Structural Racism in Academia and Medicine: A Conversation with CURE Scholar Dr. Rachel Issaka

November 6, 2020, by CRCHD Staff

Over the summer you published an essay, Good for Us All, in the Journal of the American Medical Association (JAMA). You begin the essay with an encounter where a patient had a difficult time accepting that you, the only Black person on the medical team, were a physician. You then discuss how structural racism in medicine affects providers and ultimately patients. What prompted you to write the essay, and what do you hope readers will take from it?

In the spring of 2020, in addition to the health disparities highlighted by the pandemic, the country was grappling with the ongoing police killings of Black people including Ahmaud Arbery, Breonna Taylor, and George Floyd. There were conversations to address structural racism in the criminal justice system, including a demonstration of 8 minutes and 46 seconds of silence—representing the amount of time that George Floyd had a knee to his neck before dying. This event, organized by the medical student organization White Coats for Black Lives, was recognized by students, physicians, nurses and other health professionals in cities across the country. But medical professionals weren’t talking about medicine’s role in perpetuating structural racism.

I wanted medical professionals to understand how structural racism manifests in medicine, embark on their own self-learning, and resolve to do at least one thing to address structural racism in medicine, either locally or nationally.

You are a current NCI CRCHD Continuing Umbrella of Research Experiences (CURE) K08 grantee. What examples do you see of structural racism in your area of research—colorectal cancer?

My research focuses on increasing colorectal cancer screening and follow-up of abnormal screening tests to improve disease-related mortality. We know that screening, a healthy diet, and exercise can decrease colorectal cancer risk. However, for many Black people of screening age, colonoscopy cost sharing creates financial barriers that limit prevention. Additionally, redlining policies confined generations of Black people to neighborhoods without access to safe spaces to exercise and healthy foods. Altogether, these policies and practices have likely led to higher colorectal cancer incidence and mortality for Black people.

As a first-generation college graduate and an aspiring medical student, I was told by a counselor that I didn’t have the “right pedigree” to succeed in medicine. I imagine that other first-generation and underrepresented minority students received similar messages in their academic journey. This is not acceptable. —Dr. Rachel Issaka

What do you consider to be among the most important issues pertaining to racism in academia?

That’s a tough one, as there are several. A topic pertinent to our conversation today is underfunding of underrepresented minority faculty. A now-landmark NIH study published in 2019 showed that Black applicants were less likely than their White colleagues to receive NIH funding. In that paper, the authors concluded that this disparity in funding was due to the research topic choice of Black investigators. Black applicants were more likely to propose studies at the community and population level, while White applicants were more likely to propose mechanistic studies. After controlling for several factors, area of investigation still accounted for 20% of the funding disparity. Yet we know that structural racism at the population level is a major driver of health inequities. Therefore, it is critically important that the NIH recognize the value of community and population research by supporting those conducting this research.

How has racism impacted your academic journey?

As a first-generation college graduate and an aspiring medical student, I was told by a counselor that I didn’t have the “right pedigree” to succeed in medicine. I imagine that other first-generation and underrepresented minority students received similar messages in their academic journey. This is not acceptable. Counselors and medical school admissions offices and officials influence who enters medicine and, ultimately, how diverse the field becomes. It’s important that individuals in these positions receive proper training, have term limits, and be removed and replaced if they have a track record of providing false or bad advice.

Looking back, my experiences with microaggressions and overt racism affirm for me the importance of my presence in medicine. It is important that I am an assistant professor, a gastroenterologist, and a researcher because in these roles I have the opportunity to work with colleagues, fellows, residents, and medical students who both are the recipients and the perpetrators of racism and microaggressions to help change the profession. —Dr. Rachel Issaka

How would you characterize the cumulative effect of these experiences with racism on you personally, whether it be emotions that you have felt or feel, actions that you have been prompted to take as a result, etc.?

It’s important to distinguish implicit bias, like the microaggression example in my JAMA piece, from overt racism. Throughout my career, I’ve experienced microaggressions more frequently than episodes of overt racism. In a recent New York Times piece, Dr. Kimberly Manning perfectly described microaggressions as “death by a million cuts.”

Looking back, my experiences with microaggressions and overt racism affirm for me the importance of my presence in medicine. It is important that I am an assistant professor, a gastroenterologist, and a researcher because in these roles I have the opportunity to work with colleagues, fellows, residents, and medical students who both are the recipients and the perpetrators of racism and microaggressions to help change the profession. I have the opportunity to connect with individuals and communities that are disproportionately impacted by colorectal cancer—the second highest cause of cancer deaths in the United States. Ultimately, I hope that my presence inspires learners and that my research leads to policy changes to improve mortality among historically disadvantaged populations.

What steps should academia take to confront and dismantle structural racism?

I shared several strategies in the JAMA piece that I encourage readers to reference, but I will end our conversation today with this—medical professionals have to recognize how structural racism has shaped the field and how these practices and policies lead to poor health outcomes. Until we call out structural racism and make a clear connection to the lack of Black people in medicine (the 1910 Flexner report) and poor health outcomes for Black people (policies that limit access to care), it will be challenging, if not impossible, to dismantle structural racism in medicine.