R.S. Shim is Luke and Grace Kim Professor in Cultural Psychiatry and professor of clinical psychiatry, University of California, Davis, Sacramento, California.
Acad Med. 2020 Dec;95(12):1793-1795. doi: 10.1097/ACM.0000000000003726.
Structural racism is pervasive in U.S. society, and academic medicine is not immune to the effects of this disease. The social determinants of health have been implicated as the main drivers of health disparities and inequities in society, and racism has been well established as a social determinant of health. Research consistently highlights poor health outcomes for Black populations and other communities of color compared with White populations across a variety of conditions. Medical students, residents, and faculty of all backgrounds regularly experience the destructive effects of structural racism in medicine. Renewed attention to the problem is encouraging, but, if it is consistent with history, transient. If academic medicine can arrive at a place of discarding the shackles of biological determinism, perhaps the field can begin to take initial steps toward dismantling the structural racism that drives health inequities. To make true headway, academic medicine must be willing to make bold strategic and financial commitments to do more. This work will not be easy, and there will be great resistance to the type of change that is needed. It is time to ask whether the leaders of academic institutions have the will to act and to continue to push forward in the face of opposition. The author is skeptical-because of the scope of the work that needs to be done and because it feels as if society has been here many times before-and, yet, remains optimistic.
结构性种族主义在美国社会普遍存在，医学学术也不能免受这种疾病的影响。健康的社会决定因素被认为是造成社会健康差距和不平等的主要因素，而种族主义已被充分确定为健康的社会决定因素。研究不断强调，与白人相比，黑人及其他有色人种在各种情况下的健康状况都较差。不同背景的医学生、住院医师和教师经常在医学中经历结构性种族主义的破坏性影响。对这个问题的重新关注是令人鼓舞的，但如果这与历史相符，那也只是暂时的。如果医学学术能够摆脱生物决定论的束缚，也许该领域可以开始采取初步措施来消除导致健康不平等的结构性种族主义。要取得真正的进展，医学学术必须愿意做出大胆的战略和财务承诺，以做得更多。这项工作并不容易，而且需要进行必要的变革会面临巨大的阻力。现在是时候问问学术机构的领导人是否有意愿采取行动，并在面临反对时继续推进了。作者对此持怀疑态度——因为需要做的工作范围很广，而且感觉社会似乎已经多次处于这种境地——但仍然保持乐观。
