Cayman Cardiff - Tricia C. Elliott

Addressing Racism and Advancing Health Equity in and Beyond the Exam Room

Dr. Tricia C. Elliott addressed health equity and I loved every minute of it. Dr. Elliott is in Family medicine and focuses on primary prevention, chronic disease management, women's health, migraine management, ambulatory procedural training, patient education, and community medicine. She is truly an amazing person and in her presentation she started quickly and efficiently with addressing systemic racism. She quoted MLK Jr. by saying "of all the forms of inequality, injustice in healthcare is the most shocking and inhumane." I agree... That is why my entire focus in life has shifted to one of addressing social discrepancies in the healthcare system and finding solutions to create just and equitable healthcare for all peoples. Dr. Elliott defined race as a social construct based on skin color and other physical differences with no biological or genetic basis, she even noted that there is more genetic variation within any given race/ethnic group than between and race and or ethnic groups. She went on to define racism as a "social belief" that different races possess distinct characteristics, abilities, or qualities, especially so as to distinguish them as inferior or superior to one another. I loved her definition of racism because it reiterates the point that it is a social construct. Later Dr. Elliott defined health disparities as preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that may result in excess morbidity and mortality for a group of people; they are social and economic. Her response was to show that when it comes to disparities it is not about equal opportunity but about equitable or just opportunity. Dr. Gita Suneja also made the same point and demonstrated it with an amazing graphic!

I love this graphic because it shows that equity, which helps give people better outcomes and outcomes that seem to be fair, does not actually address the root cause of the issues. Justice is what can actually create a change and we can take it one step further by providing liberation which could actually allow everyone access regardless to their situation by in this case removing the fence all together. Dr. Elliott posed the question, "where do we start?" She answered by saying that we need to know the history of structural racism. If you want to inform yourself on that history read Caste by Isabel Wilkerson, it played a very important role in our class this semester and addresses the how and why and what to do about systemic racism in our country! Dr. Elliott goes on to instruct that we need to know and train ourselves, know the community's history and resources, know your team (if you are in a healthcare setting), and then when in the exam room it is necessary to make the implicit, explicit. She explained that last one by saying we need to create a safe ad welcoming environment for patients by celebrating identity, culture and the social determinants that make them unique.

Later she goes on to describe the importance of making partnerships with the right groups, including identifying businesses and organizations actively engaged in anti-racism. She also described that there are public health agencies, governmental agencies, police departments, schools, faith based groups, community advisory boards and patient advisory boards that will open doors and break down barriers if we make the right connections. Then she explicitly reiterated the importance of reaching out to elected officials to make policy change and that is where I firmly believe our efforts should double down. we need to make changes to policy locally and within our states and the federal government. The upstream determinants are the root causes and will make a difference and get rid of the inequity when addressed.

We need to work as a nation to undo systemic racism. We need to have discussions and talk openly instead of blindly declaring that we are not racist and that our country does not suffer from the effects of racism anymore. There is so much that still needs to be done in order to change the hearts and minds of our society but unless we all decide that we will open our hearts and minds to the issues we will never make any changes.