Advancing Antiracist Efforts to Improve an Unequal Health System 

“Evidence shows that racism, especially anti-Black racism, kills.”   

That’s the context for a new opinion piece published in The Boston Globe this week by co-founders of the global health and social justice organization Partners In Heath, Dr. Paul Farmer and Ophelia Dahl, and PIH’s CEO, Dr. Sheila Davis. In the op-ed, the three highlight systemic racism that is pervasive throughout the U.S. health system and make the moral and pragmatic case for eliminating such inequities through race-conscious efforts.  

“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,” they write. “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.”  

Systemic racism kills, “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.” 

Op-Ed Responds to Boston Incident 

The leaders’ op-ed came in response to a recent incident involving two longtime colleagues of PIH: Dr. Michelle Morse, formerly at Brigham & Women’s Hospital and deputy chief medical officer and PIH, and now chief medical officer for the New York City Health Department, and Dr. Bram Wispelwey, an internal medicine and public health doctor at the Brigham and senior technical lead at PIH-US. Both doctors teach at Harvard Medical School, and both have been working with colleagues at the Harvard teaching hospitals to establish greater equity in health care for non-white communities. 

On January 22, a group described in press accounts as “white nationalists” amassed outside the Brigham holding up a bedsheet claiming that “B and W Hospital Kills Whites” and citing Morse and Wispelwey by name on pamphlets they distributed that day.  

The rage among this neo-Nazi group was apparently sparked by research and associated interventions conducted by Morse, Wispelwey, Dr. Regan March, a strategic senior advisor at PIH, and emergency medicine physician and medical director of quality, safety and equity at Brigham and Women's Hospital,  and others over the past years “addressing obvious deficiencies in the American medical system and beyond it,” as the op-ed authors put it. Notably, the doctors were among the authors of a 2019 study that showed that Black and Latinx patients in the emergency department with heart failure were less likely than white patients to be admitted to specialized cardiology units, thereby demonstrating institutional racism in the admitting process. .   

“Black and Latinx patients were less likely to be admitted to cardiology for [heart failure] care,” the study authors concluded. “This inequity may, in part, drive racial inequities in [heart failure] outcomes.” 

The research led to efforts at the Brigham to address this unequal care. In a March 2021 Boston Review piece, titled “An Antiracist Agenda for Medicine,” Morse and Wispelwey proposed a new model of health care informed by critical race theory (CRT), a framework that challenges the conventional wisdom that colorblind civil rights efforts can effectively dismantle structural racism, and called for medical restitution for BIPOC patients who have long been shut out of top-notch care.  “We hope to provide a replicable, CRT-informed framework that can move us beyond the historic cycle of documenting racial inequities while endlessly deferring their resolution,” they wrote. “The outstanding debt from the harm caused by our institutions, and owed to our BIPOC patients, is long overdue: now is the time to start settling it.”  

Morse explained the initiative in an interview with WGBH, a Boston public radio station: “What I'm trying to do is hold the medical industrial complex accountable for the harms that it's caused to communities of color and to other communities and push for racial justice and health equity in all of the institutions that I'm involved in and in partnership with the many communities that I serve. …And I think ultimately in the COVID era, part of what that means is a real serious push to make inequities more visible.”  

Wispelwey added that “racially-blind” methods were not working: “And so we wanted to take a race-explicit approach,” he said in the same news report. “We can't wait until these predominantly white institutions sort of come around...We want to actually make sure our patients are taken care of in the best way possible right now.” 

Of course, the doctors’ work reaches far beyond the walls of any single hospital. Morse is co-founder of Equal Health, a nonprofit dedicated to the pursuit of health equity through critical conciousness and movement building; Wispelwey is a key advisor to PIH-US in its efforts to build an equitable response to COVID-19, with the imperative to protect Black and Brown lives, while strengthening U.S. health and social systems into the future.  

PIH-US's Antiracism Work  

In almost every community PIH supports across the U.S., residents of color make up the majority of the population, and they are often poorer and sicker due to historical and ongoing structural racism. Race-blind approaches to health care and health outcomes have failed them.  

For this reason, PIH-US is working to embed a racial equity lens in all aspects of programming and partnerships and within organizational systems and structures. Since launching in May 2020, PIH-US has strived to challenge systemic racism in the health system, listening and learning from partners so that, together, we can dismantle harmful policies and practices within U.S. health and social systems, while building equity-driven and race-conscious alternatives. Whether working shoulder-to-shoulder to apply locally-driven models for vaccine outreach and distribution, reimagine how the public health workforce is recruited and trained, improve how federal and philanthropic funds flow to front-line community-based organizations, or advancing equity-centered health policies at the federal, state, and local level, PIH-US is committed to a relentless antiracist approach, in order to ensure fair and just access to care and repair generations of harm in the communities we serve.  

As it has for more than 30 years, PIH continues to work explicitly against racism across the globe. In a statement supporting Morse and Wispelwey, PIH leaders reaffirmed that conviction: “White supremacy will not deter the fight for health equity. Displays of racist backlash only confirm we are on the right path towards equity and justice. We stand with our colleagues whose courage helps make our society safer for people of color.”