The Plenary Session opened with the presentation of the 2018 Don Bloch award to John Rolland, a psychiatrist and creator of the Families, Systems, and Illness model. John is a Wingspread Conference legacy member and prolific writer on family-oriented approaches to healthcare. He and his lovely wife Froma Walsh are the co-founders and co-directors of the Chicago Center for Family Health over the past 27 years. It is hard to imagine of someone in the field that is more deserving of the award than Dr. John Rolland.
The session continued with a powerhouse presentation by Dayna Matthew, JD, PhD, Distinguished Professor of Law at University of Virginia and author of the book “Just Medicine: A Cure for Racial Inequality in American Health Care.” Dayna centered her remarks around three core questions:
- Why “just medicine”?
- What is “just medicine”?
- How to achieve “just medicine”?
Regarding the first question, Professor Matthew recounted both historical and recent examples of injustice and racism including the original 13th amendment that was nearly ratified and the white supremacist rally in Charlottesville, Virginia. Dayna argued that we need just medicine because injustice happens when no one is looking and that injustice must be dismantled with persistence.
“Just medicine” includes an explicit recognition that there is a real race problem in the US and that many patients are treated differently in healthcare because of the color of their skin. The two major principles of this approach to healthcare are equality/equity (giving patients what they need when they need it as much as they need it to have an equal opportunity) and population-based care that emphasizes preventative care. “Just medicine” seeks to resolve significant disparities like infant mortality rates and pregnancy-related dates that unfairly impact black- and brown-skinned patients more than white patients. The 2003 report from the Institute of Medicine states that health disparities are found at virtually every step and process of healthcare.
We achieve “just medicine” by persistently identifying and addressing the mechanisms that produce attitudes, biases, and stereotypes in health disparities. A major driver of health disparities is institutional racism: the systemic, institutionalized, historic, and legally-enabled belief that one race is better than another. Dayna shared a troubling personal experience with a Lyft driver who initially refused to serve her and then offered to take her home. She felt scared and upset by the experience and later spoke with a Lyft emergency line representative with a deep southern Virginia accent. She anticipated an unempathetic response from the man but was surprised when he affirmed her fear and hurt. “I internalized racism and your patients internalize it as well. After I heard that man on emergency line say that I cried because I let go of all that hurt”.
Professor Matthew believes that we need to take real steps toward a healthcare system a “just medicine” reality by screening for and treating health problems impacted by racism. She argues that the literature is not clear about the harmful effects of implicit bias. See the following:
- Irene Blair: 2011
- Kelly Hoffman 2016
- Michelle van Ryn: Provider bias
- Lisa Cooper: implicit attitudes about bias
- Robert T. Carter 2017: Racial discrimination and health outcomes among racial/ethnic minorities: A meta-analytic review
For those seeking to address their own individual bias, Dayna recommends a humble and mindful mindset. However, institutional racism demands a systemic and attentive reform effort including an emphasis on population-based healthcare. Disparities in education, housing, environment safety, and criminal justice are major, bi-directional drivers in health disparities. To achieve real equity in care, we must not only improve our one-on-one interactions with patients, but also join movements to dismantle the atmospheric and powerful forces of institutional racism. Professor Matthew believes that healthcare champions like the members of CFHA are in a prime position to be a part of the solution.