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New AMA policies recognize race as a social, not biological, construct


 

CHICAGO -- In support of efforts to confront our country's history of racism and injustice, the nation's leading physicians voted to adopt two new policies today recognizing race as a social construct -- rather than a biological construct -- at the American Medical Association's (AMA) Special Meeting of its House of Delegates (HOD). The policies aim to advance data-driven, anti-racist concepts challenging the current clinical application of race and its effects on vulnerable patient populations.

Both policies reflect an understanding of race as a socially constructed category different from ethnicity, genetic ancestry, or biology, and aim to end the misinterpretation of race as a biological category defined by genetic traits or biological differences. As the policies note, this practice of accepting race as a biological construct -- known as racial essentialism -- exacerbates health disparities and results in detrimental health outcomes for marginalized and minoritized communities.

Additionally, the policies call on AMA to take swift action, including:

  • Encouraging characterizing race as a social construct, rather than an inherent biological trait;
  • Supporting ending the practice of using race as a proxy for biology in medical education, research, and clinical practice;
  • Encouraging medical education programs to make curriculum changes that demonstrate how race as a biologic determinant affects health outcomes and explain how racism results in health disparities;
  • Recommending that clinicians and researchers focus on genetics and biology, the experience of racism, and social determinants of health when describing risk factors for disease.

"The AMA is dedicated to dismantling racist and discriminatory policies and practices across all of health care, and that includes the way we define race in medicine," said AMA Board Member Michael Suk, M.D., J.D., M.P.H., M.B.A. "We believe it is not sufficient for medicine to be non-racist, which is why the AMA is committed to pushing for a shift in thinking from race as a biological risk factor, to a deeper understanding of racism as a determinant of health."

In addition, the policies direct the AMA to partner with physician organizations and other stakeholders to identify any problematic aspects of medical education that may perpetuate institutional and structural racism. One of the policies asks AMA to collaborate on recommendations to improve clinical algorithms that incorrectly adjust for race and lead to less-than-optimal care for marginalized and minoritized patients, building on a previous AMA policy addressing bias in augmented intelligence (AI) health care tools.

Specifically, the new policies suggest that when race is described as a risk factor, it is more likely to be a proxy for influences like structural racism, instead of a proxy for genetics. This aligns with the AMA's position as outlined in a September 2020 letter to U.S. Congressional committee members, stating, "...myriad effects of racism, rather than race, are responsible for differences in health status and outcomes often attributed to race." The policies propose using factors such as ancestry, genetics, biology, zip code, and education instead of race in clinical settings to contribute to better health outcomes and increase health equity.

"By acknowledging that race is a social construct and not an inherent risk factor for disease, we can truly make progress toward our goal of attaining health equity for all patients. The AMA will continue to strongly support policies and regulations aimed at eliminating barriers to care and protecting the health of our nation's most vulnerable populations," said Dr. Suk.

Through its ongoing work, the AMA is striving to achieve equitable advancement of wellness and distribution of clinical and social resources for all physicians, their patients, prospective patients, and their families as it works to advance health equity. In 2019, the AMA established a Center for Health Equity that is working to achieve optimal health for all, solidifying AMA's commitment to embed health into the DNA of the organization and its work. Throughout the COVID-19 pandemic, the AMA issued strong statements denouncing police brutality, racism, and xenophobia in the language of public officials. The AMA fully understands that there is tremendous work still to be done to ensure that no one is left out and that everyone has the opportunity, conditions, resources, and power to achieve optimal health.

 
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