Brigham and Women’s, a major Boston hospital, will pursue an “An Antiracist Agenda for Medicine,” a pilot initiative to combat alleged “institutional racism” in the public health system. The plan is to provide a race-based health care program that would give preferences to black and Latino people living in five Boston neighborhoods where most of the citizens of these ethnic minorities reside.
According to an article published in the Boston Review by Harvard Medical School professors Bram Wispelwey and Michelle Morse, “institutional racism” is pervasive in the United States, and the health sector suffers from it as well, in the authors’ opinion. Thus, for them, initiatives such as reparations are critical to healing the country’s racist past and, at the same time, provide a kind of historical redress to the people who suffered from it.
For the professors, reparations are important to reduce inequality gaps in the United States, including in the health sector. But these, they argue, would not be enough.
“Federally paid reparations—urgent and long overdue—would help to mitigate racial health inequities (including those seen in COVID-19), but they would not, on their own, end institutional and structural racism.” professors wrote. “We believe we must pursue restitution programs at the institutional level while also advocating for federal reparations.”
Since reparations would fall short of fully mitigating inequities in the public health sector, the professors believe that “antiracist institutional change is essential to supplement federal reparations.”
What does the anti-racist agenda consist of?
“If we are serious about achieving equity—both now and after federal reparations are paid—we must also pursue institutional action,” they noted.
That’s why they created the “HEALING ARC,” or “The Anti-Racist Agenda for Medicine,” which would be charged, in the professors’ words, with granting preferential medical care in the area of cardiology to African American and Latino racial minorities.
“Sensitive to these injustices, we have taken redress in our particular initiative to mean providing precisely what was denied for at least a decade: a preferential admission option for Black and Latinx heart failure patients to our specialty cardiology service,” reads the professors’ article in the Boston Review.
“The Healing ARC will include a flag in our electronic medical record and admissions system suggesting that providers admit Black and Latinx heart failure patients to cardiology, rather than rely on provider discretion or patient self-advocacy to determine whether they should go to cardiology or general medicine. We will be analyzing the approach closely for the first year to see how well it works in generating equitable admissions. If it does, there will be good reason to continue the practice as a proven implementation measure to achieve equity.” they added.
An unsubstantiated “anti-racist agenda for medicine”
To understand where this anti-racist agenda, to be initiated by Brigham and Women’s Hospital next spring, comes from, it is important to note where the “concern” about racial inequities within the health center itself came from.
According to the professors, after analyzing 10 years of data, the hospital’s Latino and black patients suffering from heart failure – one of the most commonly treated diseases at the hospital – and “are more likely than white patients to end up on our general medicine service rather than our cardiology service, where patients have better outcomes.”
However, for how the situation is posed and the need to create an anti-racist agenda, the problem does not appear to be structural or overly serious either. According to their own sources, quoted in the research, “Patients who self-identified as black were 9% less likely to be admitted to specialized units. Patients who self-identified as Latinx, a gender-neutral term describing a person of Latin American origin or descent, were 17% less likely to be admitted to specialized units.”
Another cited source, which covered the same issue about specialized cardiology service and alleged preferences for white people, yielded the following conclusion:
“Theorized drivers of racial inequities in admission service did not reach statistical significance, possibly due to underpowering, the Hawthorne effect, or clinician behavior change based on knowledge of previously identified inequities. The observed trend towards racial differences in coordination of care between ED and outpatient providers, as well as in either actual or perceived self-advocacy by patients, may be as-yet undemonstrated components of structural racism driving HF care inequities.”
The conclusion of one of the reports directly contradicts the professors’ argument.
Basically, some of the studies cited by the professors to support their hypothesis actually reinforce the opposite argument: there is no such thing as institutional racism in public health, beyond the perceptions and opinions that each person may have.
Now, in addition to the fact that the “Anti-Racist Agenda” has some problems with respect to the facts, with much of the data interpreted subjectively, it also has legal issues. In fact, the authors of the article themselves admitted this “little big problem”.
“Offering preferential care based on race or ethnicity may elicit legal challenges from our system of colorblind law,” Professors Wispelwey and Morse wrote in the article and then attempted to justify their proposal in the legal framework.
“But given the ample current evidence that our health, judicial, and other systems already unfairly preference people who are white, we believe—following the ethical framework of Zack and others—that our approach is corrective and therefore mandated. We encourage other institutions to proceed confidently on behalf of equity and racial justice, with backing provided by recent White House executive orders,” they added.
The instructors linked to an executive order signed by President Joe Biden on his first day in office that called for “conducting an equity assessment in federal agencies” and revoked former President Donald Trump’s established 1776 Commission to teach foundational American civics in schools, explained The Federalist. The Biden administration removed the 1776 Report from the White House website, but you can read a copy obtained by The Federalist here.
Despite the argument presented by teachers, constitutionalists disagree. The “Anti-Racist Agenda for Medicine” proposal is illegal and could jeopardize federal funding to the hospital.
According to GianCarlo Canaparo, a senior fellow at The Heritage Foundation, the effort would violate a “number of federal and state laws,” in addition to Title VI of the 1964 Civil Rights Act, which states, “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”
“What’s more, Brigham and Women’s Hospital’s decision to discriminate in providing medical services makes it ineligible to receive federal funding and jeopardizes the federal funding of Harvard Medical School with which it is affiliated,” Canaparo noted.
“For example, the Affordable Care Act (‘Obamacare’) bars any Health and Human Services funding from going to a medical provider that discriminates on the basis of race. Likewise, Title VI of the Civil Rights Act of 1964 bars federal funds from going to any organization that engages in racial discrimination. The hospital also exposes itself and Harvard Medical School to court or federal agency enforcement of the law’s anti-discrimination requirements,” he added.
Recently, a congressional committee voted to create a commission to study and promote the need to approve reparations for black people for slave history. At the same time, the possibility of a national pardon for African-Americans as part of reparations is being discussed.
Clearly, the narrative of systemic racism is permeating American society to the point that even public and private entities are taking their own positions on the issue. In some cases, even though the laws are clear that programs such as Brigham and Women’s Hospital are unconstitutional, institutions are setting the dangerous precedent of violating laws in the name of racial justice.