Confronting Racial Injustice
A Multipart Series
Events in 2020—the coronavirus pandemic and the Black Lives Matter protests sparked by the death of George Floyd and others at the hands of police—have underscored the troubling history of racism and health disparities in the United States. In a July 14 Health and Science section devoted to racism as a public health crisis, The Washington Post quoted a New England Journal of Medicine editorial: “Slavery has produced a legacy of racism, injustice and brutality that runs from 1619 to the present, and that legacy infects medicine as it does all social institutions.”
During the virtual AACP Annual Meeting in July, Dr. Dayna Bowen Matthew, dean, George Washington University School of Law, addressed these issues in the Opening General Session. She discussed how the pandemic has revealed America’s structural inequality; the implicit bias in American healthcare and how that affects minority patients; structural racism that leads to disproportionate impacts on minority populations; and the need to train pharmacists to change the culture and improve research on the social determinants of health. The Centers for Disease Control and Prevention notes that social determinants of health have historically prevented racial and ethnic minority groups from having fair opportunities for economic, physical and emotional health.
In 2017, the National Academy of Medicine published Perspectives on Health Equity and Social Determinants of Health, in which the authors recommended additional research on the multiple effects of structural racism and implicit and explicit bias on health and healthcare delivery. The authors noted, “Martin Luther King Jr. said, ‘Injustice anywhere is a threat to justice everywhere.’ Translated to health, this means that when injustice is unchallenged, including the injustice of health disparities anywhere, society exposes its shared sense of community and nationhood to imminent risk of corrosion. These realities underscore the importance of the Academies’ report…[which] clearly outlines that health inequities are in large part a result of poverty, structural racism and discrimination, and that disparities based on race and ethnicity are the most persistent and difficult to address.”
While pharmacy has made some progress in trying to attract a diverse workforce, there is still work to be done. According to the 2019 National Pharmacist Workforce Study, 78 percent of licensed pharmacists are white; Black pharmacists represent only 4.9 percent of the profession. The study concluded that “…the racial diversity of licensed pharmacists continues to underrepresent the racial diversity of the general population in the United States.”
For this two-part feature, Academic Pharmacy Now spoke with pharmacy deans, faculty and staff to get their perspectives on what the Academy can and should be doing to address racial injustice and how pharmacy schools can take action in practice and within their communities.
Getting to the Root of Racism
This summer, AACP joined the National Pharmaceutical Association (NPhA) and other pharmacy organizations in releasing a statement to take a stand against racial injustice. Dr. Lakesha Butler, clinical professor, director of diversity, equity and inclusion, Southern Illinois University Edwardsville (SIUE) School of Pharmacy, and NPhA president, said the organization wants to be a resource for understanding and helping to address racism. “NPhA is primarily made up of Black pharmacists and other underrepresented minorities who have faced racism in their daily lives. We have provided anti-racism resources on our organization’s website and we are also hosting a three-part racial inequity webinar series about why are we here (the historical context), social determinants of health and the sharing of strategies specifically in healthcare to address racial injustice,” Butler said. “I am working with other national pharmacy organizations to develop strategies on how we can look at things from an organizational perspective. Does your organization reflect the types of individuals you want to attract? We want to call out something that has been part of our country for centuries. Oftentimes it’s been the norm to focus on racial disparities but not really delve into why those disparities exist. There is this idea that Blacks are at higher risk for certain disease states because of their lifestyle, but ultimately the most likely reason for those disparities is systemic racism. We have had over 300 years in which it was legal to discriminate against Blacks in this country. There was a shift that started the Civil Rights Act but those hundreds of years still manifest today in a variety of ways. For example, there are manifestations of redlining, with education and with resources, resulting in limited access to healthcare. We have to dig deep into our country’s history to understand why these disparities are happening and persist.”
Butler sees race as a social construct and said pharmacy schools need to move beyond that in the curriculum. “There is a gap right now in addressing the root cause of these health inequities. We’ve typically not discussed those things,” she pointed out. “The topic of racism tends to stir up feelings of defensiveness and discomfort. However, racism is structural and systemic. It’s in the very foundation of our country. It’s easy to overlook because if we don’t know what we’re looking for, we don’t know what to look for and address.”