Discussing and Teaching About Race and Health Inequities

Health inequities are prevalent in our medical institutions and result in unfair access to and delivery of health care. Some of the most profound health disparities are related to race, which has erroneously been used to make biological inferences to explain disease states in medicine. Our profession continues to shift away from such race-based medical narratives, which do not examine how social determinants of health, social injustice, systemic racism, and existing power structures shape health outcomes toward a health equity mindset and race-conscious medicine. Clinician educators are responsible for teaching and engaging with learners around issues of inequity in medicine, although many may feel they lack the knowledge or skills to do so. Opportunities for conversations on health equity abound, either as a response to statements made by clinical peers or patients, or through direct clinical care of affected populations. In this paper, we focus our discussion of health equity around the topic of race corrections in spirometry, which is one of several salient areas of conversation in the field of pulmonary medicine undergoing reconciliation. We review basic definitions and concepts in health equity and apply three strategies to engage in conversations around equity with colleagues and learners: actively learning and reflecting on health inequities, recognizing and naming inequities, and consciously role-modeling equity-conscious language and care. We also will summarize strategies for implementing health equity concepts into the continuum of medical education and our clinical learning environments.