Removing Race From Nursing

It’s Racism, Not Race, That Affects Health Disparity

First Things First

Race is not rooted in biological fact. In fact, race is a biological myth.

Race is a social and political construct that has been used for centuries to separate “white” and “black” into discrete groups but there is no scientific bases for doing so.

In 2003, the complete genome (The Human Genome Project) was mapped.

When scientists compared genetics across different parts of the world, they discovered there was not a single genetic difference between persons from different regions. That means persons from Europe have the same genetics as persons from Africa and persons from Asia have the same genetic makeup as those from Antarctica.

Genetic differences are not divided along racial lines. Period.

During my training as a nurse and nurse practitioner I was taught that racial differences are innate in medicine, even though there is evidence to the contrary: There is No Such Thing as Race. Ethnic differences in disease and medicine have been proven, but there are no differences between the bodies of Black individuals and any other human body.

Regardless, race as a determining factor in health is still being taught today.

One of the more popular beliefs in healthcare surrounding Black individuals is that they have fewer pain receptors and, therefore, do not feel pain as much as others. This ludicrous idea dates back to the 18th-century claim by doctors that blacks bore the pain of surgery better than whites.

In addition to insensitivity to pain, other common beliefs are that Black individuals have thicker skin than white people and that their blood clots faster than white people. All ridiculous claims that stem from racism, yet are prevalent in the medical community.

This thinking is inherent in medicine and it needs to stop.

When healthcare providers believe this nonsense, they make different decisions regarding a person’s medical treatment such as what testing to order, what diagnosis to make, how to interpret a lab value, or what to do next.

These beliefs have harmed Black individuals for centuries and the harm continues today. Healthcare professionals need to shift their attention away from what is different about the bodies of Black individuals and toward how the health disparities exist in the first place.

Race does not distinguish genetic diversity and is a word that needs to be phased out of all aspects of healthcare.

Myths That Fuel Racism

Fast forward to today . . . because of myths about genetic or biological predispositions, we now have a long history of rationalizing the subordination of different groups. This justified subordination has led to systematic discrimination in healthcare in the form of institutional policies and practices.

One glaring example — there are more by the way — of racism within the medical field that is still impacting healthcare today is GFR (glomerular filtration rate).

GFR is a frequently-used lab test to check the condition of the kidneys. GFR is a measure of how well the kidneys can filter serum creatinine. Creatinine is a breakdown product of muscle and the kidneys remove it from the blood. So, measuring how well serum creatinine is cleared by the kidneys (GFR) is a fairly good indicator of how well the kidneys function overall.

Presently, it is common practice for laboratories to report a GFR value as “Caucasian” and “African American” because the demographic variables for measuring how well serum creatinine is filtered through the kidneys are race, age, and sex.

Why Is Race Part Of The Formula?

I thought you’d never ask.

In the 1990s, it was discovered that, overall, GFRs for Black individuals were slightly higher than for others— approximately 16%–18% higher. This was accounted for by the belief that Black individuals have “greater muscle mass,” even though there is no proof that 1) Black individuals actually have more muscle mass, and 2) more skeletal muscle contributes to higher serum creatinine for the kidneys to filter.

A study in 2008 debunked the whole idea of adjusting GFR for Black individuals by proving there is no association between higher creatinine levels and higher muscle mass. Yet, to this day we still have two resulted lab values for GFR: one for Caucasian and an adjusted value for African Americans.

Why Is This Important?

When the healthcare system continues to report and interpret lab values based on fabricated information, it leads to health disparities.

Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”

Health disparities are the differences in healthcare received by some groups as compared to others and includes much more than access to care. It involves how that care is provided, the treatments offered, and the health outcomes.

Regarding the adjusted GFR for Black individuals, it means those persons will be treated differently when critical decisions are made regarding their health. For example, it could lead to delays in eligibility for a kidney transplant because of the overestimated GFR of Black individuals.

It also means that healthcare workers continue to believe that race impacts health when there is no biological validity. And when healthcare workers believe race impacts health, it blinds them to what is truly causing the differences they see: racism.

We can’t let these myths continue to fuel racists beliefs, especially in medicine.

Race Does Not A Health Disparity Make

It’s time to stop the outrageous claims that race contributes to health disparities.
It’s racism that affects the health status of different groups, not race.

It is important to understand that when healthcare workers — me included — use race as a risk factor for disease, we are failing to recognize the role that racism plays as the true risk factor.

If race is not biological then it has no place bumping around in my mind when I’m interpreting lab results, prescribing medications, ordering a test, or deciding what the next step is to help my patient.

I’m a nurse practitioner and my desire to treat every patient with the same care and attention I would my own family. Combating inequality in healthcare and medical treatment should be paramount in healthcare, now more than ever.

I am calling to my nursing colleagues.

— Identify, for yourselves, the manifestations of racism in the clinical setting.

— Admit the historical legacies that have contributed to racism in the daily care we provide.

— Notice how it is impacting clinical judgments such as disparities in pain management and treatment and with race-based formulas and screenings.

I urge you to see and name your own racial biases.

— Start as I have with listening and learning.

— Listen to your patients and to leading voices such as Black Lives Matter.

— Educate yourself on Race and Cultural Diversity in American Life and History.

— Promote Anti-Rasicm in Medicine by teaching and discussing racism directly with nursing colleagues and by calling out medical racism when you see it.

Wouldn’t it be amazing if 100 years from now, the world could look back at 2020 and see how the tide turned in healthcare?

How the word race suddenly disappeared from the medical literature?

How acknowledging racism as a risk factor for disease and healthcare outcomes began to populate research studies?

How changes were made in the minds and hearts of healthcare professionals around the world toward health equality for everyone?