Eradicating racism in medicine

Letter from the Dean

The promise of precision health is exhilarating. Through the latest advances in genomics, physicians can develop therapies for a patient based on the person’s genetic code.

Cutting-edge regenerative medicine can help tissues and organs repair themselves.

Despite these and many other 21st-century wonders, the best predictor of a person’s health is still a 58-year-old postal service innovation: the ZIP code. For example, life expectancy across Los Angeles County ranges by as much as 15 years. Plotted on a map, shorter life expectancy closely tracks with lower income, less home ownership, more pollution — and race. Where you live is likely to say more about your health outcomes than your doctor or your genes.

Unemployment, poor housing, food deserts, lack of health care, underdeveloped or unsafe parks, crime and violence, and high levels of stress all take a heavy toll on a person’s physical and mental health. The medical field has a sterile name for these factors: the social determinants of health.

But when all of these factors consistently and disproportionately affect Black and Latinx communities in city after city, we can also properly identify them as the products of systemic racism. Whether it was the redlining that prevented a Latina businesswoman from getting a loan, or the zoning variance that allowed a polluting factory to open in a Black neighborhood, the institutional, political and cultural processes penalize not just one generation of minority Americans but also future generations.

The insidious effects of racism have become abundantly clear during the pandemic. Anti-Asian hate crimes have soared nearly 150% amidst rising xenophobic rhetoric. And nationally, Black, Latinx and American Indian people are about four times as likely to be hospitalized with COVID-19 as white people, and nearly three times as likely to die of it, according to the Centers for Disease Control and Prevention.

We also must acknowledge the reality of racism within the health care system. In 2003, the Institute of Medicine published the report Unequal Treatment, which revealed that racial and ethnic minorities receive lower quality care even after controlling for factors such as insurance status and income. Nearly 20 years later, we continue to see reports of differential treatment for patients of color at hospitals around the country.

Recognizing that quality health care is a basic human right, Stanford Medicine envisions a better future. I believe our precision health campaign can leverage the power of modern medicine to identify the roots of these inequities, lessen their impact and ultimately dismantle them.

Stanford Medicine clinicians and researchers have conducted foundational and innovative work to better understand the interplay of factors facing individual communities and entire populations. We must go further. Academic medical centers like Stanford must make social determinants — and systemic racism — a research priority. And we must enhance our efforts to recruit, train and support a more diverse workforce for careers in health care and biomedical education. We see time and again that diversity pays dividends in clinics and classrooms.

Stanford Medicine is committed to eradicating racism. We know we don’t have all the answers, so when we created our Commission on Justice and Equity in November, we recruited leaders, advocates and experts from around the country to help us develop plans to achieve these goals at Stanford, even as we look for ways to lead nationally.

I recognize that the job before us is formidable, but I am undaunted. It will demand a sustained and determined effort, one that employs the energy and creativity of thousands of individuals. I believe we are up to the task. We cannot let racism forever define this nation.

Sincerely,

Lloyd Minor, MD

Carl and Elizabeth Naumann Dean of the School of Medicine

Professor of Otolaryngology — Head & Neck Surgery