Incorporating the Social and Structural Determinants of Health Into Clinical Practice: Risks of Race-Based Medicine

Modern medicine has developed over the past 2 centuries in societies stratified by race and ethnicity. Race-based medicine analyzes health risks and treatment based on a patient's race, often assuming that differences in health status are due to biology and genetics. In the United States, there is a history of guidelines using race-based decision-making for a variety of conditions (eg, hypertension, heart failure). These guidelines lead to profound health disparities. Genetic tests reveal precise molecular causes for differences in therapeutic and adverse effects of medications, and certain genetic variants are more common in specific groups of people. At the same time, there is growing evidence on health disparities that shows stratification of social determinants of health by race, ethnicity, income, and geography. Race-based prescribing guidelines and race-correction factors are under review across medicine to ensure that accurate data are used to provide unbiased care and that guidelines are not worsening health disparities. Race-conscious medicine focuses on the understanding that, although racial differences in health status may be influenced by genetics and epigenetics, they are just as likely to be due to racial stratification in access to resources, experiences of bias and discrimination, and social factors correlated with race.