Antiracism in PM&R
Written by Erik Andersen, MD. Last updated 4/2022
Did you know…
Comparing post-stroke activity limitations, data from 2011 National Health and Aging Trends Study showed that Black patients experienced greater activity limitations when compared to White patients (Burke et al., 2014).
A cross-sectional analysis of State Inpatient Databases in 2005-2006 showed that Blacks, women, and lower SES patients received less intensive rehabilitative care post-stroke (Freburger et al., 2011).
Data gathered from the Uniform Data System for Medical Rehabilitation in 2002-2003 showed that rehab improvements measured using FIM were significantly larger for white patients compared with black patients (Ottenbacher et al., 2008).
Written by Allison Wallingford, MD. Last updated 4/2022
Did you know…
A number of studies have revealing data showing that Hispanic and Black patients are subject to disparities in accessing inpatient rehabilitation after a TBI.
Data from National Trauma Data Bank Research set from 2007-2010 showed that Hispanic and Black patients were more likely to be discharged home when compared against their White counterparts. Also, White patients were more likely to be discharged to inpatient rehabilitation compared to Hispanic and Black patients (Meagher et al., 2015).
Data from Nationwide Inpatient Sample from 2005-2010 showed that Hispanics were 48% less likely to be discharged to inpatient rehabilitation and 57% more likely to be discharged to home when compared to Whites (Asemota et al., 2013).
Data from National Trauma Data Bank Research set from 2012-2015 showed that Blacks (16.1%) had a decrease likelihood of discharge to inpatient rehabilitation when compared to Whites (23.3%) (Haines et al., 2019).
Written by Erik Andersen, MD. Last updated 4/2022
Did you know…
Analysis of the National Trauma Data Bank from 2000-2009 showed that being Black or Asian was a significant predictor of not being discharged to acute inpatient rehab compared to white and hispanic population (Lad et al., 2013).
Black patients with SCI from 1998-2009 had lower rates of decompressive surgery which is known to improve outcomes post-injury (Dru et al., 2019).
A survey among thirteen SCI Model Systems found that minorities with low SES backgrounds were less likely to receive customizable wheelchairs (Hunt et al., 2004).
In the SCI population, being Black was found to be associated with higher rates of pressure ulcer prevalence (Saladin et al., 2009; Chen et al., 2005) and rehospitalization (Mahmoudi et al., 2014).
Written by Allison Wallingford, MD. Last updated 5/2022
Did you know…
Black patients with chronic pain have higher pain severity, more significant disability from pain, and worse mental health compared to white patients. Data from a survey in 2000 showed that among patients with chronic pain 27% of Black patients and 27% of Hispanic patients reported severe pain compared with 17% of White patients. (Anderson et al. 2009)
The under-treatment of pain in racial minorities is well-documented. Among patients with cancer-related pain, only 35% of minority patients received appropriate pain treatment according to WHO guidelines compared to 50% of non-minority patients (Cleeland et al. 1997).
Racial differences in perceptions of pain contributes to black patient being undertreated for pain. Several studies have shown that providers tend to underestimate the severity of pain among minorities (Anderson et al. 2009). White participants in one study had a higher threshold/lower tendency to perceive pain in black faces compared to white faces (Mende-Siedlecki et al 2019). Interventions have focused on providing education on implicit bias and cultural competency to healthcare providers, as well as establishing clear treatment guidelines and protocols for pain management (Anderson et al. 2009).
Some studies also have shown evidence of cultural attitudes contributing to differences in reporting pain and seeking treatment for pain. For this reason, some interventions have targeted educating patients on pain and empowering them to be active partners in their pain management (Anderson et al. 2009).
Written by Erik Andersen and Roxana Garcia, MD MPH. Last updated 4/2022
Research, with a focus on translational research. Research that involves underserved communities should benefit those communities.
Strive to be an anti-racist
Combat factors that limit access and delay admission to intensive rehab services.
Curated by Roxana Garcia, MD MPH. Last updated 4/2022
Want to learn more about antiracism?
Recommended Podcasts
Be Antiracist podcast, you might especially find the Ableism and Racism: Roots of the Same Tree
Recommended Reading
Beyond a Moment — Reckoning with Our History and Embracing Antiracism in Medicine on NEJM
“We — a Black medical student, a White medical anthropologist, a Black trauma surgeon, and a White clinician educator — acknowledge that we are a part of medical institutions that have too often failed minority communities, and we wish for this moment of reckoning to be an inflection point in that history. We believe our health professions colleagues, societies, and systems need to go beyond declarations — that each must review its own history, structures, workforces, and policies in an approach dedicated to truth and reconciliation and that we must all proactively engage in the battle against structural racism and health inequities to bring about a new era of antiracism in medicine".
EXCERPT:
“Unfortunately, existing medical education pedagogies, such as the social determinants of health and cultural competency, do not challenge the racism perpetuated by a predominantly white health care workforce charged with caring for a racially diverse public they do not represent. They are increasingly out of sync with the demands for antiracism following the murders of Ahmaud Arbery, George Floyd and Breonna Taylor and the coronavirus’s disproportionate killing of Black lives.
Recognizing the legacy of slavery in American medicine enables students to discern contemporary racism.
…challenging racism’s deleterious effects requires first identifying its many forms. Camara Phyllis Jones’ classic multilevel framework emphasizes how racism is internalized, operates interpersonally through implicit bias and micro-aggressions, and functions on more macro levels through institutions, policies and ideologies. Racism’s multiple levels can powerfully collide, resulting in dangerous clinical ‘care’.
All this must be understood against a background of white supremacy that has lynched and massacred countless Black Americans. Accordingly, white doctors’ silence when white patients hurl racial slurs at their Black colleagues is equally damaging to health.”
EXCERPT:
“Commit to racial equity and justice in institutional mission, vision, and values.
Conduct a systematic assessment of institutional policies, procedures, and norms
Collect, report, and respond to data on racial inequities
Invest funding and resources into antiracism initiatives
Invest funding and resources into antiracism initiatives
Share and yield decision-making power
Address racism intentionally
Teach and expect everyone to practice antiracism
Mobilize allies to leverage their privilege positively”
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