In November, the American Medicine Association passed a monumental policy, declaring for the first time that racism was a public health threat. In its declaration, the AMA recognized that racism was a systemic problem, even in medicine, that it caused harm to marginalized communities and society, and that they are committed to combatting racial inequities.
It was a historical moment that would not have been possible without the advocacy of brave medical students, who, since June of 2019, have put their careers in jeopardy, to combat racism in medicine.
I spoke with one of the medical school students that fought for this cause, Faith Crittenden. Faith is 4th year medical student at the University of Connecticut, where she is pursuing her master’s in public health with a focus in pediatrics.
As a Black woman that grew up in Connecticut, Faith developed a passion for fighting for health equity, inclusion, and pipelines for Black and Brown physicians.
We spoke about AMA’s historical decision, what it took to push the AMA to pass the policy and how to she hopes to hold the AMA accountable to combatting racism in medicine and society.
What does it mean that American Medical Association recognizes racism as a public health threat?
Faith: There’s lots of people that don’t know history of medicine and don’t understand the history of this moment. AMA was created in 1847, this was first org for modern medicine. They set the rules of how we do medicine in this country, they created what we know medicine to be.
When the AMA was created, we had lots of Black medical schools in the country. We had 13 or 15 schools that taught and trained Black physicians. In 1910, they wanted to create schools that met this standard…Abraham Flexner was commissioned to evaluate the quality of the medical school. If everyone does not meet the standard of the best medical school, which was John Hopkins, he thinks it’s a crappy medical school.
It was the first time that things were valuated and he looked at the 13 Black medical schools. [His valuation was] an interesting way of how he viewed race and how Black physicians’ purpose is to keep Black people in line—they are not true physicians, but are sanitizers. The belief that Black Physicians aren’t prevalent in the U.S., and only in Black communities, is because those are Black conditions and their job is to keep those diseases away from the rest of the population. He thought the standards that they are doing it are subpar, even though they were doing great work. One physician would treat 1000 patients in that era!
What were the direct consequences of Flexner’s evaluation of Black physicians and medicine?
Faith: When he wrote those terrible things about the schools, instead of 13 Black medical schools, we had two: Howard School of Medicine. Meharry Medical College in Memphis. Today, there are currently four historically Black medical schools: Morehouse, Meharry, Howard School of medicine and Charles Drew University of Medicine and Science, which is its own entity, under the UCLA system, named after one of the first Black physicians.
The outcome of 13 schools to only two in the country was astounding—Morehouse didn’t come until later. Going from that, we start seeing a shift on why we don’t have many Black physicians. Flexner’s report is a result of that.
Why did the AMA now suddenly decided that it was time to address racism in medicine and public health?
Faith: There was a report in July talking about how the effect of closing 5 medical schools cost 39,000 physicians in the country. In 2008, the AMA came out with an apology to the Medical Association, Black Physician Association. In the beginning, the AMA would not let Black physicians in at all. If you were Black, you got in with your medical society or state society for physicians.
They let them in for membership, so if your medical society didn’t accept, you had no physicians. Since the AMA represented everyone, there were no Black physicians present. This is significant because the AMA lobbies senators and representatives and Black health is on the back burner. That led to the creation of the Black Physician Association.
In 2018, the AMA apologized for how they treated Black physicians. They said that they would remove all railroads blocking the way for more Black physicians. It was an apology, but there was no action.
It left me and other medical students like, “You apologized, but you’re the third biggest lobbying group in the country.” When it comes to ACA and other issues, Obama had to get blessing from the AMA. This is an org that has a say in things, yet they did not take more action on disparities.
Medical students were frustrated at these blank apologies. How did you mobilize to push the AMA to address the disparities?
Faith: We said it was important that the AMA take a stance on racism. We were like we are going to do it. We didn’t think about history, we weren’t sure it was going to happen, we are not blind to the fact that race plays in Black, indigenous, Latin X communities. Everyone lives it, but it definitely impacts Black Americans’ life.
We started a coalition, well before the political climate where people didn’t want to talk about racism [before the uprisings of 2020]. We said this could destroy our career or something that helps us.
There’s three sections in the AMA: the medical school. Young physicians and what I like to call the old heads of medicine. The medical school section, many of them are med school students and were afraid. Some people want to say that racism is a social construct and not biology. To the common person that might make sense, but in modern medicine that’s not a thing. Racism is not even in medical books.
We wanted to say that racism is a factor in how we are treating medicine and that racism played a huge role in how we work with patients. Racism is violence. We are saying that you’re not racist, but medicine is racist. How we are creating physicians and treating patients is done with care, we can’t act like it’s not there. Folks were like y’all are crazy.
We brough this argument forth in 2019. We convinced many medical students that it was worth it. It was before the coronavirus and before the Black Lives Matter movement, and it just happened. If this work is published, we want to give it to women of color, Black women, physicians, to make sure we tackle race disparities with medicine.
How did you get so many folks to support you in this fight, when so many were concerned for their well-being and future?
Faith: At that point in 2019, we had cited 50 physicians to support our claims. We had to have some research for some folks. That was one thing that we were proud of. The next step is bringing it to the house of delegates, which is the main body of the AMA. Before the pandemic and BLM, we knew we had a fight coming, we needed more sources. We added more sources to our policy, and at the end of the day we had 100 sources.
