Advocating for a shift from race-based to race-conscious medicine

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“I am Italian-Chilean-American (Mapuche), Marie is Haitian-American, and Jenny is Taiwanese-American. We have all experienced racially-tailored care at some point in our lives. Our lived experience enhances the authority of our work,” says Yale School of Medicine MD-Ph.D. student Jessica Cerdeña, MPhil.

Cerdeña is referencing her co-authors, Howard University Ph.D. student Marie Plaisime, MPH, and Yale Emergency Medicine physician Jennifer Tsai, MD, MEd—and their article, From race-based to race-conscious medicine: how anti-racist uprisings call us to act, recently published in The Lancet.

Cerdeña, Plaisime, and Tsai had submitted their article to The Lancet, after the medical journal, in June, announced a commitment to action following George Floyd’s murder and the Black Lives Matters protests. “Our task is to educate ourselves and others about racism. We must support Black and minority ethnic health workers,” The Lancet stated. It pledged “to use science as an instrument for social change,” in part through “the research we publish, the authors we commission, and the individuals we choose to profile and recognize.”

Cerdeña, Plaisime, and Tsai, according to Cerdeña, saw this commitment to action as an opportunity “to speak to longstanding issues of race-based medicine.” In their article, the authors state that medicine “is an institution of structural racism” and that a pervasive example of this is race-based medicine, “the system by which research characterizing race as an essential, biological variable translates into clinical practice, leading to inequitable care.”

The authors seek to shift from race-based to race-conscious medicine, “to promote conscious, antiracist practices over unchecked assumptions that uphold racial hierarchies.” Additionally, as Cerdeña describes, “we had seen other work discussing issues of racism in medicine and race-based medicine, but we had not seen any actionable tools that proposed a way forward. We hope that our work provides a model for how to dismantle race-based medicine and instead address the health consequences of structural racism.”

The authors note that during European colonialization, “race was developed as a tool to divide and control populations worldwide. Race is thus a social and power construct, with meanings that have shifted over time to suit political goals, including to assert biological inferiority of dark-skinned populations.”

They describe how despite “the absence of meaningful correspondence between race and genetics, race is repeatedly used as a shortcut in clinical medicine”—and how medical education often trains students to continue this harmful practice. For example, “race is often learned as an independent risk factor for disease, rather than as a mediator of structural inequalities resulting from racist policies.” When health disparities are presented without context, students learn to associate race with disease conditions, for example, cystic fibrosis and hypertension, and develop dangerous stereotypes. Clinical rotations often reinforce these lessons, when students are taught that race is relevant to treatment decisions, and because of power dynamics, cannot “question the racialized assumptions of their supervisors.”

The authors argue that health inequities would be reduced if there was a shift to race-conscious medicine, which emphasizes “racism, rather than race, as