Dismantling Racism in the Health System: The Time is Now, an Action-Oriented Forum

On Saturday, March 12th, The Health Department’s Center for Health Equity was joined by the Icahn School of Medicine at Mount Sinai (ISMMS), the Institute for Family Health, Doctors for America-NY, White Coats for Black Lives, CUNY School of Public Health and several other organizations to co-host a day-long, action-oriented forum, “Dismantling Racism in the NYC Health System –The Time is Now.” The event marked a historic day for the health community in New York City.

Racial and ethnic disparities in healthcare exist and because they are associated with worse outcomes in many cases, are unacceptable. Having grown up in a community that was either neglected or targeted, I was often skeptical about all the talking we learned to do as medical professionals. After seeing injustice and oppression, I knew that we needed more doers and fewer talkers. I went into my third year of medical school with my eyes open. I witnessed and then became part of many patient stories. It didn’t take long to realize that institutional racism, structural violence and segregated care are alive and kicking, and that our own unconscious and conscious biases must be acknowledged and combated. We cannot perpetuate the seemingly endless cycle of oppression and, if we are to be the voice of those who are so often ignored or unheard, we must find our own voice. Obviously, in the world we are hoping to live in, we will learn to listen to those being ignored and not just become their voice.

I have been involved in a number of social justice initiatives in East Harlem, West Harlem, and the Indo-Caribbean community in Queens, NY, and have been privileged to work with fellow student leaders, community organizers, academic medicine leadership, social workers, teachers, local government officials, public health advocates, faith-based leaders and so many more inspiring individuals in various realms. I was fortunate to join the Doctors for America NY state leadership team in my third year of medical school. In this leadership position, I wanted to work with others to spearhead the formation of a citywide coalition that would have a unified voice on institutional racism. Doctors for America has been instrumental in raising awareness and action on social justice issues, including institutional racism. At the Doctors for America National Leadership Conference in November 2015, key leaders including Dr. Aletha Maybank, Deray McKesson and Jamar Brown spoke candidly on racism in health, and a true dialogue was started in the health community.

I was very familiar with the many dedicated people who were working tirelessly to undo racism in NYC – from student activists at Mount Sinai and other NY schools to faculty members at academic medical centers to community leaders advocating on a daily basis for basic human rights for all. I felt that too many people were doing extraordinary, emotionally and physically exhausting, herculean work in isolated silos. So, with lots of idealism and hope, our Doctors for America-NY team attempted to bring various stakeholders together.

On November 18th, 2015, representatives from a number of NYC institutions and organizations were able to sit together and make a commitment to dismantle institutional racism within the NYC health system. Over the past several months, we have met frequently to continue conversations and strategize for our upcoming work together. It is clear that individuals are ready to remove themselves from silos and unite their voices and hearts to combat racism. The citywide forum that we planned together was just the starting point of what promises to be sustainable, meaningful and collaborative work. We are so grateful that this work is supported by the NYC Department of Health under the leadership of both Dr. Aletha Maybank and our Commissioner of Health, Dr. Mary T. Bassett.

It has taken over 500 years to construct racism as a dominant, prevailing narrative – one that leads to inequities in health that are unfair and avoidable. It will take all of us to undo racism. This shared vision is larger than any one person, institution or organization.

We have created working groups in an effort to capitalize on the expertise of those in our coalition working in these areas, have smaller teams with actionable goals and commit to tackling a number of important issues at the same time. Creating a sustainable coalition of doers with a shared goal and united voice is our top priority. The forum was successful in setting the stage and bringing light to key areas within the realm of racism. The working groups are: Education & Curriculum Development, Health Policy & Legislation, Research, Access to Care, Representation in the Health Field, Intersectionality, Narrative Healing and Community Engagement & Advocacy.

Members of the coalition include: Center for Multicultural & Community Affairs, Icahn School of Medicine at Mount Sinai, Medical Education Department, Icahn School of Medicine at Mount Sinai, Committee of Interns and Residents / SEIU Healthcare, Department of Family & Social Medicine, Montefiore-Einstein, Doctors Council, Doctors for America-NY, Institute for Family Health, Latino Medical Students Organization, National Medical Association, Empire State Medical Association, Manhattan Central Medical Society, National Physicians Alliance-NY, New York City Department of Health’s Center for Health Equity, Physicians for a National Health Program – NY Metro Chapter, Student National Medical Association, White Coats for Black Lives, the Doctors Council, The National Medical Association, People’s Institute of Survival and Beyond-NY, SEIU, and Commission on the Public’s Health System (CPHS). You can view the NYC DOHMH press release here.

If you are interested in getting involved or holding a similar forum in your area, please contact [email protected].

