There’s no time in recent memory when social disparities haven’t been reflected in disparities of risk for disease, delayed diagnosis, poor-quality care, and premature death or disability. In the United States, racism remains a ranking driver of such disparities; those disparities widen as new tools to prevent and treat disease are made available to some and not to others. COVID-19 serves as the latest object lesson in this regard, within this nation and across the globe.
It’s a well-known fact that many forces leading to health disparities, racism among them, are concentrated beyond the walls of medical institutions. Teaching hospitals share three main goals: to care for the sick and injured, to train each generation to provide quality care, and to generate the knowledge to improve care and develop and test therapies that might prevent illness and improve health — and save lives already imperiled. But hospitals like Brigham and Women’s have an important role to play in addressing social pathologies, too.
Partners In Health, a Boston-based charity, has a similar mission, providing medical care to those who might otherwise not receive it. Twenty years ago, hospital and charity joined forces to establish, at the Brigham, a training and research unit called the Division of Global Health Equity. Its residency program in internal medicine and global health equity, accredited by the American Board of Internal Medicine, was the nation’s first and has since been followed by programs in many teaching hospitals and professions, including nursing, surgery, obstetrics and gynecology, pediatrics, and palliative care.
The objective of these efforts is to provide better care to more people, and if much of our research is focused on racism, it’s because over a century of research has shown racism to be implicated in poor health outcomes — within hospitals and outside them, in cities and towns, and in pretty much every county or country in which we’ve done research. Evidence shows that racism, especially anti-Black racism, kills, and not only with bullets: Denial of essential goods and services can also kill. And because we tend to patients of every description, we know that racism ruins our ability to provide excellent care for all, just as its corrosive effects damage our professional communities from within.
It’s in everyone’s interest that clinical medicine, training, and research be antiracist, and this tardy epiphany has spread throughout academic medical centers. So imagine our dismay when we learned that two of our former trainees and current colleagues — Dr. Michelle Morse and Dr. Bram Wispelwey, both graduates of the residency program —were recently singled out by a group of self-described white nationalists who protested in front of the Brigham with a banner claiming “B&W Hospital Kills Whites.” The protesters gathered in front of the entrance to the oldest part of the Brigham, doors through which our colleagues have for years walked in order to see patients, teach students from Harvard Medical School, and make medicine matter to those who need it most. Over the past decade, Morse and Wispelwey, in particular, put heart and soul into addressing deficiencies in the medical system in the United States and medical systems around the world.
A leaflet accused Morse and Wispelwey of being the authors of “preferential health care treatment policies for non-white patients,” putting them “ahead of the line for life-saving treatments despite being entirely less qualified for them.” In their attempts to whip up resentment against what they call “a blatant Anti-White genocidal policy fueled by the same line of thought as Critical Race Theory,” the white-supremacist demonstrators unveiled their values, which could not be farther from ours.
Let’s stop to reflect on what the protesters are contending. What does it mean to be “entirely less qualified” for a “life-saving treatment”? Are some people intrinsically “qualified” to enjoy life, and others “entirely less qualified”? Is health care a right reserved to a self-styled superior race? How could making medical care more widely available be tantamount to a genocide aimed at white people? It’s hard to take such claims seriously. But surely it’s serious when neo-Nazis refer to genocide — and deeply troubling to Morse and Wispelwey, as they’ve told us, and to the community that surrounds them.
Glaring inequalities in health care, which contribute dramatically to shorter lifespans and shockingly higher rates of maternal death among non-white and poor patients, have never looked normal to those patients or the medical professionals who care for them. If medicine were in such short supply that every ventilator, vaccine, or therapy distributed to one person had to be snatched away from another, perhaps there would be a need for debate about such allocations. But in the United States, and in Boston particularly, the means of medical treatment are plentiful. Where we fall down is in distributing these goods to those who need them.
Racism doesn’t kill because of some genetic or biological predisposition rendering Black Americans uniquely susceptible to disease, although this noxious idea remains common, as do assertions of some cultural or behavioral susceptibility. Decades of research have debunked these myths. One study — whose authors included Morse and Wispelwey — triggered soul-searching among Brigham managers and medical staff. It showed that Black and brown patients suffering from heart failure were far less likely than white patients to be referred to specialized cardiology units, suggesting the existence of unconscious race-based gatekeeping. Health disparities are often attributable to institutional and social failures. No one is disadvantaged when such gatekeeping is located, critiqued, and dismantled. Fairness benefits everybody.
That’s good news for the future of medicine and for global health equity in general. Because social pathologies — in this case, anti-Black racism — have social remedies of precisely the sort Morse and Wispelwey have sought to develop, teach, and practice. These remedies have also improved care in Haiti, Rwanda, and other settings. Both Morse and Wispelwey were deeply involved in the Massachusetts COVID-19 response, and Morse was recently named chief medical officer of New York’s Department of Health. They don’t do this work for applause, accolades, or promotions, but because they’re convinced we can collectively make things better for all by focusing attention on the most vulnerable. But neither do they expect scorn, much less violent threats.
Everyone engaged in healing and reparative efforts deserves the full support of the doctors, nurses, researchers, and administrators who make Boston, a medium-sized city, a medical powerhouse. For us to deserve this reputation, we have a lot more work to do. We’d all do well to follow Morse and Wispelwey’s example. And that means we need to practice antiracism in medicine.
Paul Farmer is professor of medicine at Harvard Medical School and chief of the division of global health equity at Brigham and Women’s Hospital. Sheila Davis is CEO of Partners In Health. Ophelia Dahl is chair of the board of Partners In Health.