Committing to diversity and inclusion in integrative care

Photo Cred: Fauxels/Pexels

By Katherine Shagoury

Racism and discrimination exist prominently in healthcare. Racial disparities in medicine are not only the result of individual actions, but of deeply engrained structural racism and implicit bias. According to a study published in the journal Health Care Financing Review, understanding racial disparities in healthcare requires an appreciation of the ways racism has operated, and continues to operate, in society as a whole.

In December last year, we sat down with Michelle Maiers, DC, PhD, and Charles Sawyer, DC, to discuss a new policy statement from Northwestern Health Sciences University that delved into the effects of racial inequalities and systemic biases in healthcare. The policy paper addressed issues of racial inequalities in integrative medicine specifically and outlined strategies for healthcare providers.

The response we received to this conversation was overwhelming. So many members of our community wanted to take action, but the biggest question we received was, “where do I begin?” Therefore, we at Integrative Practitioner felt it was our responsibility to help bridge this gap.   

As we near the end of Black History Month, we created what we hope will be an ongoing resource for practitioners to address systemic racism and promote diversity and inclusion in integrative healthcare practices. This work is a challenging, lifelong commitment, but it is necessary, and those of us with privilege must be part of the solution. To that end, this page will serve as an ongoing source of:

• Strategies to address personal biases and racism.
• Guidance on evaluating cultural competence in a healthcare practice.
• Education on structural systemic racism in healthcare.
• Resources for culturally competent care.
• Opportunities to engage and connect with other practitioners for discussion.

Note, these resources will be updated, and we encourage your suggestions by e-mailing Integrative Practitioner at [email protected]. Check back regularly for new information.

Address personal biases and implicit racism

Before we look at racism and discrimination as it directly applies to healthcare, the first step practitioners should take is broadening their own awareness of issues regarding race and racism. In “The Antiracism Starter Kit,” author L. Glenise Pike differentiates activism and antiracism. They said activism consists of financially supporting Black, Indigenous, and People of Color (BIPOC) organizations and businesses as well as participating in marches, rallies, and protests. While these are crucial activities, they focus on the result and do not address the root cause of racism.

Antiracism, on the other hand, is actively opposing racism and white supremacy in all forms, which Pike said breaks down to three responsibilities:

1. Do the self-work to identify, unpack, and dismantle the ways your behaviors uphold and perpetuate white supremacy.
2. Inspire and encourage others to start this important process for themselves.
3. Compensate BIPOC for their time and resources.

Further, individuals must recognize that becoming antiracist is an ongoing process of awareness, education, and action. Individuals must acknowledge the existence of modern-day racism, as well as identify their own prejudice and biases. The University of Washington, University of Virginia, Harvard University, and Yale University offer a free test to help individuals determine their implicit biases. Click here for more information.

As individuals with privilege, it is our responsibility to learn about ourselves and develop self-awareness as it pertains to prejudice and bias. Take the time to learn about other people, interact with and listen to people of different races, or enroll in formal diversity education either online or through a local college or community group.

There are many sources of antiracism education, from coaching and online courses to webinars and articles. It is also essential for individuals to educate themselves more broadly on how racism and discrimination impacts BIPOC throughout society. Consider the following list of resources as a starting point:

Books

• How to Be an Antiracist by Ibram X. Kendi
• Between the World and Me by Ta-Nehisi Coates
• I’m Still Here by Austin Channing Brown
• Me and White Supremacy by Layla F. Saad
• One Person, No Vote by Carol Anderson
• Tears We Cannot Stop by Michael Eric Dyson
• The New Jim Crow by Michelle Alexander
• They Can’t Kill Us All by Wesley Lowery
• When They Call You A Terrorist by Patrisse Khan-Cullors and Asha Bandele
• White Tears/Brown Scars by Ruby Hamad
• Why I’m No Longer Talking to White People About Race by Reni Eddo-Lodge
• White Fragility by Robin DiAngelo

Media

• 13th
• I Am Not Your Negro
• Whose Streets?
• Just Mercy
• LA 92
• The Hate You Give
• Dear White People
• When They See Us
• Selma
• Watchmen

E-Books

• The Antiracism Starter Kit
• The Anti-Racism & Allyship Journey Workbook

Courses and Webinars

• Understanding Diversity and Inclusion
• Unconscious Bias

Activists and Persons of Influence

• Ericka Hart
• Rachel Ricketts
• Black Lives Matter
• Ibram X. Kendi
• Brittany Packnett Cunningham
• Layla F. Saad
• From Privilege to Progress

Examine cultural competence in healthcare practice

While personal awareness, education, and action should remain ongoing, healthcare providers must examine cultural competence in their own practices. A first step for an individual provider is to listen to local communities of color and what their needs are. Listening builds trust, which is necessary to connect and make structural changes.

