The deeply unequal impact of COVID-19 and the widespread protests of the police killings of George Floyd and many other Black people have drawn renewed attention to the inequities that pervade U.S. society—and medicine.

Health equity initiatives in the U.S.

See how organizations across the country are working to center health equity and name racism as a barrier to equity in their COVID-19 responses.

Following are highlights from an article published in the AMA Journal of Ethics® (@JournalofEthics) by Alden M. Landry, MD, MPH, assistant dean for diversity inclusion and community partnership at Harvard Medical School and assistant professor of emergency medicine at Beth Israel Deaconess Medical Center, along with four other faculty members and two students at the medical school.

The authors argued that physician educators have the opportunity—indeed, the obligation—to battle the structural inequality that impedes achieving optimal health for all.

Medical school faculty have to continuously adapt their curricula to new scientific knowledge, but they can struggle to incorporate content about current social issues. The events of 2020 demand a new approach, the authors noted: one that acknowledges and incorporates the teacher’s and the learner’s and the community’s lived experiences.

“As educators, we can model how to pause, recognize and reflect—even as we care for others—by doing the following,” they wrote, outlining these eight steps to pursue.

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“Health professional educators have responsibilities to teach themselves about—and to motivate students’ understanding of—the historical, social and cultural situatedness of systemic racism, health inequity and social determinants in their own learning environments.”

Social isolation, cognitive overload, depression, anger, pain, sorrow and fear can all undermine a student’s ability to participate in discussions and manifest in difficulty concentrating and preparing for learning, as well as missed assignments.

“You can do this by explicitly inviting students affected by recent events to name their emotions, share their feelings and bring their whole selves to the tasks of strengthening learning communities and collective inquiry experiences.”

For students who are outwardly troubled, the authors advised: “Let them know you see them, care about them and recognize that current events can be significant sources of distress and distraction.”

Real-world issues enable educators to teach about the legacy of racism in medicine and discuss ways to counter it.

“Students might direct frustration towards educators, their institutions, and the health care system,” the authors wrote. “We must model trying not to take comments personally.”

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If discussing racism is daunting, trust the value of your connection with medical students. “Expressing solidarity with and support for students and listening to students are key features of caring learning environments,” the authors wrote. “Be available and listen carefully.”

In the 2018–2019 academic year, only two-thirds of medical schools provided instruction on social determinants of health at academic level 1. Even fewer offered it at higher levels. “Enabling students to participate, organize and collaborate can motivate health equity, provide opportunities for community-engaged learning and generate hope and solidarity.”

Learn more about how the AMA is challenging medical schools and residency programs to confront the structural racism embedded in their own programming. The AMA has shared a process of institutional diversity and inclusion self-study and issued a statement to protect diverse learners during educational disruptions related to COVID-19.

Launched last year, the AMA Center for Health Equity has a mandate to embed health equity across the organization so that health equity becomes part of the practice, process, action, innovation and organizational performance and outcomes.

The February 2021 issue of AMA Journal of Ethics further explores racial and ethnic health equity in the United States.

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