For health providers, “not being racist” is simply not enough to counter the history of mistreatment and discrimination in healthcare that has disadvantaged communities of color for centuries. Taking daily, concrete steps to eliminate racial disparities in healthcare is critical—in their communities and nationally. Through the following resources, health professionals and students can learn more about anti-racism and equip themselves to eliminate inequities wherever they see them. 

Explore the following sections:

What Is Anti-Racism?
The Cycle of Racism as a Moving Walkway
Institutional Racism in Healthcare
Combating Racism in Healthcare
List of Anti-Racism Healthcare Resources

Racism is a system of structures, policies, practices and norms that attribute value and opportunities based on skin color or appearance. In a racist society, some groups of people are advantaged, while other groups are severely disadvantaged. 

Anti-racism is fighting this system on every level it operates, from individual and interpersonal, to institutional and structural. 

Anti-racism has roots in abolition and the civil rights activism of Black Americans, over decades and centuries. The work of acclaimed scholar and author Ibram X. Kendi and others has brought the ideology to the forefront in recent years, emphasizing the need for structural changes such as ending medical discrimination. 

In practice, anti-racism combines awareness and action. Someone who is anti-racist is actively seeking to understand how racism functions in their society and takes steps to end racial inequities, such as racism in healthcare. 

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To better understand the need for anti-racism efforts, author and psychologist Beverly Daniel Tatum asked readers to picture a moving walkway at an airport. Active racist behavior is equivalent to walking quickly down the walkway, and passive racist behavior is standing still. Both are caught in the cycle of racism. 

“But unless they are walking actively in the opposite direction at a speed faster than the conveyor belt, unless they are actively anti-racist, they will find themselves carried along with the others,” wrote Tatum in Why Are All the Black Kids Sitting Together in the Cafeteria?

The moving walkway carries everyone on it automatically toward a more racist and inequitable society. Active racist behavior is equivalent to walking quickly with the motion of the walkway, whereas active antiracist behavior is walking backward against the walkway. Even though the person demonstrating passive racist behavior is motionless on the walkway, they still get swept along with racism. 

In other words, no one is neutral, said Kendi, who founded the Center for Antiracist Research at Boston University. “There is no in-between safe space of ‘not racist.’ The claim of ‘not racist’ neutrality is a mask for racism.”

For health professionals, practicing anti-racism in healthcare starts with understanding their position in a racist society and in a system with a history of medical discrimination. 

Going further, anti-racism entails “taking stock of and eradicating policies that are racist, that have racist outcomes, and making sure that ultimately, we’re working toward a much more egalitarian, emancipatory society,” as scholar and professor Malini Ranganathan put it in a 2020 Vox article that breaks down anti-racism. 

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Centuries of racism have profoundly harmed the health and well-being of communities of color in the United States. In April 2021, the Centers for Disease Control and Prevention (CDC) declared it a “serious public health threat,” and research continues to affirm this reality.  

Racism influences an individual’s housing, education, wealth and employment status—often called social determinants of health. In turn, these conditions drive health inequities between white and non-white groups of people. 

The disproportionate impact of COVID-19 on communities of color helps illustrate the overall racial disparities in healthcare.

FOR EVERY 100,000 PEOPLE, HOW MANY PEOPLE WERE HOSPITALIZED FOR COVID-19 BY RACE GROUP (ADJUSTING FOR AGE)?

Covid-19 Deaths

Go to a tabular version of this data.

Further examples of institutional racism in healthcare abound. Black patients were 40% less likely than white patients to receive analgesics for acute pain and 34% less likely to be given prescriptions for opioids, as reported in a 2019 analysis of 14 previously published studies on emergency departments. 

For every 100,000 live births, the most recent CDC pregnancy mortality data from November 2020 reports 41.7 deaths for non-Hispanic Black women and 28.3 deaths for non-Hispanic American Indian or Alaska Native women. By comparison, the mortality rate fell between 11 and 13 deaths for Hispanic or Latina women and non-Hispanic White and Asian or Pacific Islander women. 

For all these reasons, racism is a public health emergency. Health professionals and students have a key role in addressing these racial disparities in healthcare. 

