Wednesday, February 17, 2021

Solomon Center Hosts Panel on Racial Equity in Health Care

On February 8, 2021, the Solomon Center for Health Law and Policy, the Yale Health Law and Policy Society, and the Black Law Students Association (BLSA) hosted a panel discussion on racial equity in health care. The first of a speaker series focusing on this issue, this panel event focused on the historical, clinical, and biomedical roots and implications of racial equity in health care.

The panel, “Racial Equity in Health Care: Clinical and Historical Perspectives,” featured Udodiri Okwandu, doctoral candidate in the Department of History of Science and Presidential Scholar, Harvard University; Dr. Darshali Vyas, resident physician and Clinical Fellow in Medicine, Massachusetts General Hospital; and Dr. Kafui Dzirasa, K. Ranga Rama Krishnan Associate Professor, Departments of Psychiatry and Behavioral Sciences, Neurobiology, Biomedical Engineering, and Neurosurgery, Duke University.

Okwandu first provided a historical analysis of how “race-based scientific and medical practices [have] perpetuated discriminatory ideologies, practices, and behaviors.” Through several examples — from the Tuskegee and Guatemala syphilis studies to the sterilization of Black and Brown women in the mid-20th century — Okwandu explored the problematic nature of using race as an analytical category in science and medicine. Okwandu then highlighted the continued racialization of violence in biology, from the categorization of civil rights protest methods as an indication of a neurological disorder to recent studies associating darker pigmentation with higher levels of aggression and sexual activity. While scientific and medical disciplines “have been and continue to be conceptualized as neutral, objective, and apolitical,” Okwandu demonstrated how “race has been and is woven into the fabric of society and has left no part untouched.”

Vyas followed by describing the phenomenon of “race correction” in clinical algorithms. She emphasized that many algorithm developers offer no explanation or justification as to why race is included in their models, and rationales that are offered could be traced back to suspect racial science and eugenics. In drawing attention to the consequences of race correction, Vyas cautioned that “by baking inequities into predictive tools, we risk perpetuating inequities into future decisions based on racist structures that exist now.” While the use of race correction in clinical algorithms is currently being examined at the congressional level, Vyas encouraged the audience to critically examine the larger drivers of racial injustice in the United States that lead to inadequate access to health care as the issue of clinical algorithms only concerns patients who have access in the first instance.

Finally, Dzirasa ended the panel event with a discussion on how racial bias has been built into the broader architecture of biomedical research and health care delivery. Drawing on major scientific studies characterizing the genomic landscape that gives rise to psychiatric disorders, Dzirasa pointed out that the lack of representation of individuals of African ancestry in these studies is resulting in discoveries about genomic risk and diseases that are “built on a framework that was largely for people of European ancestry.” Furthermore, Dzirasa emphasized that the scarcity of Black scientists in positions of leadership has perpetuated this exclusionary architecture of the link between genomics and disease. While excited by the potential of the Precision Medicine Initiative in addressing this issue, Dzirasa ended by expressing concern that the same individuals may continue to be left behind in these personalized medicine initiatives.

The second event in the speaker series, “Racial Equity in Fertility Care: Legal and Clinical Perspectives,” will be held on February 22, 2021.