AMA recognizes racism as a threat to public health

On November 16th, 2020, the American Medical Association has officially defined racism as a public health threat that has created substantial health inequality.

Racism, both systemic and structural, has historically perpetuated health inequality and cut short the lives of many black, indigenous, and people of color in the US and around the world.

Over the last year, a number of county and state authorities have also labelled racism a public health threat.

Among them are county councils in San Bernardino, California, and Montgomery, Maryland, as well as authorities in Michigan, Nevada, Cleveland, Denver, and Indianapolis.

“The AMA recognizes that racism negatively impacts and exacerbates health inequities among historically marginalized communities. Without systemic and structural-level change, health inequities will continue to exist, and the overall health of the nation will suffer,” said AMA Board Member Willarda V. Edwards, MD, MBA.

“As physicians and leaders in medicine, we are committed to optimal health for all, and are working to ensure all people and communities reach their full health potential,” Dr. Edwards said. “Declaring racism as an urgent public health threat is a step in the right direction toward advancing equity in medicine and public health, while creating pathways for truth, healing, and reconciliation.”

To that end, the AMA House of Delegates (HOD) adopted new policy to:

  • Acknowledge that, although the primary drivers of racial health inequity are systemic and structural racism, racism and unconscious bias within medical research and health care delivery have caused and continue to cause harm to marginalized communities and society as a whole.

  • Recognize racism, in its systemic, cultural, interpersonal and other forms, as a serious threat to public health, to the advancement of health equity and a barrier to appropriate medical care.

  • Support the development of policy to combat racism and its effects.

  • Encourage governmental agencies and nongovernmental organizations to increase funding for research into the epidemiology of risks and damages related to racism and how to prevent or repair them.

  • Encourage the development, implementation and evaluation of undergraduate, graduate and continuing medical education programs and curricula that engender greater understanding of the causes, influences, and effects of systemic, cultural, institutional and interpersonal racism, as well as how to prevent and ameliorate the health effects of racism.

Delegates also directed the AMA to:

  • Identify a set of current best practices for health care institutions, physician practices and academic medical centers to recognize, address and mitigate the effects of racism on patients, providers, international medical graduates, and populations.

  • Work to prevent and combat the influences of racism and bias in innovative health technologies.

Recognizing race as social construct

In an additional move to promote anti-racist practices, the AMA discussed the use of race as a proxy for ancestry, genetics and biology in medical research and health care delivery. Delegates adopted new policy to:

  • Recognize that race is a social construct and is distinct from ethnicity, genetic ancestry or biology.

  • Support ending the practice of using race as a proxy for biology or genetics in medical education, research and clinical practice.

The AMA also will encourage undergraduate medical education, graduate medical education and continuing medical education programs to recognize the harmful effects of presenting race as biology in medical education and that they work to mitigate these effects through curriculum change that:

  • Demonstrates how the category of “race” can influence health outcomes.

  • Supports race as a social construct and not a biological determinant.

  • Presents race within a socioecological model of individual, community and society to explain how racism and systemic oppression result in racial health disparities.

Delegates also directed the AMA to “recommend that clinicians and researchers focus on genetics and biology, the experience of racism, and social determinants of health—and not race—when describing risk factors for disease.”