GC: Hannah, it's my understanding that you've been active in equity and anti-racism work prior to the current wave of protests. When did you first start engaging this work and can you tell me about the setting and your motivations and activities at that time?
HBD: My dedication to equity work has been a long path. In college I majored in feminist and gender studies, and it was there that I was really awakened to my own naivete around race. By being held accountable in academic and activist spaces, I realized there was a hell of a lot I wasn’t seeing, and that pushed my learning and advocacy in new directions. In medical school I also got my MPH, and it was then I channeled my social justice and equity concerns into educating my fellow medical students. Since then I’ve run sessions for students, trainees, and faculty on a variety of inter-related topics – power and privilege, LGBTQ patients, weight bias, implicit bias, and anti-racism. It’s definitely been a learning experience and I will say keeps me quite humble.
GC: I know you've been involved in the BASCE (Brown Activists for Social Change and Equity) fellowship. Can you please describe the fellowship, and who can participate?
HBD: The BASCE fellowship is a year-long program run by Brown’s ODMA. Monthly sessions facilitate learning about medical racism, as well as build our skills as future educators and facilitators about racism and anti-racism. Each fellow is expected to produce a project at the end of the year. Anyone in medicine can participate – my year had medical students, residents, fellows, attendings, a social worker and a genetic counselor. It was an excellent opportunity to learn and collaborate.
GC: Hannah, as a new-ish fellow in a new city, you're providing leadership in Brown EM's curriculum named "Discussing Anti-Racism in Emergency Medicine" at Brown EM. What are the program's goals, and what are some of the planned activities?
Yes, I’ve been working with Dr. Taneisha Wilson since the beginning of this year on the DARE (Discussing Anti-Racism and Equity) curriculum. We are hoping to eventually reach all EM and PEM frontline providers; we are starting with physicians, trainees, APPs and nurses in September. Broadly, our goal is to change behaviors, our emergency medicine culture, and ultimately provide equitable and actively anti-racist care to our patients. The curriculum includes interactive conference sessions, simulation, a reading group, and pulling an anti-racism and equity lens into existing education such as M&M.
GC: Why is it important for white people to learn about and become anti-racist?
HBD: Sitting on the sidelines is not an option anymore. Frankly, it never was, but with current events a lot of folks are having their eyes opened up to the racism that runs through our society. White people have a responsibility to raise our voices alongside BIPOC (black, indigenous, and people of color) to create revolutionary and lasting change. As Ibram X. Kendi points out, to be “not racist” is the same as being racist; we require an active stance of anti-racism to uproot racism in our society. The norm in our society is racism; to be silent or passively “not racist” is to implicitly uphold that norm. The scales of power remain firmly tilted towards White people, so it will take the buy-in and sustained work of White people to help create an anti-racist reality.
GC: Is there a special need for white physicians to get their game on, and why?
HBD: Yes! Medical racism remains a huge issue. It is shameful that we can take for granted that significant health disparities exist along lines of race, and instead of rooting them out and using our power as physicians to prioritize health equity, we instead treat race as a “risk factor.” And that’s just the beginning of our issues! When the problems are this big, we all need to be on board. How could we sit by and not address racism, when racism will literally shorten the lives of our patients? When it will make them less likely to receive transplants, get appropriate pain medication, or achieve good control of their asthma symptoms? In public health, we learn that public health initiatives have changed life expectancy more than a single medical breakthrough ever has. Racism is one of the greatest public health threats of our time, and it is our responsibility as physicians to address it head on.
GC: Do physicians' obligations to work for equity stop at the hospital's front door, and if not, what are some of the most important and effective ways for docs to engage this work outside the hospital?
HBD: I think you can guess my answer here. No, our obligations do not stop when we leave the hospital. Racism certainly does not stop affecting our patients’ (and colleagues’) lives when they pass out of the hospital doors. The poorer health outcomes our Black and other patients of color see is not just because of racism in medicine – it’s also because of racism in housing, employment, poverty, education, voting, you name it. As doctors, there’s many different ways to address racism outside of the hospital. The first step is always learning. With a little effort we can become as fluent in the language of anti-racism as we are in medical-speak – so that we can just as easily answer the relative who asks us to look at a funny rash as the one who asks, “And what do you think of those protests?” After that, I think the most effective step for doctors is to look at their own work and consider how race touches that work, and how anti-racism might change that. Are you a pulmonologist engaged in clinical research? Have you thought about how race-correcting PFTs is altering your research and the conclusions you draw? Are you a pediatrician concerned about asthma care? How will environmental factors influenced by racism make it difficult to treat that severely atopic child with medication alone? I think that for all doctors, using this lens will change their medical practice, and for some it will necessarily push them further into the world of advocacy and policy outside of the clinic or hospital.
GC: What kind of support and investment will be needed to accomplish significant and sustained progress in anti-racism and equity in medicine?
This is the long haul. I am so thrilled and inspired that the medical community is taking a hard look at itself right now. I think it’s incredibly important to make firm and long-lasting commitments to anti-racism and equity work (including funding it) so that it doesn’t get lost in the next news cycle or major COVID outbreak. Actions are much louder than words, and while a lot of the medical establishment has been putting out statements against racism, I’m waiting to see that turn into action items. Our medical students at Brown recently presented a list of demands that is quite powerful. Significant progress will require anti-racism touching all of what we do – changing our approach to recruitment and retention; bringing a commitment to anti-racism to our research; carefully examining our clinical practice; and altering the way we teach our students all the way up to our most experienced faculty.
GC: How do we measure success inside and outside of the hospital?
HBD: We measure success in actions and in outcomes. First of all, we have to be measuring it to begin with. As part of the DARE program, we plan to break down internal measures by race – looking at basic measures of efficient EM care as well as specific care areas where we’ve seen racial disparities in the literature. Then we will work to enact change and follow our data to make sure it’s actually working. No matter what intervention you choose to put into place in pursuing health equity, it’s just as important to follow the data as you would for any other initiative.
GC: Hannah, thank you so much!