The March Against the White Race Continues (Healthcare Edition)

 Bram  Wispelwey (right)

In an essay in the Boston Review, titled An Antiracist Agenda for Medicine, Bram Wispelwey and Michelle Morse write:

We are experienced physicians...

Implicit bias training and checklists offer indirect solutions where more direct forms of race-explicit action are available; the objectivity aspired to in clinical criteria is also inevitably tainted by the pervasiveness of structural racism. What we need instead, we have come to believe, is a proactively antiracist agenda for medicine.

Our path to this realization, as with nearly all advancements in social medicine, took us outside our discipline—through the field of critical race theory (CRT), in particular. This body of scholarship emerged thirty years ago when a group of legal scholars challenged the conventional wisdom that colorblind civil rights efforts could effectively dismantle structural racism. “The general use of so-called neutral standards to continue exclusionary practices,” Harvard law professor Derrick Bell argued in 1992, “reduces the effectiveness of traditional civil rights laws, while rendering discriminatory actions more oppressive than ever.” After more than five decades of colorblind law, the phenomenon Bell described has only worsened, and the stubborn persistence of racial inequities—both in health care and across society at large—gives the lie to the effectiveness of colorblind policies. Yet such solutions remain the go-to response, restricting the range of tools at our disposal for making desperately needed change and even inviting charges by prominent physicians that speaking of racism is counterproductive.

Recognizing this problem, public health scholars Chandra Ford and Collins Airhihenbuwa brought CRT’s legal approach to the public health realm in 2010 with their landmark proposal of a Public Health Critical Race Framework. Following their lead, we have sought to implement that framework in our own advocacy and clinical work on equitable heart failure admissions. Together with a coalition of fellow practitioners and hospital leaders, we have developed what we hope will be a replicable pilot program for direct redress of many racial health care inequities—one that takes seriously the limitations of colorblind solutions and empowers institutions in variety of contexts to take decisive action to achieve racial equity.

Building on calls for reparations, we call this a vision for medical restitution. 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. We believe we must pursue restitution programs at the institutional level while also advocating for federal reparations...

[W]e believe antiracist institutional change is essential to supplement federal reparations. If we are serious about achieving equity—both now and after federal reparations are paid—we must also pursue institutional action. Crucial to this work is a pragmatic orientation to what philosopher Naomi Zack calls “applicative justice”—“applying justice to those who don’t now receive it”—as opposed to more idealistic conceptions of justice, whether derived from John Rawls or John Locke, on which some arguments for reparations are based.

This is exactly what we have tried to achieve in the design our new pilot initiative at Brigham and Women’s Hospital set to launch later this spring. Adapting Darity’s reparations framework of acknowledgment, redress, and closure (ARC) to an institutional level, we have designed a program—we call it a Healing ARC—with initiatives for all three components. Each centers Black and Latinx patients and community members: those most impacted by unjust heart failure management and under whose direction appropriate restitution can begin to take shape...

[W]e 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. 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.

Offering preferential care based on race or ethnicity may elicit legal challenges from our system of colorblind law. 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.

Critical Race Theory is a takers theory based on the absurd idea that handouts should be provided to "people of color," primarily blacks, at the expense of whites. The hidden implication is that the white race will continue to provide goods and services that would be taken from them in large quabtities without a breaking point.

Thus, the theory is, of course, nothing but a high-level power play that will do nothing but advance the destruction of Western Civilization.

This could get very ugly but, at the length, the truth will out.

Here is what I said about the truth will out in 2017 (9 minutes 15 seconds):

 

 -RW