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Practicing anti-racism as a health professional requires first understanding that racism operates on multiple levels. Camara Phyllis Jones’ framework proposes that racism has three specific levels (PDF, 228 KB): internalized, personally mediated and institutionalized. The latter form is often hidden.

“Many times, institutional practices have been so ingrained in the tradition and fabric of our organizations that it is extremely challenging to see the problems that are, and have been, right in front of us,” as described in a 2020 Nursing Outlook article on institutional racism. 

The following list of anti-racism resources for healthcare professionals can help individuals combat racial bias within themselves and in their interactions with others, as well as recognizing discrimination in nursing and other fields. Fighting racism at the systems level often requires a group, as well as institutional support and investment. The following action steps are guideposts that health leaders may consider.

How to Introduce and Implement Anti-Racism Efforts in Nursing and Healthcare

FIRST, LAY THE FOUNDATION

Activists in health organizations can start combating institutional racism by laying a foundation. Consider the following action steps:        

• Define the problem(s), and set clear goals.
• Incorporate shared anti-racist language in daily communications.
• Establish support from leadership.
• Dedicate funding and resources.
• Bring in expertise where needed.
• Create ongoing, meaningful partnerships in the community.  

NEXT, BEGIN A MULTI-LEVEL AND LONG-TERM APPROACH

With this foundation, health professionals can build a culture of anti-racism and begin (or continue) meaningful anti-racist work in their communities. Action steps for health organizations may include: 

• Learn about the legacy of slavery in the American health system. 
• Create a network of leaders to oversee anti-racism work and give them support.
• Provide training and education focused on anti-racism in healthcare. 
• Re-evaluate policies through an anti-racist lens and implement changes as necessary. 
• Develop an accountability structure for reporting racism, giving feedback and intervening.  
• Use the health system’s resources to address structural barriers to care, such as transportation or finances. 
• Update the selection process for boards of trustees to prioritize inclusivity. 
• Back scientific research that focuses on addressing and eradicating racism.

Sources:
Hassen, Nadha, et al., “Implementing Anti-Racism Interventions in Healthcare Settings: A Scoping Review,” International Journal of Environmental Research and Public Health, February 3, 2021. Accessed on August 6, 2021.
Legha, Rupinder Kaur, “Teaching Antiracism to the Next Generation of Doctors,” Scientific American, October 21, 2020. Accessed on August 6, 2021.
South, Eugenia C., Butler, Paris D., & Merchant, Raina M. “Toward an Equitable Society: Building a Culture of Antiracism in Health Care,” The Journal of Clinical Investigation, July 21, 2020. Accessed on August 6, 2021. 

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For health professionals and leaders seeking to learn more about anti-racism in healthcare, the following articles, books and organizations—some of which may offer anti-racism training—can help. 

These articles can educate health professionals and students on historical racism in the medical system and healthcare discrimination. 

Achieving Health Equity Through Eradicating Structural Racism in the United States: A Call to Action for Nursing Leadership
Authors: Deena Nardi, Roberta Waite, Marian Nowak, Barbara Hatcher, Vicki Hines-Martin, and Jeanne-Marie R. Stacciarini

Changing How Race Is Portrayed in Medical Education: Recommendations From Medical Students
Authors: Edwin Nieblas-Bedolla, Briana Christophers, Naomi T. Nkinsi, Paul D. Schumann, and Elizabeth Stein

Drawing on Antiracist Approaches Toward a Critical Antidiscriminatory Pedagogy for Nursing
Authors: Amélie Blanchet Garneau, Annette J. Browne, and Colleen Varcoe 

Getting Our Knees Off Black People’s Necks: An Anti-Racist Approach to Medical Care
Authors: Rupinder K. Legha, David R. Williams, Lonnie Snowden, and Jeanne Miranda

“I Can’t Breathe”: A Call for Antiracist Nursing Practice
Authors: Kara S. Koschmann, Noelene K. Jeffers, and Omeid Heidari

The Impact of Racism on Child and Adolescent Health
Authors: Maria Trent, Danielle G. Dooley, and Jacqueline Dougé

Race, Research, and Women’s Health: Best Practice Guidelines for Investigators
Authors: Luwam Ghidei, Anne Murray, and Janet Singer

Race, Racism and Health: Disparities, Mechanisms, and Interventions
Authors: Elizabeth Brondolo, Linda C. Gallo, and Hector F. Myers

