School of Public Health MD/MPH student Rohan Khazanchi and co-authors wrote a post for the journal Health Affairs that briefly outlines the American Medical Association’s (AMA) historical role in exacerbating health inequity in America, highlights recent grassroots efforts to move the organization forward, and defines steps the medical community and policymakers can take to move from antiracist declarations to tangible actions.

“While many cities, states, organizations, and more have recently declared that racism is a public health crisis, we emphasize that the many ways in which our healthcare system continues to fail our patients and communities underscores the necessity to move beyond declarations of support,” says Khazanchi.

The authors point out that the history of the AMA is rife with examples of structural racism, ranging from the organization’s exclusion of Black physicians from its membership for more than 100 years to opposing the introduction of Medicaid and Medicare in the mid-twentieth century. 

“The organization is still among the most powerful lobbying groups in the United States — and its policies continue to be directly informed by its membership, its leadership, and its democratic House of Delegates,” says Khazanchi. “We explicitly name and acknowledge the history of the AMA because understanding the history is an imperative first step to moving the organization forward.”

In 2020, Khazanchi and two of the article’s co-authors were medical student section delegates to the AMA’s House of Delegates. Alongside a grassroots coalition of delegates spanning multiple states and sections, the students organized a successful effort to pass multiple landmark resolutions calling on the AMA to address the many results of racism on health, health care, and medical education. 

“These new AMA policies explicitly name and address racism as a public health threat, denounce and combat racial essentialism in medicine by addressing the misuse of race as a proxy for biological traits, and recognize police brutality as a manifestation of structural racism,” says Khazanchi.

The authors say there are a number of next steps the medical community and policymakers should take to substantively address the harms of racism on health: 

• Explicitly name and address structural root causes of health disparity in medical education; reevaluate aspects of clinical practice that are rooted in a scientifically inaccurate understanding of race as biology; intentionally advance health equity through iterative evaluation of patient safety and quality metrics; and dismantle systemic business practices, such as hospital price discrimination, which deepen inequities in health access and outcomes.
• Prioritize equitable resource allocation in governmental relief measures to help communities economically rebuild after the COVID-19 pandemic; reverse policies, such as Medicaid work requirements and reproductive health exclusions, which disproportionately and adversely impact access to care for marginalized groups; reform payment and care delivery systems to better address social and structural determinants of health; enact regulatory interventions to reduce price divergence and curb provider consolidation; and invest in efforts to diversify the healthcare workforce.

“Overall, we need to embrace a ‘health and equity in all policies’ perspective which explicitly recognizes the relationships between institutional practices, governmental policies, and the health outcomes of marginalized populations,” says Khazanchi.

Khazanchi is an MD/MPH dual degree student advised by Assistant Professor Bill Lohman. Khazanchi was recently profiled as a Student of SPH. He and his colleagues wrote this Health Affairs Blog piece with mentorship from Aletha Maybank, chief health equity officer and senior vice president at the AMA.