5 Minute Read
There is a necessary connection between our work in integrating behavioral health and medicine and the work of rooting out racism in health care. That connection lies at the root of what those of us who call ourselves champions of integrated care are doing: we are reforming a fragmented and too-often ineffective system that serves interests other than caring for people as whole human beings. To that end, racism stands as a glaring enemy of integrators, keeping us from realizing our goal of an equitable system of care that treats humans humanely and provides caregivers with the tools and teams to flourish as well. In short, there is no integrated care without an anti-racist health system. We are frustratingly not there, but one step along that road can be simply adopted, even today, by health institutions in the country: adopt the CLAS Standards.
Let me be transparent here. I generally abhor top-down policy. I dislike the litigious nature of our country. I generally believe that policies and laws are a horrible way of changing human behavior. That’s my bias. But Dayna Matthew, author of the book, “Just Medicine: A Cure For Racial Inequality In American Healthcare,” makes a compelling argument that adopting the CLAS standards should be mandatory. Yes, Dr. Matthew even goes so far as to say that implicit bias should be illegal in healthcare and subject to legal remedy under Title VI of the Civil Rights Act. Practically speaking this would mean that an organization, found to have disparate outcomes for patients in different racial classes could come under legal scrutiny for the care they are providing. Let that sink in for a moment.
My first reaction is to reject that as a tool for changing the underlying causes of racism in the country. In other words, just like I feel that malpractice litigation does little to improve healthcare in America (and potentially harms good healthcare practices) how could such a policy provide a fix to systemic problems affecting health outcomes in populations, especially given that healthcare has little control over many of those systemic factors (eg. poverty)?
In short, there is no integrated care without an anti-racist health system.
What has changed my mind is what we have witnessed with police violence over the last year. Even despite the strong cultural winds of anti-racist sentiment in the country still we see the same outcomes: unarmed black people killed or seriously injured when multiple other humane options existed. What we see here is the power of a system at work. A system that is producing the intended outcome for which that system was designed. In other words, reforming the one individual police officer will not solve the problem. Reforming, or as some put it, dismantling the system is the only real way to achieve a different outcome. Sound familiar? This is what we have been talking about for a long time in healthcare.
Clearly the legal system is a crucial part of what has sustained and enabled police brutality over centuries. Essentially the immunity that police officers have has provided an unchecked expression of the racism that has pervaded America from its inception. Now there are calls for reforming the legal system so that it holds police officers accountable for inhumane policing practices. If the system changes, the outcomes will change. That is the hope.
We in healthcare face a similar issue. Our outcomes for treating black and brown people fall short of any objective standard you can conjure. Why shouldn’t our systems change? Why shouldn’t we be held legally accountable for ensuring that we are doing our part to provide integrated, anti-racist care? And honestly, I haven’t worked out yet in my head what that looks like with the myriad of factors that influence the development of health and disease. Clearly health institutions on their own cannot solve the inequities in healthcare. However, the status quo, the current system is not designed to root out inequities. If we are honest we would recognize that the current system is designed around profit efficiencies which are much easier to navigate for people of means and discriminatory against those who do not regardless of color.
That’s where the CLAS Standards come in. I’ve read them. They are not difficult to understand or even ground-breaking in any substantial way. They can be summed up pretty easily: provide care that is culturally humble and aware and make your organization continuously accountable for providing that care. I think, as Dr. Matthew believes, that the CLAS Standards are a step in the right direction. They appear to be easily embedded into any Patent-Centered Medical Home (PCMH) or quality improvement work your organization may be doing. You don’t have to buy the argument that Dr. Matthew makes about making it illegal to provide healthcare driven by implicit bias to adopt them. But you may change your mind once you do adopt them. It should be illegal to be ignorant in today’s world of easy information exchange. There is no reason, other than willful ignorance, to provide healthcare to people of color that ignores who they are (and who we are) and what they bring to the healthcare encounter. And it should be illegal for institutions to not have a plan for addressing the inequities that plague their patients. We don’t have to be perfect at it. We don’t have to solve everything at once. We don’t have to practice in fear. We just have to have a plan, partner with our communities of color and be accountable for our care.
Much of this should sound familiar to those of you championing integrated care. Many of the same arguments and thoughts pertain to that effort. The two are inextricably intertwined, so much so that it should be no surprise that most of the progress with integrated care has come in clinics and hospitals serving underserved populations. To repeat, we cannot have integrated care without anti-racist health systems. Adopt CLAS today.
Note that these are my opinions and not necessarily representative of CFHA membership or its board.