FOR IMMEDIATE RELEASE
October 18, 2022
Contact:
Michael K. Frisby
202-625-4328
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HEALING ARC FRAMEWORK APPLIED TO NYC ANALYSIS OF RACISM IN CLINICAL ALGORITHMS IMPACTING PATIENT CARE AND TREATMENT
Coalition Targets Clinical Algorithms Based on Debunked Race & Ethnicity Theories
BOSTON – The New York City Health Department is building in the Healing ARC framework to help shape initiatives that confront explicit and implicit racism in medicine and improve equity in patient care. The Healing ARC (Acknowledgment, Redress, and Closure), which encourages race-conscious interventions, was developed to eliminate an inequity in patient care delivery for heart failure at Brigham and Women’s Hospital (BWH) in Boston.
With guidance from The Healing ARC and other reparative paradigms, the NYC Health Department is prioritizing health justice, including leadership of the Coalition to End Racism in Clinical Algorithms (CERCA). Specifically, this coalition of 11 health care providers is examining the use of race and ethnicity in clinical algorithms that can play central roles in patient care decisions. But race modifiers in these algorithms are frequently based on debunked, racist theories, leaving patients with delayed and compromised treatment.
“Racism exists throughout medical research and healthcare systems in the U.S., diminishing the health outcomes of people of color,” said Dr. Bram Wispelwey, Instructor in Medicine at BWH and Instructor at the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health. “It’s critical that entities, like CERCA, work to eliminate the embedded racism that fuels discriminatory behaviors, protocols and patterns that shape patient care.”
The CERCA report cited several examples of harmful race-based equations:
- Until recent shifts in national guidelines, equations to estimate kidney function ascribed a healthier “adjusted” value for Black patients, sometimes delaying necessary care, such as kidney transplants.
- Race modifiers in pregnancy-related tools have disparately increased the likelihood of receiving a repeat caesarean section for Black and Latino pregnant people, potentially exacerbating birth inequities.
- Race-specific reference equations are used to assess the lung capacity of Asian, Black, and “Caucasian/Other” individuals, insinuating the presence of intrinsic racial differences in lung biology where none exist.
“Research over decades has demonstrated that the human genetic variation cannot be meaningfully categorized within socially and historically derived racial categories, but far too many diagnostic algorithms and practice guidelines continue to biologize race by modifying their outcomes based on race or ethnicity,” said Dr. Wispelwey, a leader of the Healing ARC Campaign, which seeks to expand implementation of the Healing ARC framework and other race-conscious interventions at hospitals and healthcare systems to eliminate racism in patient care.
Dr. Wispelwey and Dr. Michelle E. Morse, who is Chief Medical Officer and Deputy Commissioner for New York City’s Health Department and Assistant Professor at Harvard Medical School, and others developed the Healing ARC framework after their study at BWH in Boston found a pattern of inequity in the treatment of heart patients.
Over a 10-year period, on average, fewer Black and Hispanic patients diagnosed with heart failure in the BWH Emergency Department were admitted to the specialty cardiology unit that improves patient outcomes. Under a pilot program at BWH, when the emergency room treats a person of color with heart failure a new, more equitable, process is in place. Today, when an emergency room physician selects general medicine admission for a Black or Hispanic heart patient, the clinician receives an alert through the electronic health record system reminding of the option to admit to cardiology.
Prominent health professionals, community leaders, and healthcare equity advocates recently launched The Healing ARC Campaign to educate hospital administrators, lawmakers, social justice advocates and communities about the value of race-conscious interventions. The campaign is urging hospital administrators, lawmakers, social justice advocates and communities to support interventions inspired by The Healing ARC, as NYC is doing.
The CERCA report said the Healing ARC framework “can guide institutional racial equity initiatives to ensure harms resulting from structural racism are remedied and that patients experience equitable improvement in care and outcomes. The Health Department will explore the use of Healing ARC with CERCA members and patient advocacy groups as part of continued work around ending racism in clinical algorithms.”
CERCA is creating a model for holding the scientific community accountable to actual research, not debunked race theories. In doing so, CERCA is examining the “norms” of clinical algorithms that make biological distinctions by race when none exist. It is a public health issue that impacts not just individual patients, but entire communities for generations.
Dr. Michael Wilson, an Associate Physician of Emergency Medicine Associate Physician at BWH and an Instructor Harvard Medical School, said that health equity cannot be achieved without eliminating “racial essentialism,” a belief in innate biological differences between racial groups.
“For centuries, this wrong ideology has shaped science and somehow managed to persist in medical education and clinical practice,” Dr. Wilson said. “Chronic diseases from diabetes to hypertension and lung disease have racial inequities in incidence and impact and clear environmental and structural etiologies. Yet, their racialized outcomes have frequently been misattributed to intrinsic genetic or biological susceptibility or ‘bad choices.’”
About the Healing ARC Campaign
Our campaign educates hospital and healthcare system administrators, lawmakers, social justice advocates, civic and community leaders about the effectiveness of race-conscious interventions, such as those implemented under the Healing ARC framework. By implementing applications under the Healing ARC framework, America can prevent inequities in healthcare and improve the quality of life for many families and individuals.