Moving From Race-Based Corrections to Race-Conscious Medical Care
By Julia Olff. Julia is a myelofibrosis (MF) patient, certified health educator, patient advocate, and former hospital administrator.
Medical review by Diane B. Francis, PhD
Race is a factor in medical diagnosis and decision-making.
When we see a doctor for a routine health check or a medical problem, we will likely have a range of medical tests. We’ve all had the oxygen levels in our blood measured using a pulse oximeter on a finger. Or have had our kidney health checked for a physical exam, with a blood test called eGFR or estimated glomerular filtration rate. Healthcare providers widely use these and many other tests, formulas, and calculations to diagnose diseases and plan treatment. Providers rely on them to help determine the chances of having a disease or health problem, the level of severity, when treatment is needed, and which treatments are best.
These clinical tools use racial classifications, or race corrections, to explain differences in how diseases affect large groups of people.
Using race corrections to make medical decisions is problematic.
Medicine has long made use of race to inform clinical diagnoses and decision-making. They can have the effect of reinforcing false, disproven ideas of race and biology and relying on racist assumptions. For example, calculations embedded in the eGFR test of kidney health are based on outdated, racist ideas about the biology of Black people. With race corrections, the eGFR test automatically calculates a Black patient’s kidney function levels to be higher or better than white patients. Poorly done, outdated research was used for the test’s calculations suggesting Black people release more creatinine than whites. This chemical in the body supplies energy to muscles and is removed by the kidneys. The test also relies on the falsehood that Blacks have more muscle mass. Although new studies have challenged this muscle-mass idea, the eGFR calculation has not been updated. The continued use of eGFR means the kidney function of Black patients may appear better than it is, and patients may not get the treatment they need.
Other examples of calculators or guidelines using race corrections exist for heart disease, lung function and diabetes tests, and childbirth. VBAC is a common calculator used to predict a woman's success in having a vaginal birth after a cesarean section, or c-section. It uses a racial correction that lowers the score for Black and Hispanic/Latina women and therefore underestimates their chance of having a healthy vaginal birth. VBAC calculations can bias providers towards c-sections for women of color.
Research also shows some clinical tools, like pulse oximeters, are less effective or can be misused in certain groups. They are less accurate in darker skin and are three times more likely to miss low oxygen levels in Black patients than White patients.
Race corrections in medicine can lead to undertreatment or overtreatment, delayed care, and disparities that harm people of color. And while society groups people according to their race, race is a social idea created in the 18th century to categorize humans for purposes of control and oppression. Science has now made it clear race has no biological meaning. In other words, differences in genetics are not fixed based on the color of your skin or your ancestry. There is no Black biology or white biology that’s distinct. But there are some genetic differences in and across groups that may explain increased chances of having a disease or differences in treatment response. For example, the BRCA breast gene mutation is common among European Jews and can increase their chances of having breast cancer.
We know that race is a poor substitute for genetic ancestry. And frankly, a provider can’t tell someone’s racial identity just by looking at them. And many more Americans are multiracial. Studies show providers most often misclassify Hispanic or Latino people in electronic medical records.
The legacy of racial classification and racial bias also influence medical and healthcare training. To reduce racial stereotyping and biases, more medical and allied health professional schools are including humanities and social science subjects in their curriculum. Without this education, medical students may connect disease to race instead of relevant historical, social or environmental factors, worsening racial bias. Relying on race, or race corrections in tests, doesn’t help the provider know the actual risk factors the person is exposed to. Leaders in the medical and scientific community have called for rethinking how racial categorization is used in healthcare.
The medical community is moving away from race-based corrections.
Race-conscious medicine can avoid continuing the disproven concept of biological race and help identify and address how racial and ethnic groups experience health and healthcare disparities. Race-conscious medicine is an alternative approach that focuses on racism instead of race as an influence on disease and health. Since 2020, more institutions such as Mass General Brigham Hospital, the University of Washington, Vanderbilt University, and the New York Health and Hospitals Corporation have removed race corrections from their clinical calculators. In 2021, the New York City Department of Health formed a Coalition to End Racism in Clinical Algorithms (CERCA). Anti-racist medical standards that do away with race corrections are one step towards equal access to health for all.
What can you do now?
Learn. If you have a disease or health problem, learn about the specific tests and how they may impact your health and treatment.
Understand. Know what’s normal and abnormal for diagnostic tests you get and how they may be affected by race corrections.
Equip yourself. Take information to your next doctor visit to help you have a more informed conversation with your provider. Check out the Diagnostics 101 Hub and download specific test information.
Call to Action
DHH is expanding and amplifying research on inequities in diagnostic testing. We believe this topic impacts EVERYONE, as tests are the baseline for care and treatment of any health issue or disease. Stay tuned to learn with us, as we continue to report on what you need to know to advocate for yourself and others. Subscribe for the latest.
Sources
Use of Race in Clinical Diagnosis and Decision Making: Overview and Implications. Kaiser Family Foundation website. Accessed December 18, 2024. https://www.kff.org/racial-equity-and-health-policy/issue-brief/use-of-race-in-clinical-diagnosis-and-decision-making-overview-and-implications/
Eliminating Race From Medical Practice. Penn Medicine and the Afterlife of Slavery Project. Accessed June 21, 2023. https://prss.sas.upenn.edu/penn-medicine-and-afterlives-slavery-pmas/eliminating-race-medical-practice
Abolish Race Correction. D. Roberts. The Lancet. Vol. 397. January 2, 2021 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32716-1/fulltext
Health Department Launches Coalition to Confront Racism in Medical Algorithms. New York City Department of Health website. Accessed December 18, 2024. https://www.nyc.gov/site/doh/about/press/pr2021/health-department-launches-cerca.page
Megan Gannon. Race Is a Social Construct, Scientists Argue. Scientific American website. Accessed December 18, 2024 https://www.scientificamerican.com/article/race-is-a-social-construct-scientists-argue/
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