Rooting Out White Supremacy and Implementing Antiracism in Nursing Education
Author: Amie M. Koch

Systemic Racism and U.S. Health Care
Authors: Joe Feagin and Zinobia Bennefield

Teaching Antiracism to the Next Generation of Doctors
Author: Rupinder Kaur Legha

Toward the Abolition of Biological Race in Medicine: Transforming Clinical Education, Research, and Practice
Authors: Noor Chadha, Bernadette Lim, Madeleine Kane, and Brenly Rowland

Understanding Racism as a Historical Trauma That Remains Today: Implications for the Nursing Profession
Authors: Roberta Waite and Deena Nardi

These books on race, racism and injustices in the health field offer perspective for students entering the field and professionals already in it.

The Beauty in Breaking
Author: Michele Harper
Memoir of a female, African American emergency room physician covering systematic disenfranchisement and her personal journey of healing. 

Black Man in a White Coat
Author: Damon Tweedy 
Memoir of a Black physician, exploring the challenges faced by Black doctors and the disproportionate health burdens carried by Black patients.

Breathing Race Into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics
Author: Lundy Braun
Narrative history of the spirometer, a medical instrument, that helps illuminate the ways medical instruments “naturalize racial and ethnic differences.”

Fatal Invention: How Science, Politics, and Big Business Re-Create Race in the Twenty-First Century
Author: Dorothy Roberts
Nonfiction book on how the myth of race as a biological concept continues to create inequalities and harm to non-white individuals. 

Heavy: An American Memoir
Author: Kiese Laymon
Coming-of-age memoir of a Black boy in Jackson, Mississippi, that explores class, race, weight, eating disorders and sexual violence to highlight national, systemic failures. 

The Immortal Life of Henrietta Lacks
Author: Rebecca Skloot
Nonfiction, bioethics narrative about Henrietta Lacks, whose anonymized cells became an extremely lucrative human biological material, and her descendants, who never received any profits. 

Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present
Author: Harriet A. Washington
A history of the mistreatment of Black Americans by medical practitioners, which is considered as context for their mistrust of health researchers today. 

The Morehouse Model: How One School of Medicine Revolutionized Community Engagement and Health Equity
Authors: Ronald L. Braithwaite, Tabia Henry Akintobi, Daniel S. Blumenthal, and W. Mary Langley
A how-to book exploring the partnership between the Morehouse School of Medicine and their community, detailing the ways in which they are improving health equity. 

The Racial Divide in American Medicine: Black Physicians and the Struggle for Justice in Health Care
Author: Richard D. deShazo
Nonfiction book documenting the struggle for health equity among Black physicians, linking current racial disparities in healthcare to a history of segregation, neglect and mistreatment. 

The Science of Health Disparities Research
Editors: Irene Dankwa-Mullan, Eliseo J. Pérez-Stable, Kevin L. Gardner, Xinzhi Zhang, and Adelaida M. Rosario
Textbook that presents policies for addressing the diseases, disorders and poor health outcomes that more often affect minority population groups and individuals from socially disadvantaged communities. 

Stamped From the Beginning: The Definitive History of Racist Ideas in America
Author: Ibram X. Kendi
Nonfiction book exploring the history of racism in America and a guide for individuals to practice anti-racism in their daily lives. 

These nursing and medical organizations are dedicated to promoting social justice and health equity throughout the United States. 

African American Policy Forum
American College of Epidemiology
Asian American/Pacific Islander Nurses Association
Capitol City Black Nurses Association
Healthy African American Families
National Alaska Native American Indian Nurses Association
National Association of Hispanic Nurses
National Association of Indian Nurses of America
National Black Nurses Association
National Commission to Address Racism in Nursing
National Nurses United
North Carolina Environmental Justice Network
Nurses for Social Justice
Nursing Community Coalition
Pennsylvania Action Coalition
Philippine Nurses Association of America
Society for the Analysis of African American Public Health Issues
Texas Nurses Association
The Spirit of 1848 Caucus

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The following section contains tabular data from the graphics in this post.

Source: “Disparities in Deaths from COVID-19,” CDC, December 10, 2020. Accessed August 6, 2021.

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Last updated August 2021.