Read on for an overview of the content of the forum:

Raising Awareness and Getting on the Same Page

Associate Commissioner of the NYC Department of Health and Director of the Center for Health Equity, Dr. Aletha Maybank, and Chair of SEIU Healthcare, Dr. Toni Lewis, chaired the program. Kamini Doobay, fourth year medical student at ISMMS and DFA-NY co-leader, shared the story behind the formation of the coalition and gave an overview of its goals and objectives. Dr. Ayman A.E. El-Mohandes, internationally renowned public health leader and Dean of the CUNY School of Public Health, welcomed participants to the CUNY Graduate Center and urged participants to fully engage and experience the energy and passion in the room: “Something is about to happen.”

NYC Health Commissioner Mary T. Bassett delivered the first keynote presentation on “Race, Racism and Public Health.” She delved deep into NYC’s racialized pattern of health, referencing studies she published in 1986 and beyond.  Commissioner Bassett dismissed claims that lifestyle choices allow for widely disparate outcomes.

“I don’t think anyone decides, ‘I want to live in a neighborhood with really bad housing, or poor air quality,’” she said. “Nobody says, ‘I really prefer a neighborhood where there is only fast food available.’ … These are not personal choices. These are a lack of choice.”

In addition to substantiating her claims with past and current data, Dr. Bassett told provocative, emotionally stirring stories from her childhood and her days working in the Black Panther Party’s free medical clinic in Boston. Her presentation was compelling, informative and awe-inspiring.

Dr. Neil Calman, Chair of Mount Sinai’s Department of Family Medicine and Community Health and CEO of Instiute for Family Health, then delivered a talk on medical apartheid in NYC hospitals.

“We don’t have signs that say ‘colored’ anymore, but we’ve found more subtle ways to create racism in our health care system,” he stated. He showed data that revealed that the US population whitens with age due to the premature death of people of color.

Dr. Calman also reported that enormous profits are being made by some of the institutions in NYC with the lowest numbers of uninsured patients and those on Medicaid. He proposed a “tax” on those profits to help to subsidize the care for the uninsured and those on Medicaid whose care is being provided largely by the public hospital system. A long time advocate for eliminating racial and ethnic disparities in the health care and health outcomes, he is known for his truth-telling and this forum was no exception. He was bold, transparent and moving.

Next up was an abbreviated form of the People’s Institute for Survival and Beyond’s Undoing Racism Workshop (URW). With an interactive workshop, Diana Dunn, Milta Vega-Cardona, Candida Brooks-Harrison and Christiana Best, challenged participants to analyze structures of power and privilege that hinder equity within the health system. They provided history that allowed us to understand how racism was consciously and systematically erected, and how it can be dismantled if people understand what it is, how it functions and why it is perpetuated.

After the URW, emotions and energy were high. Participants formed smaller groups and reflected on what they were thinking and feeling after the morning’s sessions. Together, they explored their emotions and continued to create a safe space to engage and strategize.

Translating Awareness into Action

How do we use our knowledge to create action? That was the theme of the afternoon.

Dr. Camara P. Jones, President of the American Public Health Association and Senior Fellow at the Satcher Health Leadership Institute and the Cardiovascular Research Institute, Morehouse School of Medicine, delivered the second keynote presentation on, “Achieving Health Equity: Tools for a National Campaign against Racism.” Her talk rejuvenated the spirits of everyone in the room and served as a call to action.

Dr. Jones’ lifelong passion has been naming and addressing the impacts of racism on the health of our nation, and she has developed allegories that enable us to understand the many layers and nuances of institutionalized, personally-mediated and internalized racism. She shared her allegory, “A Gardener’s Tale,” in the jam-packed room filled with participants who were in awe of her passion, brilliance and vision.

The strategy and action panel was next up.  In addition to collectively raising awareness of how racism affects health, the forum was the official kickoff of the coalition’s working groups. Leaders in the fields of each of the working group areas were invited to speak on work they have done and what they envision as actionable goals for the working groups. The following speakers were dynamic, engaging, and informative:

  • Education and Curriculum Development: Sharon Washington , Ed.D., MPH

  • Health Policy and Legislation: Assembly Member Richard Gottfried

  • Access to Care: Neil Calman, MD

  • Community Engagement: Anthony Feliciano

  • Research: B. Cameron Webb, MD, JD

  • Intersectionality: Elizabeth Lorde-Rollins, MD, MSc

  • Narrative Healing: Alan Pean & Adjoa Duker, MD, MPH

  • Representation in the Health Field: Adam Aponte, MD

Kamini Doobay then delivered concluding remarks. She urged participants to commit to undoing racism in the health system together. “There is so much energy, passion and fire in this room. This shared goal is larger than any one of us, and now is the time for us to join together and have a unified voice – for the sake of our patients, communities, society and generations to come.” She ended with proposed next steps.

We thank our champion sponsors, the Department of Medical Education at Icahn School of Medicine at Mt. Sinai, NYC DOHMH’s Center for Health Equity, and the CUNY Graduate School of Public Health, and all of the other sponsoring organizations.

Kamini Doobay is a medical student co-leader of DFA-NY, who facilitated the formation of the coalition and is the liaison between member organizations.