Protecting and Advancing Diversity, Equity, Inclusion and Justice in Health, Healthcare and Medical Education to Save Black Lives

WHEREAS, Health equity is best defined as the assurance of the conditions for optimal health for all people as described by Dr. Camara Jones, noted physician scientist and change agent; and 

WHEREAS, The National Association for the Advancement of Colored People (NAACP) recognizes that health and healthcare inequities have historically and disproportionately impacted the Black community, leading to lower life expectancy, poorer health outcomes and reduced access to care. Specifically, Black people experience and die from preventable and treatable causes of sickness and disease at higher rates, which is rooted in racism, other forms of discrimination, and structural barriers; and 

WHEREAS, Racism is a system of structuring opportunity whereby one group is born with unfair privileges and advantages and another group is born with unfair disadvantages based on the social construct of race which saps the strength of society as whole;1 and 

WHEREAS, The Journal of Law and Medical Ethics defines health justice as a community led movement for power building and transformational change to eliminate health disparity. It focuses on recognizing and building communities to create and sustain conditions that support health and justice through legislation and action; and 

WHEREAS, It is understood that racism is a public health crisis which operates across systems and sectors, within institutions and organizations, interpersonally, and on an individual level; and 

WHEREAS, The published literature demonstrates that barriers to health and wellbeing drive disparities in health and healthcare at multiple levels including: (1) differences in life opportunities and exposures; (2) differences in access to care; and (3) differences in the quality of care received which exacerbate both the health and wealth gaps experienced by the Black population;2 and 

WHEREAS, There are system-wide examples of how racism impacts patient care and outcomes, in particular, there is clear evidence, for example, of its impact on minimizing the pain of Black people,3 the care pediatric and adult Black patients receive in emergency departments,4 and the use of race-based clinical algorithms that have negatively impacted Black patients in the evaluation of kidney and lung function and on organ transplant lists;5,6 and 

WHEREAS, It is understood that combatting these disparities and disrupting and redesigning the systems that resulted in such inequalities will require more diverse, inclusive, and equitable solution-makers and innovators at the policy, practice, and leadership tables, especially as they pertain to the health ecosystem; and 

WHEREAS, Only 5.7%7 of active physicians in the U.S. are Black or African American, and it is known that when Black patients are cared for by Black providers, it leads to higher patient satisfaction, improves follow-through on medical recommendations, and encourages people to share more accurate medical histories with their physicians and to receive the necessary preventive care;3 and 

WHEREAS, A recent study8 showed significant improvement in the mortality rate for Black newborns when treated by Black doctors, another study9 revealed lower all-cause mortality and decreased disparities in mortality rates between Black and white residents in counties where there are more Black doctors — even if there is only one Black doctor in the county, life expectancy for the Black population improved; and 

WHEREAS, The aim of diversity, equity, inclusion, and belonging (DEIB) efforts across the health ecosystem is to achieve health equity and eliminate disparities, to grow the pipeline, promotion and retention of Black and diverse physicians and clinical providers, including medical and clinical students and trainees, to advance the understanding of racism and other forms of discrimination and their impacts on care and Black health outcomes and other historically marginalized groups, and to elevate the human experience in care, the NAACP continues to advocate firmly for DEIB in health care and society at large. 

THEREFORE, BE IT RESOLVED that the NAACP calls for comprehensive DEIB efforts in health, healthcare and medical education driven by the most recently available data of Black/African Americans to save and protect Black lives and those of other historically disadvantaged populations and communities of color, to achieve culturally responsive and fluent health care systems, to drive health equity, and advance racial justice. 

BE IT FURTHER RESOLVED that the NAACP opposes the EDUCATE Act which aims to dismantle and ban DEI in medical education; it would amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving federal funding, including student loans, if they adopt policies and requirements relating to diversity, equity, and inclusion. 

BE IT FURTHER RESOLVED that the NAACP will advocate for DEIB actions across the health ecosystem to be charged with tackling and eliminating Black patients' experiences of racism in healthcare; Black healthcare staff's experiences of racism; assessing healthcare staff's racial attitudes and beliefs; understanding and solutioning around the effects of racism in healthcare on various treatment choices; creating safe and inclusive spaces and opportunities for healthcare staff's reflections on racism in healthcare; and organizational responsibility to provide antiracist training in healthcare.

BE IT FURTHER RESOLVED that the NAACP will work with healthcare providers, organizations and societies, policymakers, agencies, and community members to promote DEIB and to elevate the human experience in care to help cultivate shared humanity, empathy, more inclusive communication and language, health literacy, self and collective efficacy, value-based care strategies, and whole person-centered, safe, and high-quality care. 

BE IT FINALLY RESOLVED that the NAACP commits to raising awareness and fostering accountability around the power of DEIB to improve patient care, patient outcomes, the patient and human experience (i.e., provider performance and employee retention), patient and provider communication and shared decision-making.

References:

1. American Public Health Association. Racial equity. Accessed 22, April 2024. https://apha.org/topics-and-issues/racial-equity
2. Urban Institute. Dr. Camara Jones explains the cliff of good health. Accessed 22, April 2024. https://www.urban.org/policy-centers/cross-center-initiatives/social-determinants-health/projects/dr-camara-jones-explains-cliff-good-health
3. Boyle, P. (2023, June 6). Do Black patients fare better with Black doctors? AAMC. Accessed 22, April 2024.
4. Zhang, X., Carabello, M., Hill, T., He, K., Friese, C. R., & Mahajan, P. (2019). Racial and ethnic disparities in emergency department care and health outcomes among children in the United States. Frontiers in pediatrics, 7, 525. https://doi.org/10.3389/fped.2019.00525
5. Schmidt, I. M., & Waikar, S. S. (2021). Separate and unequal: race-based algorithms and implications for nephrology. Journal of the American Society of Nephrology : JASN, 32(3), 529–533. https://doi.org/10.1681/ASN.2020081175
6. American Thoracic Society. (2023, June 23). Race-Neutral testing could have given access to life-saving lung transplants for more Black patients. Accessed 22, April 2024. 
   https://www.thoracic.org/about/newsroom/press-releases/journal/2023/race-neutral-testing-and-lung-transplants.php#:~:text=Lung%20transplantation%20is%20a%20life,biased%20allocatio n%20of%20lung%20transplants.%E2%80%9D
7. AAMC. What's your specialty? New data show the choices of American's doctors by gender, race, and age. Accessed 22, April 2024. https://www.aamc.org/news/what-s-your-specialty-new-data-show-choices-america-s-doctors-gender-race-and-age
8. Greenwood, B.N., Hardeman, R.R., Huang, L., & Sojourner, A. (2020, August 17). Physician-patient racial concordance and disparities in birthing mortality for newborns. PNAS. Accessed 22, April 2024. https://www.pnas.org/doi/10.1073/pnas.1913405117
9. Snyder JE, Upton RD, Hassett TC, Lee H, Nouri Z, Dill M. Black representation in the primary care physician workforce and its association with population life expectancy and mortality rates in the US. JAMA Netw Open. 2023;6(4):e236687.