Acknowledging Race

 Last month The New England Journal of Medicine published an opinion piece by Mary T. Bassett, MD, MPH, commissioner of New York City’s Department of Health and Mental Hygiene. Entitled “#BlackLivesMatter – A Challenge to the Medical and Public Health Communities,” it challenged those of us in health care to take a stand on race-related issues in our field. Bassett calls for increased research on health disparities and public advocacy in support of reforms in law, policy, and practice.  She also urges a review of health care institutions to identify and address overt or latent racism. Steps here include promoting greater diversity among caregivers, engaging our staffs in discussions of race and health, and working more actively with minority communities to build partnerships that engender trust and better health outcomes.

Bassett’s impassioned appeal struck a chord and caused me to reflect on what we at Columbia Nursing are doing to create racial equity in health care. Most broadly, we’re creating opportunities for our students, staff and faculty to discuss race and how it affects our care, policies, and research.

For example, we have included modules in our curriculum to expose and sensitize students to the needs and circumstances of minority racial and ethnic communities. Our students tell us that rotations in clinics throughout Washington Heights, Inwood, and Harlem have taught them to better understand and relate to patients whose backgrounds and circumstances are often different from their own and which may influence their health care needs.

In a program sponsored by our Office of Diversity and Cultural Affairs, beginning students participate in a diversity orientation focusing on self-awareness, identity, and privilege. This year, in partnership with the Tanenbaum Foundation – a non-sectarian organization addressing religious prejudice and mutual respect – the orientation will incorporate a focus on patients with special needs and disabilities.  In addition, the Office, partnering with the Office of Student Services, will sponsor sessions with expert speakers on the topic of discrimination as well as conduct workshops on potential racially-based interactions with patients and co-workers.

Bassett’s emphasis on engaging with minority communities to build trust and improve health outcomes is exemplified by research our school, Columbia University, NewYork-Presbyterian Hospital, the Visiting Nurse Service of New York, and several community-based organizations are conducting. The Washington Heights/Inwood Informatics Infrastructure for Comparative Effectiveness Research Project, or WICER for short, is addressing key public health challenges. Bilingual community health workers, mostly from the area, have conducted interviews with almost 6,000 Latinos; a significant proportion have also provided biospecimens for genomic studies and agreed to contact for future research. To further advance the trust that has been built through WICER, these survey data are being shared with the community to inform development of individual and community-level interventions as well as being integrated with clinical data from multiple facilities and settings of care to support innovative comparative effectiveness research.

Despite efforts such as these, there is much work to be done. For example, a recent survey of nurses by the American Nurses Association led by Hattie Bessent, RN, EdD, FAAN, found that 59 percent of African American and 46 percent of Hispanic respondents felt that “they had been denied promotion because of their race or ethnicity.” These nurses were also “more likely than their Caucasian colleagues to believe that minority patients do not receive the same quality of care as whites.” It is my hope that as increasing numbers of culturally-conscious, self-aware nurses move through the educational process and into positions of leadership, this problem will be ameliorated.