UCSF's Department of Medicine Grand Rounds on January 6, 2022 included (from left to right): Bob Wachter and Camara Phyllis Jones. Illustration by Molly Oleson; photos from screenshots of live event.

At this week’s Grand Rounds, physician and epidemiologist Dr. Camara Phyllis Jones called anti-racism a “legitimate medical intervention.” 

To explain the reality of racism, Jones used a metaphor from the restaurant world: that hungry people, unable to enter a restaurant, would look at an “open” sign, and understand that it was closed to them. 

“That’s when I recognized that racism structures open/closed signs in our society, that racism structures — if you will — a dual reality,” she said. For those who are inside, they might not even notice the sign is two-sided, “because it is difficult for any of us to recognize a system of inequity that privileges us.” 

This is the case with male privilege, white privilege, and American privilege in the global context, especially considering the amount of global vaccine supply our country has sequestered, Jones said.

Those outside the restaurant are “very well aware that there’s a two-sided sign going on, because it proclaims ‘closed’ to them,” Jones said.

Naming racism is not a scary thing, but an empowering one that equips you to act, Jones said.

However, we must go beyond simply naming systemic racism, Jones said. 

“We need to dismantle the lock, take the door off the hinges, because once we start acting, we will not forget why we are acting,” she said. 

To exemplify how structural disadvantages manifest themselves as health outcomes, Jones cited the fact that three times as many black women die in childbirth or within a year of pregnancy compared to white women; for indigenous women, they’re three to eight times more likely to die.  

How does racism manifest itself in these outcomes? There are three levels of racism, Jones said: institutionalized/structural, personally-mediated and internalized.

Institutional racism is “the constellation of structures, policies, practices, norms and values that put together result in differential access to the goods, services and opportunities of society by race,” while personally-mediated racism is “differential assumptions about the abilities, motives and intents of others by race, and then differential actions based on those assumptions.” 

Internalized racism is “acceptance by members of stigmatized races of negative messages about our own abilities and intrinsic worth” and a “sense of entitlement” for members of structurally advantaged races, she said.

“Racism is not a cloud or a miasma we can’t get a handle on. It is a system with identifiable and addressable mechanisms in our structures, policies, practices, norms and values.” 

Thinking about who is at the table, and who is not, as well as the when, where, how and why of decision-making can allow us to intervene earlier. 

To get rid of health disparities, we need health equity, which requires three things: valuing all individuals and populations, equally recognizing and rectifying historical injustices, and providing resources according to need, she said. 

Jones identified seven barriers to health equity: a narrow focus on the individual the renders systems invisible, an ahistorical stance that ignores how past injustices shape the present, the myth of meritocracy, the myth of zero-sum game, the nation’s limited future orientation which disregards children and the planet, the endorsement of the myth of American exceptionalism, and white supremacist ideology. 

So what can people do to move forward, especially those who are less marginalized? Actively look for evidence of two-sided signs, examine opportunity structures and outcomes, “burst through our bubbles of experience to experience our common humanity,” be interested in the stories of others, “develop a sensitivity to the absence of who is not at the table, what is not on the agenda, what policies are not in place,” and reveal inaction, Jones said. 

Those who are locked out of the restaurant “need to know that action is power, and especially that collective action is power because collective action will inform us, inspire us, protect us, propel us,” Jones said. 

See our previous Grand Rounds coverage here.

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FREELANCER. Madison Alvarado was raised in the Bay Area and moved to San Francisco after attending undergrad at Duke University. She fell in love with reporting in high school, and after a brief hiatus is eager to continue learning and growing as a storyteller. She has been covering UCSF's Grand Rounds since the summer of 2020.

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1 Comment

  1. I think I understood much of this, what is “the myth of zero-sum game”?

    I find that especially interesting as much of what I perceive on twitter and in the common press as various anti-racist strategies seems to be a zero sum game struggle instead of a positive sum game future.

    Anonymous because third rails

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