Structural Racism and <i>JAMA Network Open</i>
Authors: Frederick P. Rivara, Steven M. Bradley, Daniel V. Catenacci, Angel N. Desai, Ishani Ganguli, Sebastien J. P. A. Haneuse, Sharon K. Inouye, Elizabeth A. Jacobs, Kristin Kan, Howard S. Kim, Arden M. Morris, Olugbenga Ogedegbe, Eli N. Perencevich, Roy H. Perlis, Elizabeth Powell, Gordon D. Rubenfeld, Lawrence N. Shulman, N. Seth Trueger, Stephan D. Fihn
Journal: JAMA Network Open (2021)

podcast and corresponding tweet suggesting that structural racism does not exist and that no physicians are racist.Although we have not written about this issue until now, these events have prompted a deep internal reexamination of how we engage constructively to acknowledge and reverse structural racism and of our own contributions to perpetuating it.We are challenging ourselves to consider how we can be truly antiracist in our roles as physicians, scientists, editors, and members of the communities in which we work and live.First, we, the editors of JAMA Network Open, affirm the entrenched history and ongoing harms of structural racism.In recent times, the horrific killings of George Floyd, Breonna Taylor, Philando Castile, and hundreds of other individuals who were members of racially/ethnically marginalized groups, such as Black and Latinx individuals, at the hands of police have forced critical and long overdue conversations about this centuries-old problem.Structural racism persists in essentially every social system in the US, including, but not confined to, housing, employment, education, health care, finance, transportation, law enforcement, the environment, criminal justice, and politics.Although not always visible, prejudice is embedded in all aspects of US life.Acknowledging the problem is necessary but insufficient.Structural racism requires active dismantling, not only to reverse the status quo but also to counteract ongoing efforts to worsen structural racism through active steps, such as legislation targeted at impeding voting rights.Second, structural racism has deeply and adversely affected health and health care specifically, as manifested by reduced life expectancy, 1,2 higher burden of various illnesses, 3 and higher infant and maternal mortality, 4,5 especially among Black and Hispanic or Latinx individuals.This stark disparity has become further exacerbated during the COVID-19 pandemic.Black and Hispanic or Latinx populations have experienced rates of hospitalizations and deaths due to COVID-19 that are 3-fold higher than White populations. 6,7This discrepancy has led to a further widening the nearly 6-year lower in life expectancy among Black persons compared with White persons in the US. 8 This distressing trend is a direct manifestation of the disparities in the availability of and access to highquality health services, with associated inferior treatment and outcomes.Uneven access to highly effective vaccines risks deepening these disparities, which have been documented for decades, in many cases without any evidence of improvement over time.The disparate risks of infection with SARS-CoV-2 and subsequent death from COVID-19 among people of racial and ethnic minority backgrounds, such as Black and Hispanic or Latinx individuals, have appropriately attracted attention but must be viewed in the context of systems that have failed the communities in which people of racial and ethnic minority backgrounds live, go to school, and work for generations.The persistent underrepresentation of racial and ethnic minority groups among trainees and clinicians and the myriad obstacles to their professional advancement contribute to these challenges.The resulting lack of clinicians with intimate understanding of and commitment to people of racial and ethnic minority backgrounds, compounded by other structural issues, including disparities in funding, further contributes to the standard of health care that these communities receive.As an example, a 2019 study 9 estimated that if the 5 historically Black medical schools that closed owing to the 1910 Flexner report had remained open, there would have been more than 35 000 additional