Reflecting on systemic racism in medicine 20 years after the publication of the “Unequal treatment” report

We already know that the COVID pandemic has exacerbated health inequalities, from infection and vaccination rates to deaths. People in Massachusetts from marginalized backgrounds have been hit harder, which comes as no surprise to many in health care fields.

The impact of systemic racism in medicine was highlighted 20 years ago in the Unequal Treatment Report, published by the National Academy of Medicine, formerly known as the Institute of Medicine.

Dr. Joseph Betancourt was one of the doctors who worked on this report. He is now senior vice president for equity and community health at Massachusetts General Hospital. He joined morning edition host Rupa Shenoy to talk about the progress, or lack thereof, in addressing health disparities over the past 20 years.

The highlights of this interview have been lightly edited for clarity.

Interview Highlights:

On what the report said and the reaction when it was released:

“Inequality of treatment was a milestone in our work on health care disparities. After researching this topic for almost two years, we found that there were differences in the way people are treated within the healthcare system based on their ethnicity across the country for different conditions, regardless of whether individuals were sicker or poorer I think the real contribution of unequal treatment was really looking at specifically disparities in health care.

“The initial reaction was shock and outrage from upset people, especially in the healthcare professions, where we pride ourselves on our dedication to treating everyone to the best of our abilities. The ‘not me’ phenomenon has was very powerful. But over time, the evidence was so overwhelming that we, as a health care community that based all of our work on evidence, began to see that, yes, it was real and that we had to pay attention to it.”

On the lack of progress in addressing the report’s findings:

“We presented a fairly broad and comprehensive blueprint of findings and recommendations. In the area of ​​disparities, we saw early adopters, progressive leaders taking action. But fundamentally, the real changes we needed to see did not happen. large scale products even to today.

“Progress is happening at different rates in different places. So we have some states that have done better, and we’re lucky that Massachusetts has done better in that area. That being said, I think the pandemic has given us really caught up in a place where we hadn’t pulled out all the stops from an emergency preparedness disparity perspective I think the pandemic is an example, both nationally and locally, of the delay in not having these systems ready. And what we are seeing are higher rates of morbidity and mortality among minority populations as a result of the pandemic.”

On what is missing in our fight to achieve health equity:

“What we haven’t had are two things that are really essential here: a regulatory framework that really obliges hospitals and health centers to fully integrate equity into equality. And also financial mechanisms to both spur action and discourage disparities. I think that’s what And we hope to make that happen. We hope that the past two years have taught us lessons and reanimated the playbook we established there 20 years for these actions and for lasting change.

“There is not a single suspect and there is not a single solution, as is the case with many complex problems. There is a whole series of things that we had to address, certainly increasing the awareness of the problem, doing better around collecting data to understand how we are performing and developing interventions to address it, and increasing the diversity of our care teams It’s a large portfolio, but it’s all very We’ve done it in other areas and we certainly could do it in the space of equity and disparities.

“I’m hopeful. At the end of the day, we’re not short of great solutions to address disparities and achieve equity. I think what we really need now is sustained action to to embed all of these wonderful strategies in the way we deliver healthcare that will require integration techniques to have funded and regulated this work so that we can all live our mission, vision and values ​​of high quality care for all .”

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