Declaring racism as a public health crisis from the lens of two Latinx student doctors

“I often heard as a child that Mexicans were lazy and dirty. As a Mexican-American, I did not wear shorts for years despite the heat because I thought my knees looked dirty. Now I fully embrace my identity. However, as a medical student, I still feel the pressure to disprove these stereotypes.”
– Camila Hurtado

“Growing up in the barrio, my white classmates would tease and bully the brown Latino kids constantly. I was called a wet-back, brownie, and an illegal alien. I was scared, stressed, and worried I would get bullied if I spoke up.  Now, as a medical student, I am determined to speak up for myself and my community.”
– Yesenia Salazar

The recent events inciting conversations around racism have provoked familiar memories for the Latinx community. We first witnessed the disproportionate amount of Black and brown communities affected by COVID-19 at outstandingly high rates, which was then compounded by the deaths of Black people due to police brutality. As medical professionals, we have a duty to provide equal treatment to all. As Latinx medical students, it is imperative to advocate for the health of all people of color, especially our fellow Black and brown brothers and sisters. To do so, we must address the center of the issue: systemic racism in medicine.

Discriminatory practices based on race are widely recognized to be unethical and unconstitutional. However, subtle racism operates at various levels within systems such as housing, health care, and employment that ultimately affects the health of marginalized communities. Health care is not exempt from such systems, and in fact, has a long history of perpetuating these oppressive systems.

In health care, one example of how racism is perpetuated is through race-based science. Race and individual behavioral practices are often used to explain worse health outcomes among communities of color. For instance, doctors routinely interpret GFR based on the assumption that Black Americans have more muscle mass despite a lack of evidence. The GFR algorithm disproportionally affects and contributes to more severe rates of GFR decline and end-stage renal disease (ESRD) mortality in Black Americans. In turn, Black Americans lack timely dialysis treatment and are systematically prioritized to a lesser degree for a kidney transplant than white Americans.

In addition to the racism seen in race-based science, systemic racism continues to be the root of social determinants of health (i.e., health insurance, residency status, stable housing) that lead to the disproportionate health outcomes among Black, indigenous, and people of color (BIPOC).

As a medical community, we must declare racism as a public health crisis. We must use a holistic lens that acknowledges racist principles underpinning our medical community and move forward in creating a new antiracist system that addresses the social determinants of health in our communities. We encourage our medical community to:

1. Study the medical community’s exploitative history of people of color to recognize the failings of our system, reflect on our current practices, and change our policies to prevent further harm.

2. Incorporate an antiracist framework into the medical curriculum led by qualified experts in the field to teach that racism, not race, leads to disproportionate health outcomes.

3. Create a new system for academic medicine by investing in:

  • research focusing on interventions to address racism on a systemic level
  • underrepresented medical and premedical students
  • the hiring and promotion of faculty of color

Antiracism requires action-oriented work and calls us to ask, how will we work to become antiracist? How will we change our institutional culture and systems to become antiracist? As Latina medical students, we have seen and experienced racism in many aspects of society and have felt the need to change our institutional culture. If we act now, we will foster physician leaders adequately equipped to address health disparities. We are calling on other Latinx people, other non-Black people, and allies in medicine to go beyond these protests and commit to the journey of antiracism and health equity for all.

Yesenia Salazar and Camila Hurtado are medical students.

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