A practitioner may also have open discussions with their patients of color. Healthcare delivery must align with individual patients’ social, cultural, and linguistic needs. Steps should be taken to identify and understand these needs. Connect with community-based organizations or reach out to providers of color and build working relationships. Consider the following resources for analyzing and building cultural competence in a healthcare practice:

• Becoming a Culturally Competent Health Care Organization (American Hospital Association)
• Diversity and inclusion in the workplace
• Leading with Effective Communication (Inclusive Leadership Training)
• Inclusion of Minorities in Community Development
• Optimizing Diversity on Teams
• Build an inclusive culture
• Managing People: Teamwork and Diversity

Understand structural systemic racism in healthcare

The natural bridge between structural racism and healthcare are the social determinants of health, which are heavily influenced by systemic racial policies. Social determinants of health are the economic and social conditions that influence individual and group differences in health status, which include five key areas: economic stability, education, social and community context, neighborhood and built environment, and health and healthcare.

National data reveal that, over the past 50 years, the health of both Black and white people has improved, with increases in life expectancy and declines in mortality, according to a study published in the journal Health Care Financing Review. However, Black individuals continue to have higher rates of morbidity and mortality, and Hispanics and Native Americans have elevated disease and death rates.

Although the study authors said the role of medical care as a determinant of health is somewhat limited, medical care, especially preventive care, early intervention, and appropriate management of chronic disease, can play a role in health. Therefore, racial and ethnic differences in the quantity and quality of care are likely a contributor to racial disparities in health status.

For example, patients of color often have less access to medical care due to higher rates of unemployment and under-representation in jobs that include health insurance. Additionally, an increasing number of studies point to racial discrepancies in the receipt of major therapeutic procedures. Research suggests that some providers are less likely to offer treatment or perform a procedure on a patient of color versus a white patient, even if the diagnosis is the same.   

Racial disparities exist in healthcare and are not the result of individual behaviors, but rather a widespread societal problem. Policy and research points to improving equal access to quality medical care, improved data and monitoring, regulatory vigilance, and education and training initiatives, along with recruiting providers from disadvantaged minority backgrounds. Individuals providers can do their part to recognize this deeply rooted systemic racism and discrimination in healthcare, and both educate themselves and take action in their practices and communities.

Some helpful books and online resources related to systemic racism in healthcare include:

• Death Gap: How Inequality Kills by David A. Ansell
• Black and Blue by John Hoberman
• Black Man in a White Coat by Damon Tweedy
• Breathing Race into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics by Lundy Braun
• In the Wake by Christina Sharpe
• Precarious Prescriptions by James W. Moore
• Troublesome Science by Rob DeSalle
• Body and Soul: The Black Panther Party and the Fight against Medical Discrimination
• Medical Bondage: Race, Gender, and the Origins of American Gynecology

Resources for culturally competent care

This list will be updated. Check back regularly for new resources. Have a suggestion or contribution? E-mail [email protected].

Webinars

• 2020 EDI Forum Leadership Roundtable (American Chiropractic Association)
• In Focus: Disparities and distrust in BIPOC health care (MRP News)

Podcasts

• Movement is Life Podcast
• Podcasts on Health Equity, Diversity and Inclusion (AHA Trustee Services)
• Diversity and Inclusion Podcasts (Institute for Diversity and Health Equity)

Articles and Websites

• Racial Inequities in Integrative Healthcare
• Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (National Library of Medicine)
• Eliminating racial and ethnic disparities in health care: what is the role of academic medicine? (National Library of Medicine)
• Racism and Health (American Public Health Association)
• Syllabus: 21-Day Racial Equity Habit-Building Challenge (American Bar Association)
• National LGBTQIA+ Health Education Center

Contributors

We sincerely appreciate contributions and insights from the following individuals:

Michele Maiers, DC, MPH, PhD

Michele Maiers is the Executive Director of Research and Innovation at Northwestern Health Sciences University (NWHSU). As a principal at NWHSU’s Center for Healthcare Innovation and Policy, Maiers spearheads the school’s policy efforts and produces original research to inform clinical practice and shape public health policy. Maiers volunteers in a leadership capacity as the president of the American Chiropractic Association.

Charles Sawyer, DC

Charles Sawyer is the special assistant to the president at Northwestern Health Sciences University (NWHSU). For over four decades, Sawyer has worked at NWHSU spearheading its policy efforts, and has been recognized as a top 100 influential healthcare leaders. Sawyer earned his Doctor of Chiropractic from NWHSU and also studied at the College of St. Thomas.

Editor’s note: We welcome your suggestions and contributions to this resource. Please e-mail Integrative Practitioner editor Katherine Rushlau and [email protected].