We were going to combat everything that they throw to us. I’m happy that corona and police brutality aspect did happen. it made it easier for us to bring it physicians that turn a blind eye to it—they could no longer do it. Still, it’s sad that we had to show how COVID-19 was impacting Black and Latin X communities. It was sad to show that Black folks were dying. Unfortunately, that’s what moved the room.
We also talked about former AMA president, Dr. Patrice Harris, who came out with statement on police brutality, and that made it easier to talk with other physicians about racism in medicine. When we brought policy to the room in November of 2020, we had a policy that said that racism isn’t just a public health issue. Our policy is one of the moving policies right now, helping to think of anti-racism medical curriculum in medical school.
Physicians must take them to be physicians, that racism is no longer social construct in medicine, there’s other policies like recognize that police brutality is a form of racism. Many folks who weren’t in AMA must now speak and lobby for antiracism legislation within our congress.
Tell me about your med student coalition that joined you in this fight? Were they mostly Black students, POC, white students?
Faith: There was lot of us. The main writers were myself, Rohan Khazanchi and Anna Heffron. It was a mixed bag and not just Black kids. In order for us to do great policy, you must have buy-in from different races. I’m a Black kid in Connecticut, Rohan and Indian kid in Nebraska and Anna, a white woman, in Wisconsin. We said that we needed to do this, who cares if this impacts our careers and nobody hires us.
We submitted the medical school students in June 2019, our annual meetings are in June. It has to pass to one section first, before the House of Delegations. In June 2019, it passed the medical students and then it was brought to the house of delegates of medical student residents and old heads.
Before we wrote the policy, we had to touch base with the AMA anytime our lawyers or people were speaking on behalf of AMA. They had to review our policies for our stances. Only two policies throughout the policy digest, 1000 pages, said the word racism, twice. It was something that had to be done. We had many things on health disparity.
Third step is the implementation, the policy is the will of the house and of the AMA. It was so unanimous, for all the policies we had over 400 delegates, and we have roughly 500 delegates. It’s important to note that the will of the house will never be overturned.
We are taking it to AMA staff now, it’s their job to take what we say and make it policy. If Biden calls us up or VP Harris, we now have policies for how we can do this in medical sphere. We can talk about lobby certain legislation on that, which is huge. When the AMA speaks everyone listens.
As a Black med school student working to becoming a medical professional, what does this mean for you and your patients?
Faith: This was the foundational policy. We have others in line. Foundationally, when we talk about Black and Brown communities, we have something that says this is what you said and it passed.
Day to day life with patients, one thing with policy as activist and healthy policy, it sucks how slow it is. It will take time to see the impacts for patients, but it will shift mindsets among physicians. For so long that racism didn’t impact biological problems. If someone’s kidney function or lung function that were based on the belief that made Blacks feel inferior to Whites.
Having that policy now, taking out race corrections in how we look at people’s health will be the first step to help the average patient. It will help with certain communities, like Black women with maternity. We had Serena Williams and Beyoncé talk about their challenges with their pregnancies.
We have to consider now the public health focus. How is the environment they are living impacting their health? How is police brutality and violence stressing children, and impacting outcome of the birth? That wasn’t a conversation before and also dealing with how people of color are treated in general by health care system.
We need to have those conversations. You can’t write that this person is combative in notes, but you won’t say that this white person combative for seeking extra treatments.
With this decision passing, could we see a rise of Black and Brown physicians in the future?
Faith: The concept that I don’t see race or color belief is prevalent in medicine. If you can’t see color, then how can you see your patients, because that is who they are. Medical education, increasing and broadening the pipeline, we know that we don’t have enough Black, Brown physicians.
We need to be making sure that any legislation coming from congress that we don’t increase defunding for pipeline programs, making sure the fed is staying true to word and having Black and Brown physicians.
You need to know politics, not because you want to be political, but your life is political. Our lives are always at stake, especially in medicine and health care. Lots of heath care passed, expansion of ACA, Medicare was made to help POC and low-income White people.
This is a great first step, but what comes next?
I tell people of color in the AMA, I need you to be there. I’m not saying that their efforts are futile, but your voice are needed. I need you to bring up policy ideas that I might not be thinking about. We can create as many policies that we need—racism is so insidious in us and in medicine that we could create so many things to address. This is just the foundational piece; it may take a generation or two to address all the issues in medicine.
I started to bring students into AMA, folks that were activist, come to the table. Bring the knowledge of the streets into the room. The civil rights movement was important, because folks was in the streets and in the room where decisions are made. You must be able to do both.
History is made behind closed doors, if you are not there where the conversation happens, you are missing out on so much. In order for us to keep the AMA accountable, we have to be present to change it. Does it mean we are pissing off conservative folks? Yeah, but it’s to make things better. I’m doing it for poor white people and other POC too—their health is being compromised every time things aren’t addressed.
We are fighting for resources, but if we uplift the health of everyone—we are the greatest country in the world—if we help everyone, then health resources could be shared with everyone. You have to be willing to change the mindset at the end of the day!
My next big thing and it’s my baby is National hair discrimination. This should be heard in June 2021. I know there is policy about hair discrimination in the U.S. congress, but its stalling. I hope the AMA will support legislation for our country and say hair discrimination is unacceptable.