It’s Time to Challenge Race-Based Medicine

Monica Hahn, MD, MPH, MS, AAHIVS, CAFP’s 2021 Educator of the Year

As you may be aware, a national movement to challenge structural racism in medicine is gaining momentum. At my home institution, SF General Hospital, race-based eGFR reporting was eliminated in 2019. In 2020, following a successful petition effort, we were able to abolish racebased eGFR reporting at affiliated UCSF laboratories and medical centers. Many other institutions have since followed suit. Today I’d like to answer some of the many questions my colleagues and I have received from physicians all over the country about pushing for systems change at their own institutions by sharing some invaluable resources.

First and foremost, I’m proud to share a valuable resource: the Institute for Healing and Justice in Medicine (IHJM): https://www.instituteforhealingandjustice.org/, an advocacy epicenter and dialogue space centered on uplifting social justice and community activism in medicine and public health.

UCSF student co-founders of the IHJM published a 50-page report, “Towards the Abolition of Biological Race in Medicine Transforming Clinical Education, Research, and Practice”, documenting history of the various manifestations of structural racism in healthcare lurking in our commonplace clinical algorithms and calculators. The IHJM was launched in May of 2020 in response to the growing attention to the many flawed uses of race-based medicine that were coming to light, and was elevated by the publication of this report. I am proud to be a co-founder of IHJM with these health justice colleagues and advocates.

IHJM’s mission centers around publishing and uplifting perspectives (narratives, experiences, research, and other works) related to healing, social justice, and community activism in Western medicine and public health. IHJM fosters a space for vibrant dialogue and debate, consciousnessraising, and movement building, seeking to sharpen our collective analysis and develop methods to critique structures of power in medicine through community scholarship and solidarity.

Institute for Healing and Justice in Medicine fosters a space for vibrant dialogue and debate, consciousnessraising, and movement building, seeking to sharpen our collective analysis and develop methods to critique structures of power in medicine through community scholarship and solidarity.

Through IHJM’s movement building efforts, we have held multiple teach-ins and conference speaking events, we have launched several national petitions to abolish race-based eGFR, we have created a crowd-sourced eGFR advocacy toolkit to help catalyze institutions across the nation to eliminate race-correction from eGFR. IHJM is currently hosting multiple interdisciplinary national working groups that are aimed at dismantling structural racism in medicine. Our national working groups have now expanded to include eGFR, ASCVD, PFTs, and reproductive health. Over 300 people have signed up to participate in our working groups, and we are always accepting more members to join.

We are also in the process of building a Health Justice Library and Repository. We aim to bridge, share, and amplify all existing work and activism related to social justice and community activism in medicine and public health. This includes advocacy by community and members and students including but not limited to syllabi, Op-Eds, theses, and more. We also aim to host regular regional gatherings with leaders to facilitate connection and community. We definitely encourage you to check it out on our website, and reach out to us if you have your own resources to share with our community.

I see CAFP and AAFP as organizations that are really positioning family physician advocates at the forefront as leaders in advancing racial equity in family medicine...

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CAFP passed a resolution last spring to reject the use of flawed notions of race-based medicine and shortly after, AAFP’s congress of delegates upheld a policy officially opposing the use of race as a proxy for biology or genetics (July 2020 AAFP policy: https://www.aafp.org/about/policies/all/ racebased-medicine.html) It has been very encouraging to see the progress that has been made challenging structural racism in medicine over the past few years. I see CAFP and AAFP as organizations that are really positioning family physician advocates at the forefront as leaders in advancing racial equity in family medicine and I’m proud to be one of many family physicians championing this cause.

RESOURCES

So many additional resources are available to learn more about this important topic. Below are some I recommend.

PRESENTATIONS:

AAFP CME panel on understanding racism in healthcare: Racism in Healthcare: Understanding https://www.aafp.org/cme/all/ online/racism-in-healthcare-understanding.html

CAFP Clinical Forum health equity track sessions (links to these activities in Homeroom are listed in this Campus News)

National AIDS Education & Training Center on the role of structural racism in health inequities in COVID and HIV: New Pandemic, Old Inequities: Impacts of COVID-19 and HIV on Marginalized Populations - https://aidsetc.org/resource/newpandemic-old-inequities-impacts-covid-19-and-hiv-marginalizedpopulations

PUBLICATIONS:

• Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms - https://www.nejm.org/doi/ full/10.1056/NEJMms2004740

• On Racism: A New Standard For Publishing On Racial Health Inequities - https://www.healthaffairs.org/do/10.1377/ hblog20200630.939347/full/

• How Structural Racism Works — Racist Policies as a Root Cause of US Racial Health Inequities | NEJM - https://www.nejm.org/ doi/10.1056/NEJMms2025396

• Levels of racism: a theoretic framework and a gardener's tale - https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.90.8.1212

• Precision in GFR Reporting | American Society of Nephrology - https://cjasn.asnjournals.org/content/15/8/1201