What could reparations in medicine look like?
There was not a single day over the past four years when I felt as though medical school was teaching me the right medicine — a justice-driven medicine, a community-based medicine, a sustainable medicine, a grounded-in-the-messiness-of-reality medicine, an anti-racist medicine, a radical medicine that dared to question or even remember its historical and socioeconomic foundations. Nearly all calls to learn a liberatory medicine were consistently silenced with an ease and completeness that was impressive in its efficacy, and exhausting. What, exactly, this liberatory medicine we wish we had learned could or would look like is a topic on which myself and some of my peers reflect constantly, and about which I have many more questions than answers.
Can we reform our current system of healthcare or healthcare education into one that is just, or must the shift be more paradigmatic and foundational than a liberal framework of incremental, pacifying, “token concessions” has the potential to produce (Delgado & Stefancic, 2012, p. 146)? Under capitalism, can our medical system be anything other than profit-driven and thus inherently exploitative, and how do we (or do we have to?) triage racial justice in relation to the intertwined work of class mobilization (particularly if we tend more toward a materialist or mixed over a purely idealist lens)? Do we treat the fact that most if not all progress toward a more anti-racist/racially just society is explicable in terms of interest convergence as a shameful reflection of the self-serving tendencies of individuals and groups that possess political and economic capital, or a reality (sans moral judgement) that may be exploited as an organizing tactic (p. 147)? If the latter, are we dooming racial justice projects and movements to transience or vulnerability to corruption, cooptation, and sanitization over time? That is, if racial justice (or any anti-oppression) work is accomplished by its alignment or attachment to the actions that those who possess power reliably take to maintain their hegemony, are victories of this work inherently unsustainable or tainted because of the amorally-driven forces to which they are tied (p. 19–42)? Is there an equally efficacious but more ethical or sustainable and still reality-rooted option? From within a system that largely fails to provide adequate or critical education surrounding social determinants of health, how do we, as future providers, learn to employ medicine to achieve justice on fronts that undeniably impact the health of our patients and providers, but occur outside of clinics and hospitals — e.g., police brutality, mass incarceration, food and housing instability/predation, racialized health disparities (in the absence of a collective ability within medicine to acknowledge the social construction or race, nor name the material and structural existence of racism)? In the setting of a brutal and well-documented (but too infrequently-acknowledged) history of exploitation and abuse of people of color within American medicine (Washington, 2008), in what forms could reparations manifest, specifically in the context of medicine? Do reparations have the potential to engender fundamental structural shifts in the distribution of power, health and disease both among those who practice medicine and those who access medical care, or is their potential power only symbolic or substantive via a purely idealist lens?
This is a significantly truncated version of my growing string of questions that cycle and morph as I learn more conceptual, contextual, and linguistic tools to process the patterned manifestations of racism and intersecting systems of oppression in which I find myself embedded in the world of medicine. Reparations, specifically in the context of medicine, is one topic I find particularly compelling, as I understand their practical application as possessing the potential to be multifaceted, and their conceptual foundation as bridging the materialist-idealist/structural-symbolic divides. Broadly defined, we can think about reparations as representing “the full acceptance of our collective biography and its consequences … more than recompense for past injustices — more than a handout, a payoff, hush money, or a reluctant bribe … a national reckoning that would lead to spiritual renewal” (Coates, 2014).
What if we employed this conceptual and material framework in our efforts to fundamentally shift the power and resource distribution and disseminate a broader education surrounding the deeply racist history on which medical institutions lie? What if this consisted of employing crowdsourced mobilization to (symbolically begin to) pay financial reparations to students of color in acknowledgement of profound historical abuses, as students at Georgetown University recently voted to do as reparations for the slavery that ensured their institution’s survival (Desai, 2019)? What if this act served not only to pressure our more monied administrators and professionals with whom we work to bolster these funds to meaningful levels, but also to shine light on the need for radical curricular evolution in order to even understand why a body of students might opt to increase their own tuition for this purpose? What if reparations looked like replacing the dominant narratives (or entirely absent histories) with totally accessible (but uncomfortable and thus usually avoided) counternarratives, and using these histories to inform critical discussion of why our classmates and faculty are mostly white, why our patients of color may be hesitant to access birth control or enroll in clinical research trials, how the racialization of the glomerular filtration rate is based on faulty science and has devastating consequences for those classified as black, how genetic arguments for race-based medicine rooted in bad science have served to promote pharmaceutical profits but not patient health (and so on)? Could this framework act as a catalyst (or at least a first step) toward the teaching of a medicine that is truly liberatory?
References
Coates, T. (2014, June 22). The Case for Reparations. Retrieved May 29, 2019, from https://www.theatlantic.com/magazine/archive/2014/06/the-case-for-reparations/361631/
Delgado, R., & Stefancic, J. (2014). Critical Race Theory An Introduction, Second Edition. NYU Press.
Desai, S. (2019, April 19). The First Reparations Attempt at an American College Comes From Its Students. Retrieved May 29, 2019, from https://www.theatlantic.com/education/archive/2019/04/why-are-georgetown-students-paying-reparations/587443/
Washington, H. A. (2008). Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to the present. New York: Anchor Books.
