Inequality in America can be measured by countless means, including income, education, incarceration, food security. But one of the more dramatic measures is health outcomes, as tragically demonstrated by the COVID-19 pandemic that has laid bare the country’s pervasive health inequities.
So how should physicians pursue optimal health for all? An editorial in the AMA Journal of Ethics® argues that the medical community must first ask some difficult questions.
Audiey C. Kao, MD, PhD, argues that medical ethics is fundamentally situated to lead a conversation about structural racism, how it harms individuals and communities and what to do about it. Dr. Kao is editor-in-chief of the AMA Journal of Ethics and vice president of ethics standards at the AMA.
Systemwide bias and institutionalized racism continue to contribute to inequities across the U.S. health care system. Learn how the AMA is fighting for greater health equity by identifying and eliminating inequities through advocacy, community leadership and education, along with COVID-19 resources from the AMA Center for Health Equity.
Death by ZIP Code
A study of two neighborhoods in Chicago, conducted by researchers at NYU Grossman School of Medicine and based on data from the Centers for Disease Control and Prevention from 2010 to 2015, illustrated just how dramatic the differences can be.
Residents of Streeterville, a mainly white downtown neighborhood with the lux Magnificent Mile shopping district on its west side and the lakefront to the east, enjoyed a life expectancy of 90 years. Meanwhile, the predominantly black residents of Englewood, a mere nine miles away on the city’s South Side, lived to just 60, on average.
“Inequity in health status of this magnitude is not accidental but a consequence of transgenerationally entrenched power structures that produce and reproduce inequity over time,” Dr. Kao wrote in an AMA Journal of Ethics editorial published last year. “This is a justice problem and cannot be fixed without tackling social, political and economic root causes that advantage some of us and disadvantage some of us.”
The AMA is making a $2 million investment in a Chicago-based collaborative, West Side United, that is working to promote health and well-being for a portion of the city where life expectancy is far below the national average and 14 years lower than in the Windy City’s famous downtown “Loop” just five miles away.
Probing questions
Achieving health equity “requires deep examination of critical issues that are particularly complex and potentially divisive,” Dr. Kao added, and medical ethics can play a key role in this process.
“It's fair to say that whether it's health equity or some other macro-level topic that relates to health and health care, there's a tendency to focus on micro-level solutions,” Dr. Kao said in an interview for this article. “Most physicians are generally concerned with individual patients at the bedside or in the exam room.”
Broadening the conversation
Recognizing the social determinants of health and addressing macro-level structural inequities that contribute to poor health are critical. “That encompasses a broader notion of the physician’s and the larger profession’s roles in advancing social justice,“ Dr Kao said.
Each issue of the AMA Journal of Ethics now explores some dimension of health equity, regardless of the issue’s larger theme. A two-part theme issue entirely dedicated to racial and ethnic health inequity in the U.S. kicked off in February.
The journal invites submissions examining these and other thought-provoking ethical questions.
