Social Mission Alliance (then The Beyond Flexner Alliance) submitted invited commentary and recommendations to the Chair of the House Ways and Means Committee regarding the special responsibility of health professional schools, academic health centers, and training hospitals in producing future health care providers. Training institutions must be held responsible for dismantling racism in health care delivery, research, and training, and incorporating social mission in training and practice.
Read the letter below, or access the PDF version here.
October 16, 2020
The Honorable Richard Neal
Chairman, Ways and Means Committee
United States House of Representatives
1102 Longworth House Office Building
Washington, D.C. 20515
Dear Chairman Neal and the House Ways and Means Committee,
The Beyond Flexner Alliance appreciates the opportunity to comment on the Chairman’s Request for Information regarding the important and timely topic of racial equity in clinical algorithms, care, and research. The Beyond Flexner Alliance (BFA) is a national movement, focused on health equity and training health professionals as agents of more equitable health care. BFA aims to promote social mission, which is defined as the contribution of the school in
its mission, programs, and the performance of its graduates, faculty and leadership in advancing health equity and addressing the health disparities of the society in which it exists.
The 13th amendment may have abolished slavery, but it did not abolish oppression, discrimination, and misuse of race and ethnicity, often exemplified in today’s health care system. The most notable examples include race adjusted algorithms in cardiology, nephrology, obstetrics, and urology which in turn impact the care and course of treatment a Black patient receives compared to a white patient (1). This is problematic because race is a social construct, rooted in white supremacy and the concept of othering (2). There is no genetic or biological difference among races and therefore, race should not be used as a risk factor in determining treatment or diagnosis. Training in race-based medicine must be eliminated and interdisciplinary health professionals must be trained in race-conscious health care and social mission.
Health professional schools, academic health centers, and training hospitals hold a special responsibility in training and producing future health care providers. The very intent of training is to establish the knowledge and skills needed to provide high quality health care, and a growing body of evidence shows training programs imprint practice behaviors that can be detected nearly 20 years later (3). Therefore, the misuse of race and ethnicity in these training institutions not only impacts the clinical service and research at these organizations today, it will impact health care and disparities for decades to come.
Training institutions must be held responsible for dismantling racism in health care delivery, research, and training, and incorporating social mission in training and practice. Professional organizations and accrediting bodies can use their standing and institutional power to drive policy change. Federal and state policies can be leveraged to advance local, regional, and national change. Organizations must acknowledge their complicity in the misuse of race and ethnicity and strive for higher standards to eliminate the misuse of race and ethnicity in algorithms, research, and care. We suggest 2 strategies for this:
A number of policy levers can be applied to advance these goals. In 2015, the federal government provided nearly $15 billion to support graduate medical education (GME), largely through Medicare, Medicaid, and the VA.6 Despite these major investments, major gaps continue to exist in the physician workforce, and national experts have called for major GME reforms. Accountability for clinical training environments is one area where federal GME funding could be leveraged to dismantle racism and address health disparities. The federal government makes additional health workforce investments through the Health Resources and Services Administration programs, including the National Health Service Corps, Health Professions Training for Diversity programs, Primary Care and Oral Health Training Programs, and Nursing Workforce Development Programs. These programs could provide grants to implement needed changes or require accountability for race-conscious health care to receive funding. Similarly, NIH funding – of which academic health centers are major recipients – could apply accountability for race-conscious research and environments to be eligible for funding. The Beyond Flexner Alliance envisions health professions education in which social mission is present, prominent, and valued to drive health equity and improved health for individuals,
communities, and nations. Standing for health equity means standing for anti-racist movements, including abolishing the misuse of race in algorithms, research and clinical care. Health professionals– current and future– must be trained in race-conscious medicine and social mission if we are to truly eradicate disparities and improve health outcomes. We thank the Chairman and the Committee for the opportunity to comment on this topic. If you have any comments or inquiries, please feel free to reach out to BFA Director, Toyese Oyeyemi at email@example.com.
The Beyond Flexner Alliance