Fundamentals of Race and Racism

Race and racism have been foundational to medicine as an institution and to the U.S. health system. This learning module traces the history of racism in medicine as a continuum, with deep roots in the institution of slavery, and shows how racism has affected African Americans’ health and health care practices. It documents how medical doctors, philosophers, and scientists throughout history have contributed to the creation and perpetuation of racial inferiority and race-based stereotypes. These theories were first taught in the U.S. medical schools in the 18th, 19th, and first part of the 20th century. They demonstrate how this institutional practice throughout the United States, coupled with 246 years of slavery and biased education, led to what Byrd and Clayton (2001) call “medical and scientific abuse, unethical experimentation, and overutilization of African Americans as subjects for teaching and training purposes.”

Aerial view from the front of the Robert E. Lee monument on Monument Avenue. The monument is covered with graffiti and there are people on the ground surrounding the monument.

In 2020, the Robert E. Lee statue, the last of five major Confederate statues to be removed, on Richmond's Monument Avenue became a symbol of the "Black Lives Matter" social movement (photo by Max Schlickenmeyer, VCU University Marketing).

Learning objectives

Define race, racism and structural racism
Describe how race and racism pervaded the institution of medicine
Explain how structural racism impacts health and healthcare in the United States.

NOTE: Users who are pursuing the History and Health: Racial Equity badge, credit through the VCU Health System DEI learning requirement, or those who would like to claim continuing education credit must complete and submit the Reflection Activity at the bottom of this page. Please visit VCU Health Continuing Education for more information.

Learning materials

We ask that you spend an hour reading and viewing the materials below.

The Impact of Medicine on Race and Racism

Lexicon of Negro diseases and Negro physiological peculiarities utilized by health professionals until the late 20th century

Lexicon of Negro diseases and Negro physiological peculiarities utilized by health professionals until the late 20th century. (Byrd, Clayton, 2001)

Although the conceptualization of race has moved from the biological to the social sphere over time, many medical fields still rely on and reproduce biological conceptions of race. Racism continues to be a factor that negatively impacts African Americans and other racial and ethnic minorities. As you read Race, Medicine, and Health Care in the United States: A Historical Survey, try to identify key figures in the history of western biomedical sciences and reflect on how racism in medicine has paralleled racism in society.

Structural racism

VCU Health team members kneel in support of Black Lives Matter to stand against racism.

Photo of VCU Health team members kneeling in support of Black Lives Matter to stand against racism (photo by VCU University Marketing).

Let’s consider structural racism, or broader social, political, and economic factors that determine individual and community health. How have racist policies, laws, and institutions have resulted in racialized health and healthcare inequities and disparities in the United States? Read this brief essay to find out: How Structural Racism Works — Racist Policies as a Root Cause of US Racial Health Inequities | NEJM

Race-based medicine

Sociologist Dorothy Roberts in front of a TEDMed signage during her presentation

Photo of sociologist Dorothy Roberts giving a TED Talk (courtesy Ted.com).

Sociologist Dorothy Roberts uses a personal experience to dig deeper into the historical roots of race-based medicine practices. Where is race used to make false biological predictions? Roberts mentions diagnosis, measurements, treatments, prescriptions, and definitions of diseases. She explores race as a social construct and calls doctors to practice evidence-based medicine rather than continuing to treat patients by race. Further exploration leads us to address how race has been implemented as a shortcut around other relevant social factors that doctors don‘t address. She explores how race blinds physicians to these more important measures and leaves certain populations vulnerable due to stereotypes of tolerance and addiction levels. She further examines how drugs are marketed to black patients, how race stands in as a proxy for unknown genetic factors, and the resulting wariness black people have to use drugs targeted to blacks due to the history of medicine. Lastly, she digs into how racial discrimination has a staggering biological impact as a result of social inequality that no pill can fix in her TED Talk: Dorothy Roberts: The Problem with Race-Based Medicine

Resources

We ask that you spend the hour reading and viewing the resources above and viewing as many of the linked resources below as possible before completing the reflection activity. Reflections will be evaluated, and individuals may be asked to resubmit if answers are incomplete or do not meet the length requirement.

These first two documents below (reading lists) are extensive, and offer some really helpful information and much more comprehensive overviews of Racism, Anti-Racism, Health, and Medicine:

Syllabus: A History of Anti-Black Racism in Medicine

Racism and Health: A Reading List

Recommended readings of general interest:

"Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" at NAP.edu

Race and Racism in Health Care | Harvey Cushing/John Hay Whitney Medical Library

Metzl JM, Petty J, Olowojoba OV. Using a structural competency framework to teach structural racism in pre-health education. Soc Sci Med. 2018 Feb;199:189-201. doi: 10.1016/j.socscimed.2017.06.029. Epub 2017 Jun 22. PMID: 28689630.

Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017 Apr 8.389(10077):1453-1463. doi: 10.1016/S0140-6736(17)30569-X. PMID: 28402827.

Time to reflect on what you have learned

To get started, click here.

Reflection activity directions

Users who are pursuing VCU’s History and Health; Racial Equity badge, credit through VCU Health System DEI learning requirement, or those who would like to claim continuing education credit must complete and submit the Reflection Activity. The form asks the user to submit basic biographical information (e.g., name, department) and to answer one of the following 3 prompts. Your response must be a minimum of 250 words.

PROMPT OPTION 1: Now that you have completed the readings and have watched the TED Talk, consider what you have learned about medicine, health, and healthcare. What would you draw from the readings and video to challenge the argument that medicine cannot be racist since it just uses science to help sick people get better? How has racism and structural racism affected health and healthcare in Richmond, VA? Provide some specific examples.

-OR-

PROMPT OPTION 2: If you are a VCU team member, how would you incorporate some of the readings and the video into your own practice? Describe an encounter with a patient that you now recognize as informed by structural racism, the history of racism in medicine, and/or race-based medicine.

How might you interact with your patient differently?
What are some of the limitations of focusing exclusively on changing individual attitudes and interactions?
What additional transformations are necessary to address racism and structural racism in medicine and in the US more broadly? How might you participate in such transformations?

-OR-

PROMPT OPTION 3: If you are a patient (or have ever been one), describe an encounter with a healthcare provider, or with a medical institution that clearly reflects or demonstrates the operation of structural racism, racism in medicine, and/or race-based medicine.

What broader issues and histories affected your encounter with the healthcare provider or medical institution?
What could your provider have done differently?
What should medicine--and other institutions, including VCU--do to redress the inequities and disparities in healthcare and medicine?
How might you participate in transforming structural racism? What are some of the obstacles to participating?

Office of Health Equity

Office of the Senior Vice President for Health Sciences