这些“具体步骤”可能有助于打击医疗保健领域的种族主义

Doctors, hospitals and medical schools should take specific actions to fight the structural racism that threatens the health of millions of Americans, 根据一份旨在帮助指导医疗机构的新报告.

Among the recommendations, which are part of the 2020 美国心脏协会 and American College of Cardiology Consensus Conference on Professionalism and Ethics report:

– Medical schools should require first-year students to take a course on social justice, race and racism, 受训人员应该花线上电子游戏飞禽走兽沉浸在他们所服务的社区中.

– Education about national, local and institutional history related to race and racism should be a part of medical school curriculums and continuing education programs.

– Health care entities should conduct annual reviews that ask, "How is racism operating here?"

It's all part of a broader report, published simultaneously Tuesday in the AHA's journal Circulation and in the Journal of the American College of Cardiology. The report offers guidance for medical schools, physicians and other health care professionals.

It follows statements from several professional societies and the Centers for Disease Control and Prevention that acknowledge how racism threatens public health. 但该报告不仅仅是指出了这个问题. Camara P. 他是社会正义和种族主义部分的合著者.

"These are concrete action steps that can equip people who are trying to move to action to know what we do first," said Jones, a family physician, 流行病学家和前美国公共卫生协会主席.

Most aspects of a person's health are determined by factors outside of a health care setting, she said. 我们的健康是由我们的生活条件——学校教育——创造的, and by housing, 以及获取新鲜水果和蔬菜的途径, 生活在一个干净的环境中, and by income and wealth.“在美国，种族主义严重影响了所有这些情况.

Dr. Willie E. Lawrence Jr., 一位心脏病专家，也是撰写这些建议的工作组的联合主席, 他说，解决种族主义问题对解决各种健康问题至关重要, 比如高血压.

"If it is your goal as a medical institution to train physicians to provide better care to a broad range of people, then one of the things that you have to recognize is that it's not just what you learn in your pharmacology class that's going to lead to better management of hypertension," said Lawrence, 密歇根州Spectrum health健康公平医疗总监.

琼斯列举的这些因素, 被称为健康的社会决定因素, "may have a bigger impact on whether you get that patient's blood pressure controlled, 你是否真的让病人吃了药."

建立社区是对抗种族主义的基石之一, Jones said, which is why getting medical trainees to do home visits or work in community settings is essential.

Lawrence agreed, saying doctors need to know how to reach patients where they are. That applies to medical professionals of all backgrounds, and he used himself as an example.

Lawrence, who was raised mostly in a single-parent home on the east side of Cleveland before attending Harvard University and training at Johns Hopkins Hospital, said it can be easy for any well-off doctor to overlook the challenges of being poor, when something as simple as a $4 co-pay for a medication can put it out of reach.

可能存在“某种假设，因为我是黑人, 我能自动理解我可怜的黑人病人," he said. “嗯，这并不一定是一个安全的假设. 因为事实上，有些东西我在医学院从来没学过."

他不知道这件臭名昭著的事 Tuskegee syphilis study 直到他长大成人, for example, 从来没有人教过他歧视亚裔美国人的历史.

他说，对这些事情的了解“让我们更有同情心”. 我认为这让我们成为更好的医生."

这就是我们的想法，琼斯说.

报告的建议是要求学生上历史课, she said, came out of work she did recently that proved to be "revelatory" for the schools and hospital systems that took part. For the participants, 了解他们工作场所的历史——地点是如何选择的, 谁不能作为病人, or who was or wasn't allowed as physicians – "opened their eyes" to how racism works.

她和劳伦斯承认前方的挑战.

“我认为种族是一个很难谈论的话题，”劳伦斯说. “如果你想让房间安静下来, 你走进来，开始谈论一些与种族有关的问题. It's uncomfortable."

但他说，这些建议并不激进. 它们将对医学院的课程产生“重大影响”. But at their core, they want to foster the idea of allyship – working in partnership with people who are enduring structural racism or other systemic discrimination – and a greater understanding of patients.

“它们并不是真正崇高的目标，”他说. “它们是与实现卫生公平相关的基本目标."

To succeed, Jones said, it will require support from and training for all levels of the medical establishment. "Because we certainly don't want the next generation to grow up still ill-equipped to deal with these broader issues" or to lack the understanding that anti-racism is a core part of their work as physicians.

"So what I'm saying is, we are all planting seeds" that eventually will bear fruit within the world of health care and throughout society, she said. “这并不是故事的结局. This is the beginning."

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