eric Garner gave rise to the Black Lives Matter movement. There are now more than 70 chapters on medical campuses across the country. 

They’re not just calling out antiquated, erroneous medical teaching, but also making forward-looking demands. At the University of California, San Diego, Black medical students want funding for mandatory anti-racist training for faculty and staff and for the creation of an anti-racist task force, to be led by a director of anti-racism and include student and community representation.

At George Washington University School of Medicine and Health Sciences, WC4BL has many demands, including a commitment to admitting incoming classes with an over-representation of Black, Latinx and Native American students, and incorporating a screening tool in its secondary application to detect racial bias among applicants. The group has also asked the school to stop teaching the use of race as a “disease risk factor.” 

White Coats 4 Black Lives at the University of California, Davis welcomed and criticized the AMA’s statement on racism as a public health threat, saying the association hasn’t yet determined what it will do to “dismantle its own oppressive system.”

In a statement responding to an inquiry for this post, the student group called the AMA declaration “long overdue and frankly inadequate.”

“Stand-alone statements without a committed action, policy or incentive do not breed accountability, which is what we need from our institutions to meaningfully work towards becoming proactively anti-racist,”  the student group said.

Nevertheless, the students hope the declaration will be a springboard to further change. “Though this statement leaves much to be desired in terms of accountability, it does provide a framework and foundation to legitimize important anti-racist work that physicians, institutions and communities are already doing. Hopefully this statement will pave the path for investment, resources and research into how to better engage in anti-racism work.”

Maybank concedes that more must be done. “Accountability will be critical to this future work,” she said. “Accountability amongst ourselves as physicians/leaders in this space, accountability to the communities we serve, accountability to name racism, and also accountability to what we are doing at the institutional and societal levels.”

The students’ efforts are leading to changes. The Association of American Medical Colleges issued guidance in July on how selection committees at undergraduate schools and graduate medical programs can use a holistic approach to review prospective medical students. At the University of Washington School of Medicine, student pushback has led to a new way to measure kidney function that doesn’t factor in race. Research has shown that using race in such calculations can delay care and kidney transplantation for Black patients.

So, the pressure is working. 

Institutionalized racism that has shaped our health care system and harmed millions of people for centuries is tough to resolve. The collective voices of people calling for justice and inclusion were loud enough to move a 173-year-old organization from silence and complicity to action. Acknowledgement by the AMA is one thing. But setting visible and measurable benchmarks to instill sustainable change is another hill to climb. We don’t know what movement, rally cry or legislation will come in the future to secure real transformation. What we do know is that it’s the oppressor’s turn to accept the onus for change.