Reaching Equity Resources

Repeated Cesarean births increase maternal morbidity, and Black and Hispanic patients face increased danger due to the inappropriate inclusion of race/ethnicity in VBAC probability calculations. These calculators give lower scores for non-white people which often results in VBAC not being offered to qualified patients. Visit the resource page and display posters in your office.

Disease knows no borders, and one of the most important tools in our public health arsenal is information. Global Health Lives is a podcast exploring some of the most important issues in global health from the perspective of the people working in it. By tuning in for ~30 minutes you can get first–hand information on cutting edge global health news from people like Dr. Michelle Morse, who discussed racial justice and health equity in the episode. 

Patients’ Perspectives on Race and the Use of Race-Based Algorithms in Clinical Decision-Making:

It is now known that race is not biological, but the presence of racial bias in medicine is still prevalent, and the use of race as a variable in clinical equations contributes to existing health disparities. Race-based algorithms are discussed in academic and medical contexts – but little is known about patients’ awareness of and perspectives on these applications. Read more about this underexplored perspective here. 

February: Race-Based Diagnosis, Part 3 – ITT Episode 35:

Listen to this podcast from the New England Journal of Medicine that discusses how clinical algorithms in medicine still reflect historical White supremacy. The podcast features Dr. Michelle Morse, acting commissioner of health. It discusses the importance of re-examining clinical algorithms, the role of professional societies and health care organizations in this conversation, and how race-consciousness can rectify the harms of outdated racialized medicine. 

A race-free algorithm is merely the start for a safety net hospital confronting an onslaught of kidney disease:

Race–based clinical algorithms are harmful and lead to inequitable care for non-white patients. One Brooklyn Health, a partner in the CMO office’s CERCA initiative, recently explored how these algorithms pervade medicine and are difficult to remove from clinical practices and processes. Read more in the STAT News Embedded Bias Series.

Preventing discrimination against race, ethnicity, or language and establishing equitable care in our healthcare infrastructure is of utter importance. Discrimination in healthcare settings negative impacts patients’ health outcomes and decrease staff morale. Read more from The Commonwealth Fund and find out how you can help prevent discrimination in healthcare spaces and encourage staff to speak up.  

The American Heart Association released new sex-specific, race-free risk equations for predicting risk of cardiovascular disease events, such as stroke and heart disease. The new PREVENT equations are another example of how we can eliminate racism in clinical algorithms and stop the use of race as a biological variable – much like eGFR, VBAC, and PFT. Read more in this statement from the AHA.  

The Doris Duke Foundation announced its Encoding Equity[in Clinical Research & Practice: Rethinking Race in Clinical Algorithms] program at National Academy of Medicine on June 21st. Backed by a grant to the Council of Medical Specialty Societies (CMSS), the Encoding Equity alliance aims to assemble diverse organizational missions to urgently raise awareness of race in clinical algorithms across research and clinical world. Read more about the program and find out how you can stay informed and get involved. 

Clinical algorithms that incorporate race as a modifying factor to guide clinical decision-making have been criticized for propagating racial bias in medicine. Equations used to calculate lung or kidney function are examples of clinical algorithms that have different diagnostic parameters depending on an individual’s race. While these clinical measures have multiple implications for clinical care, patients’ awareness of and their perspectives on the application of such algorithms are mostly unknown. In 2023, The Journal of General Internal Medicine published a study on patient perspectives. Read the study and learn about patients’ understanding of race in medicine and clinical decision-making.  

ATS Publishes Official Statement on Race, Ethnicity and Pulmonary Function Test Interpretation:

The American Thoracic Society issued an official statement for clinicians explaining why race and ethnicity should no longer be considered factors in interpreting the results of spirometry, the most commonly used type of pulmonary function test (PFT). Race and ethnicity have long been considered an important component in testing and medical algorithms for interpreting test results. Many studies show that race and ethnicity do not impact results in the ways we assumed, further widening the health equity gap and hurting patients of color.  

Importance of Institutional Anti-Racism in Healthcare

The Harvard Institutional Antiracism and Accountability Project published a report of case studies identifying which organizational changes can close racial gaps in healthcare outcomes. Several case studies in the report address attempts at institutional change in the NYC healthcare landscape. Read the report to familiarize yourself and staff with the importance of racial equity in healthcare and the progress of long-term transformation. 

Chief Medical Officer’s Quarterly Updates 

Read the most recent publication of The Bridge, the quarterly newsletter from the NYC Health Department’s CMO Office. The newsletter includes updates on the agency’s strategic plan to commit to anti-racism in public health and healthcare in NYC along with patient resources and upcoming events. 

Global Health Lives is a podcast exploring important issues in global health including racial justice and health equity. The podcast discusses these issues from the perspective of folks working in the public health sector, their lives, what influenced them, and the challenges they face both professionally and personally. Listen to this episode featuring Dr. Michelle Morse, the NYC Health Department’s Chief Medical Officer and Deputy Commissioner for the Center for Health Equity and Community Wellness.  

