Thread by @Theresa_Chapple

Okay, I'm about to start listening.
Thanks @AmyBaugher for bringing this podcast to my attention, and thanks @statsepi for preparing me for the offenses I'm about to hear.

And to think, this was released during #BlackHistoryMonth

🧵 live tweeting this podcast
@JAMA_current

Title: #StructuralRacism for Doctors- What is it?
1st the title is distressing. Why are we still asking what is it? Why aren't we focused on addressing it? Still defining something that is clear, noted in research, & pervasive is problematic & stalls progress.
Pressing play now

"We discussed structural racism. Going into this interview I didn't understand the concept." I'm confused, who are you? There's no introduction of the narrator. What field is he from? What work does he do? Does he interact with patients & not understand this life & death concept?

"Racism is defined as the use of race to make decisions about what people can and can't do."

Here's a problem. We have discussions about Racism in America and think you can define it in 18 words. No! Racism is a complex phenomenon interweaved in our culture since the beginning

It has levels and manifests differently based on who, what, why, when and how. To even begin to give a simple definition of this complex structure is just... wrong.

Okay, back to listening.

"The use of race for any sought of transactional activity was made patently illegal by the Civil rights legislation passed in the 1960s. Given that racism is illegal, how could it be so embedded in society that its considered structural? As a child of the 60's I didn't get it."

Okay, I'm gonna need a drink for this.

He literally just said "In today's JAMA clinical reviews podcast, we discuss structural racism for skeptics"
HOW IS THIS A THING?
In next week's podcast will you discuss "Covid a pandemic or PLANdemic".
Or do you only approve podcast that gaslight experiences of minorities?

Dr. Katz starts off great. He clarifies that structural racism and racism in general aren't the same interchangeable term. It has little to do with individual opinions, but a system with policies that perpetuate inequality.

Using a built environment example of truck routes through low income neighborhoods, the impacts on the environment which leads to bad health outcomes for residents, asthma for children, missed school days, despite Civil rights laws, neighborhoods are segregated. All good points.

"In certain neighborhoods the schools are not as good... & the hospitals cannot provide the same level of care, NOT BECAUSE THEY DON'T WANT TO, not bc the drs aren't every bit of not more committed bc they are choosing to work in safetynet hospitals,...

but bc the resources aren't there"

Let's pause. Is this a true statement for all? Are some there for loan repayment programs and don't care any about the people? Are some there bc of white savior complex? Are some there bc other places don't want them? Are some there to skid by?

Let's not paint with too broad of a brush, everyone doesn't have altruistic reasons for coming into my community. Some are passing time and causing harm.

"we know that racial disparities in the US are connected to income."

Let me stop you here.
Racial disparities exist EVEN AFTER controlling for income.

Suggested reading... anything by Dr. Art James.

Life changing moment for me was learning that Black doctors have infant mortality rates higher than White high school drop outs. I learned this 20 years ago.
Miss me with the income explanation.

Host- "I think the term racism is hurting us... I grew up anti-racist"
Yall! I almost threw the computer when he defined "anti-racist"- "never ever even think about a person's race or ethnicity when you're evaluating them.

Full stop! Being color blind is not anti-racist, it's harmful!

"What you're talking about isn't so much racism as much as, that there are population, it's a socioeconomic phenomenon, that have a hard time getting our of their place bc of their environment. It isn't their race, it isn't their color, it's their SES. Is that a fair assessment?"

Yall! the response was "Yes!"
and also "you are not a racist"

I need a break.

30 seconds later, after reaffirming colorblindness and not calling it out as harmful, Dr. Katz then says
"where it goes beyond SES but still stays as a societal issue is bc of the countries past with slavery... there are biased views and society should not reinforce them"

"I do believe... whatever people's belief, they cannot necessarily prevent the idea that they may react differently to a person who looks different then they do."

okay so nearly 2 minutes later, the response is "you may treat ppl differently, but your not racist, you can't help your implicit bias"

2nd time from the host "I think using the term racism invokes feelings that are negative... then they're turned off by the whole structural racism phenomenon. Is there a better term we could use, a better word than racism? '

Dr. Katz- "there may well be... When I describe it, I always try to get people to focus on the "structural" part."
Okay, so with that, I'm quitting this podcast.
In the US all the levels of racism works together. Structural racism wouldn't work if it wasn't upheld by racist ppl.

This phrase caused me walk away from the podcast, because this is how all the "isms" in this country remain in place. When pushed, well-meaning (white?) people in power cower.
No, racism can't be taken out of the phrase. If it makes you uncomfortable, fix it. Don't ignore it.

It seems as if Dr. Katz knows better. But when pushed, opted to keep structured racism in place by not bucking the systems. Each person failing to recognize the harm, is a part of the system.
This podcast was harmful and should be removed.

The host holds a position of power, a position that allows for gatekeeping of research, his role should be reassessed.
Dr. Katz needs to reassess his role in aiding and abetting structural and interpersonal racism through being complicit and not calling out misinformation.