Race and Medicine

Race and Medicine

Disclosures: Doubeni reports no relevant financial disclosures.
March 05, 2021
4 min read
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Task force calls on health care community to join forces in addressing systemic racism

Disclosures: Doubeni reports no relevant financial disclosures.
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Recommendations from the U.S. Preventive Services Task Force aim to prevent premature deaths among all Americans — equally.

However, data show that the potential life-saving benefits of many clinical preventive services are not equitably available to all people, specifically Black, Hispanic and Indigenous individuals, according to a viewpoint published in JAMA. For instance, in its 2020 systematic review to form colorectal cancer screening recommendations, the task force found “consistent evidence of inequalities” in access to and quality of screening and treatment.

Chyke A. Doubeni, MD, MPH, a family physician and inaugural director of the Mayo Clinic Center for Health Equity and Community Engagement Research.

In the viewpoint, USPSTF committed to advancing methods to better identify when systemic racism contributes to health inequities and to provide evidence-based strategies to overcome the effects of these inequities on preventable disease.

To achieve these goals, the task force stated it will:

  • consider race primarily as a social, and not a biological, construct, using consistent terminology to reflect this view;
  • promote racial and ethnic diversity in addition to gender, geographic and disciplinary diversity in task force membership and leadership, and foster a culture of diversity and inclusivity, which will be assessed annually;
  • commission a review of the evidence, including an environmental scan and interviews with clinicians, researchers, community leaders, policy experts, other guideline developers and disproportionately affected patient groups to summarize the evidence on how systemic racism undermines the benefits of evidence-based clinical preventive services and causes preventable deaths — to be completed by June;
  • update USPSTF methods to integrate the best evidence and consistently address evidence gaps for Black, Hispanic and Indigenous populations;
  • use a consistent and transparent approach to communicate gaps in the evidence related to systemic racism in preventive care in the task force’s recommendation statements and annual report to Congress; and
  • collaborate with other guideline-making bodies, professional societies, policymakers and patient advocacy organizations on efforts to reduce the influence of systemic racism on health.

“The COVID-19 pandemic has provided the opportunity to bring systemic racism to the forefront of health care and we now have the opportunity to address this significant issue on a national level,” Chyke A. Doubeni, MD, MPH, a family physician and inaugural director of the Mayo Clinic Center for Health Equity and Community Engagement Research, said during an interview with Healio. “As we each figure out our own role in this, we must join forces to address systemic racism in health care. We need partnership to make this effort a reality and we are calling on everyone to join us to help realize the outcomes of these efforts to end racism and its impact on the delivery of preventive services for the entire U.S. population.”

Doubeni spoke with Healio about what prompted this viewpoint, what makes this topic so relevant today and key guidance recommended by USPSTF to help overcome systemic racism in health care for all Americans.

Healio: What prompted the writing of this viewpoint?

Doubeni: The issues surrounding racism, social injustice and health inequities have been present for centuries. The COVID-19 pandemic has brought to light many of these issues, making it a national priority. Although the task force has dealt with issues surrounding inequities in our recommendations before, we see this as an opportunity to refocus on the issue. This is a moment for us to take advantage of and address some of the issues of systemic racism.

Healio: In what ways has systemic racism manifested in health care?

Doubeni: Racism self-manifests in many ways, which is why it is labeled systemic. When it comes to health care, the effects of racism unfortunately manifest in many ways by affecting people’s risk for and outcomes of health conditions. In addition, it affects the quality of care an individual receives. Racism affects each step in the continuum of care in a patient’s journey from when they may seek care to when they receive care.

Not surprisingly, many of the racial groups who experience racism in society in general also experience racism in health care. For example, many Black individuals have some of the highest risks for many preventable conditions because of social circumstances and restricted access to health care and prevention services. Blacks also receive poorer quality of care, which is a serious issue. All of this is avoidable and is a very important area in medicine and, given the congressional mandate, it is important for the task force to address systemic racism in an effective and intentional way.

When it comes to cancer care, systemic racism occurs in very similar ways as we see it occur in other health conditions and it is known to affect cancer outcomes. There are known disparities in certain cancer types, such as colorectal and lung cancers. Access to and quality of screening are affected. Consequently, racial/ethnic minorities do not receive a timely diagnostic workup and treatments are suggested to be of lower quality.

The pattern plays out across a laundry list of conditions, particularly those that are preventable and appear in the portfolio of the USPSTF.

Healio: What key guidance does USPSTF recommend in this area?

Doubeni: Our key recommendation is to ensure that every individual receives equitable access to clinical preventive services. The USPSTF has been authorized by Congress to make clinical services recommendations, and one area of impetus is the prevention of cancer and the associated deaths due to cancer to improve the health of all Americans. We must ensure that the recommendations we make are based upon the best available data and evidence. Also, and very importantly, delivery of these services must be done in an equitable way, irrespective of someone’s racial background. In the context of racism, being a Black, Hispanic or Indigenous person should not be a reason that a person receives less access to clinical preventive services, including screening and diagnostic workups.

Healio: What outcomes do you hope come of this guidance?

Doubeni: Our hope is that as we address the issues of racism in this country, we get to the point of health equity. Specifically, regarding cancer care disparities, we want to eliminate avoidable differences in the outcomes of cancer. We address a fairly broad number of areas in our guidance, but they are all directed at ensuring that we have the needed evidence and that more research is done for the populations at higher risk. We address the need to ensure that decision-making around cancer care delivery and recommendations are inclusive of the groups most affected by systemic racism. In the end, we are calling on everyone to join forces with us because recommendations of the USPSTF are just one slice of the approach needed. There is a wider societal issue that demands all our attention. We must join together to be successful in combating systemic racism in health care.

Healio: What ongoing efforts are needed?

Doubeni: There are several. The USPSTF will work toward changing our review methods, ensuring there is diversity and broad perspectives in our reviews of the literature. We will also continue to address and communicate the importance of addressing issues of systemic racism and inequities in health care.

There is also a great need for the clinical research that informs our recommendations to be more inclusive of minority populations affected. This all needs to happen now.

For more information:

Chyke A. Doubeni, MD, MPH, can be reached at doubeni.chyke@mayo.edu.