Racial Equity in Clinical Equations, an effort led by the Doris Duke Foundation, advances health equity by interrogating the use – and misuse – of race in the design of clinical algorithms currently guiding medical care. It is the first national coordinated effort to focus on research and on providing the evidence necessary to move the field beyond the use of tools that are known to be inconsistent in their use of race as a factor. Enlisting medical specialty organizations, hospital groups, funders and others who can inform the transformation of medical thinking, Racial Equity in Clinical Equations seeks to accelerate the creation of uniform evidence-based guidelines for the use of race information in research related to the design and use of clinical decision-making tools. 

Make Maternal Health a Priority:

Black New Yorkers are five times more likely than white counterparts to die from pregnancy-related causes and two times more likely to experience serious complications from pregnancy. Read about how the New York Coalition for Doula Access can improve infant & maternal mortality. The National Association of Community Health Centers also outlines how doulas can improve maternal mental health.   

Driving Equity through New Models in Research and Implementation:

Race is included as a variable in many clinical algorithms, affecting diagnosis and treatment decisions made by physicians across the U.S. However, a lack of consistency in the consideration of race when clinical algorithms are developed is negatively impacting health equity. This report describes these issues through the lens of a meeting sponsored in June 2023 by the Doris Duke Foundation in partnership with the Gordon and Betty Moore Foundation, the Council of Medical Specialty Societies, and the National Academy of Medicine. 

The Bridge (Issue 7):
The quarterly newsletter includes updates on the Chief Medical Officer’s Strategic Plan along with links to new resources, health equity-related publications, and agency updates.  

Coalition to End Racism in Clinical Algorithms (CERCA) Two-Year Anniversary: 

Last month, the NYC Health Department celebrated the two-year anniversary of the Coalition to End Racism in Clinical Algorithms (CERCA). CERCA addresses racism in clinical algorithms. The first phase of CERCA’s efforts included a focus on kidney function, lung function, and vaginal births after cesareans, which resulted in seven health systems improving racial equity in their clinical algorithms. Read more about the next phase and CERCA’s work in this press release from the NYC Health Department. 

Preconception HbA1c levels in adolescents and young adults and adverse birth outcomes:
This 2024 article found positive associations between prediabetes and increased likelihood of maternal cardiometabolic morbidity and excess maternal risk at first birth.

New York City’s Public Health Approach to Reexamining Race-Based Clinical Algorithms:

This article is about the NYC Health Department-convened Coalition to End Racism in Clinical Algorithms (CERCA), a model for collaboration between public health and health systems to de-implement race-adjusted clinical algorithms and implement systems-level change

Watch the keynote presentation from the inaugural Anti-Racism in Medical Education Symposium that provides an expansive background on racism and bias in medicine and medical education. The speaker, Dr. Malika Fair is the Senior Director of Equity and Social Accountability at the Association of American Medical Colleges.   

Genomic supremacy: the harm of conflating genetic ancestry and race:

Last month’s resource taught us about difference of genetic ancestry and race in research. This month’s article from BioMed Central discusses the impact of that research on clinical algorithms regularly used to treat patients.  

CERCA: Ending the Use of Race in Clinical Algorithms Radio Interview: 

On a recent episode of “THE MEASURE OF EVERYDAY LIFE” on Measure Radio, our NYC Health Department colleague Adriana Joseph had a very insightful and informative interview regarding CERCA. The episode is available online now here: https://measureradio.libsyn.com/ending-the-use-of-race-in-clinical-algorithms.  

Genetic Ancestry in Precision Medicine is Reshaping the Race Debate:

Research helps us understand diseases and patterns to develop treatments. The field of precision medicine looks specifically at genetic variation to increase treatment efficacy. In such precise research, it is imperative to recognize the important difference of race and genetic ancestry. Read this article from Proceedings of the National Academy of Sciences of the United States of America (PNAS) that details the specific differences between race, ethnicity, and genetic ancestry and why it is important to include more genetic diversity in medical research. 

Assumptions about a patient’s race can be detrimental to their care and clinical outcome. In 2020, the AMA House of Delegates voted to adopt policies that recognize race as a social construct, rather than a biological one. Treating patients through the lens of race as a biological construct exacerbates health disparities and inequities. Read the 2020 press release from AMA to learn about the updated policies and their intended impacts on medical education and recommendations for research and clinical practice.  

Despite the fact that race is a social construct – not a biological predictor – race continues to be a part of clinical algorithms and decision–making tools in healthcare. Read this brief from Kaiser Family Foundation to learn about the history of race and implicit bias in medical decision making and its implications for health equity.  

In 2021, the New York City Board of Health declared racism as a public health crisis. Understanding the history and current state of structural racism is imperative to working to eliminate it. Without addressing racism in our communities and work, we cannot address the health of our community members. Learn about the impacts of structural racism and potential solutions the journal, Circulation (December 2020),  from the American Heart Association. Access to Circulation is free.  

There are long-standing, unjust wealth gaps between racial and ethnic groups. Created by the history of enslavement and structural racism, wealth gaps have major implications for health equity, chronic disease, life expectancy, and COVID-19 impacts. We must address these injustices. For over a year, authors from the NYC Health Department and partners worked to develop a report exploring the racial wealth gap and health inequities, Analyzing the Racial Wealth Gap & Implications for Health Equity. 

Read more about the NYC Health Department’s commitment to anti-racism in healthcare.