How segregation’s legacy continues to shape U.S. health care


The Civil Rights Act of 1964 contained financial enforcement structures that ended legally sanctioned racial segregation in U.S. hospitals, but structural racism remains deeply embedded in the nation’s health care system.

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This includes sorting patients by insurance status, an action that perpetuates segregation by race and class.

The January issue of AMA Journal of Ethics® (@JournalofEthics) investigates how the demand for health justice calls for the end of normalizing structural racism everywhere the nation’s ill and injured are cared for—especially in academic health centers.

This theme issue considers sources of ethical, clinical, public health and educational responsibilities to remediate health injustice where medical students, resident physicians and other health professionals learn their professions and internalize professional norms.

The January issue of AMA Journal of Ethics includes the following articles:

  1. Training to Build Antiracist, Equitable Health Care Systems.”

    1. Increased awareness of conscious and unconscious biases and structural drivers of health can increase the likelihood of upstander interventions.
  2. Why VIP Services Are Ethically Indefensible in Health Care.”

    1. “Very important persons” care contributes to multitiered, racially segregated health service delivery streams that influence clinicians’ conceptions of what patients deserve from them.
  3. How Should Academic Health Centers Desegregate Health Professions Education?

    1. One expression of structural injustice in the United States is delivery of health care according to patients’ race and insurance status.
  4. Is It Reasonable to Expect Students and Trainees to Internalize Equity as a Core Professional Value When Teaching and Learning Occurs in Segregated Settings?

    1. Training in a segregated health care system means that health professions students and trainees learn bias and experience helplessness and burnout.

The journal’s January “Ethics Talk” podcast features a discussion with Lisa Lehmann, MD, PhD, director of the Brigham and Women’s Hospital Center for Bioethics. She talks about “grateful patient programs,” pressures clinicians face to fundraise on behalf of health care organizations for which they work, and whether “VIP” care really is better for patients.

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Call race-based algorithms what they are: sources of harm

The January issue also features six author-interview podcasts. Listen to previous episodes of the “Ethics Talk” podcast or subscribe in Apple Podcasts or other services.

Also, CME modules drawn from this month’s issue are collected at the AMA Ed Hub™ AMA Journal of Ethics webpage.

Upcoming issues of the journal will focus on child abuse and neglect, clinicians in government, and meat and health. Sign up to receive email alerts when new issues are published.

Table of Contents

  1. Listen and learn
  2. A look ahead