We’ve written about the steps that can be taken by institutions to help end racism as a public health crisis. One prevalent issue that must be addressed in that process is the failure to examine racism in medical journals and publish health research that reports on its impacts.
Health Affairs published a report in 2021 that analyzed how many scientific articles mentioning the word “racism” were published between 1990 and 2020, by the top four medical journals—the New England Journal of Medicine (NEJM), The Lancet, Journal of the American Medical Association (JAMA), and the British Medical Journal (BMJ). Publications in the American Journal Public Health (AJPH) were also searched and used as a comparison to the other 4 journals. The analysis built upon a previous 2018 literature review that examined articles in 50 public health journals published between 2002 and 2015.
Health Affairs Report results
The Health Affairs report found that publication of articles on racism had more of an increase in 2020, a tumultuous year that brought increased national awareness of police violence against Black and Brown communities. However, the analysis showed that prior to 2020, these numbers remained fairly low and unchanged throughout the 30 year period for three of the top four journals—specifically the NEJM, JAMA, and The Lancet. BMJ had an increase in previous years, a subsequent decrease, and then a significant uptick in publications mentioning racism in 2020, similar to the other three journals. AJPH showed an increase in publications using the word “racism” that was fairly consistent over the years.
Source: Krieger, N. Boyd, R.W., De Majo, F., Maybank, A. (2021). Medicine’s Privileged Gatekeepers: Producing Harmful Ignorance About Racism And Health: Exhibit 1. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/forefront.20210415.305480/full/ [1][/caption]
Health Affairs also conducted a quick search of its own website in 2020, finding that the word racism only appeared in 114 articles in its 39-year history at the time.
Comparatively, 60 percent of the articles obtained from AJPH with the word “racism” contained empirical studies or review articles with significant data. However, racism was not a major focus in any of AJPH’s articles, and the term was generally found in the discussion section “as a possible interpretation of the patterns observed in the study, or as an area needing more research.” Very few of the articles obtained from this journal (less than 10 percent) measured any form of racism.
Racism was not a major focus in any of AJPH’s articles.
It is also important to note that the total number of articles that contained the word “racism” overall were low for all of the journals.
The harms of not publishing articles on racism
The authors shared that conducting a search for the word “racism” in the study was purposeful, given the fact that its use is often censored in journals. When medical institutions refuse to examine or publish articles on racism and its health impacts, a sense of ignorance is produced, because society looks to these institutions for knowledge on these issues.
When medical institutions refuse to examine or publish articles on racism and its health impacts, a sense of ignorance is produced, because society looks to these institutions for knowledge on these issues.
History has already proven this, as many of today’s beliefs and policies stem from the inaccurate, racist, and xenophobic scientific theories of the “eugenics movement.” This movement sought to “use of methods such as involuntary sterilization, segregation and social exclusion [to] rid society of individuals deemed by them to be unfit.”[2] It used science to legitimize white supremacy, and to justify slavery and other racist ideals—the crux of scientific racism. Experts, at the time, made claims that a person’s heredity and race determined their health, issues with disease, as well as their social and intellectual capabilities.
Some of these ideas still circulate in today’s medical research. One prevalent example in the medical field is the idea that the mistrust that specific races or groups hold for providers is a cause of disparities in health. This inadvertently places blame on these individuals for systemic harms. Patient mistrust of providers is often a symptom of medical mistreatment and discrimination, but it is never a cause of disparities. Mistrust alone is not enough to cause disparities—but systemic and institutional racism IS. Trusting a provider will not end disparities spanning across an entire race or group of people.
Patient mistrust of providers is often a symptom of medical mistreatment and discrimination, but it is never a cause of disparities.
The authors of the study share four negative consequences of the non-publication of evidence-based research on racism’s impacts on health:
- It can lead scientists, funders, and the general public to believe that research on the intersection of racism and health is not important, and that studying or publishing work on the topic is not needed.
- As stated before, ignorance on this topic is promoted among health professionals, and this misinformation is then shared with clients, patients, and others in the public, perpetuating a broader sense of ignorance among society.
- Pertinent evidence needed by policy makers, funders, advocates and others to help create more equitable policy and systemic solutions to racism and its impacts becomes limited.
- The work of researchers who study the intersections of health and racism can become excluded from publication, leading to a harmful cycle in which reviewers and editors continue to perpetuate ignorance by censoring these articles. Generally, the scholars who undertake this work are not white. This causes disproportionate negative impacts on the careers of scholars of color, especially Black scholars. This is exacerbated by the lack of diversity of women and BIPOC individuals that exists among editors and reviewers of journals.Other harms in not directly addressing racism in medical research include hyper-focusing on band-aid solutions, which can slow down progress towards ending racism. An example is encouraging white providers to acknowledge their implicit bias. This often leads to the centering of articles from white authors on their reflections on racism, but not on solutions to challenge practices that perpetuate it. Additionally, Black and Brown communities are often retraumatized and experiencing survey fatigue as researchers look to find more and more evidence of existing inequities, but not solutions to address them. While confronting our own biases IS important and necessary, there must ALSO be action steps taken to address systems that uphold inequities.
Ignorance is neither neutral nor benign, especially when it cloaks evidence of harm.
Our previous series shares Dr. Camara Jones’ suggestion on how naming racism is an important first step in ending its effects. Medical journals must begin to examine and publish articles on racism, but more specifically, those that focus on evidence-based research on racism and its health impacts. Commentaries on racism are not enough in a field that views evidence-based research as more trustworthy than opinion.
In the words of the authors of the Health Affairs report: “Ignorance is neither neutral nor benign, especially when it cloaks evidence of harm.”
[1] Krieger, N. Boyd, R.W., De Majo, F., Maybank, A. (2021). Medicine’s Privileged Gatekeepers: Producing Harmful Ignorance About Racism And Health: Exhibit 1. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/forefront.20210415.305480/full/
[2] National Human Genome Research Institute. (2022). Eugenics and scientific racism. https://www.genome.gov/about-genomics/fact-sheets/Eugenics-and-Scientific-Racism
