Two doctors and Harvard professors call for racial discrimination in health care

We are experienced physicians. But in the early days of the pandemic, when we felt like fresh interns nervously awaiting a flood of disease presentations we had never seen before, we had a nagging sense of déjà vu: it seemed that a disproportionate number of COVID-19 patients admitted to our Boston hospital were people of color. We asked around; our colleagues corroborated. The trend was confirmed by data coming out of Milwaukee first, then sporadically elsewhere. Now it is a well-known and tragic fact of the pandemic.

In 2015 some of us wondered why Black and Latinx patients with heart failure—our hospital's most common diagnosis—seemed more likely than white patients to end up on our general medicine service rather than on our cardiology service, where patients have better outcomes (along with a more comfortable experience, including private rooms and better amenities).

After analyzing ten years of hospital data, we concluded that the trend we observed was painfully robust: white patients at Brigham and Women's Hospital—a prominent, predominantly white Harvard teaching hospital—were indeed more likely to be admitted to the cardiology service.

Alarmed by these findings, we sought an immediate solution. As we began to advocate for change within our institution, however, we encountered significant resistance to calling this discrepancy an instance of institutional racism and to making race-explicit interventions—even at a time when the documentation of racial health inequities is accelerating.

Together with a coalition of fellow practitioners and hospital leaders, we have developed what we hope will be a replicable pilot program for direct redress of many racial health care inequities—one that takes seriously the limitations of colorblind solutions and empowers institutions in variety of contexts to take decisive action to achieve racial equity.

Building on calls for reparations, we call this a vision for medical restitution. Federally paid reparations—urgent and long overdue—would help to mitigate racial health inequities (including those seen in COVID-19), but they would not, on their own, end institutional and structural racism. We believe we must pursue restitution programs at the institutional level while also advocating for federal reparations.

Redress could take multiple forms, from cash transfers and discounted or free care to taxes on nonprofit hospitals that exclude patients of color and race-explicit protocol changes (such as preferentially admitting patients historically denied access to certain forms of medical care).

Sensitive to these injustices, we have taken redress in our particular initiative to mean providing precisely what was denied for at least a decade: a preferential admission option for Black and Latinx heart failure patients to our specialty cardiology service.

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Two doctors and Harvard professors call for racial discrimination in health care

Relax - it's about applicative justice and combating structural racism. Discrimination against whites and Asians is not even real discrimination.