Beyond Race-Based Ideology in HPE DEI Attempts: A Framework and Vocabulary for Sociohistorical Justice

Health professions education (HPE) institutions in the United States (US) are increasingly calling for health justice for 'historically excluded' groups. However, the language and concepts within many HPE equity frameworks offer insufficient attunement to historically-informed, locally-relevant lived expertise of racialized healthcare trauma. These present-bound, race-based, frameworks obscure the distinct and generationally-transmitted healthcare inequities borne by foundationally minoritized populations - the modern-day descendants of Indigenous and/or enslaved people whose land and labor have been continuously stolen throughout a colonized nation's history since its first founding settlements. Unfortunately, prevailing equity frameworks in the US presume that a modern racially minoritized identity automatically confers US-specific historical relevance to their multigenerational rights and knowledges, regardless of the sociopolitical context those historic harms and knowledges occurred. In doing so, these equity efforts erase the critical role of sociohistorical identity - 'socio' honors the unique sociopolitical construction of race within a defined geographic region and/or nation, and 'historical' differentiates the temporal aspects of endured harm for contemporary minoritized persons (i.e., ancestry, ethnicity, chronicity of endured harm within a given social context). An epistemological variant of racial essentialism occurs whenever HPE institutions legitimize locally-relevant, history-based knowledge claims about racism for anyone who looks a certain way, regardless of their history. Therefore, to honor the epistemology of subjugated knowledge, HPE institutions must clearly define the 'historical' elements of minoritized peoples' experiences within societies that are historically, racially, ethnically, and nationally diverse. Without historical nuance, justice efforts risk misallocating opportunities, perpetuating injustice, and undermining their own goals. Herein, we introduce the Sociohistorical Justice vocabulary and framework, which gives HPE institutions a nuanced language to disaggregate racialized groups not just by present identity, but by how oppression is carried across lineages and rooted in place and time. Moreover, not all historic harms were enacted along race-based lines, as historic exclusions were executed by location, class, and gender, too. We argue that HPE institutions must critically interrogate whether proclaimed equity efforts for 'historically excluded' populations are tangibly benefiting lineages bearing historically-compounded harm caused by these institutions' own actions. If HPE institutions truly desire to centralize representation of historically excluded clinicians and scholars, justice efforts must invite history-based knowledge claims and offer targeted benefit only to people whose lineages have been directly and continuously deprived by a named historic harm (i.e., people whose ancestors were present at the indicated place and time of the original harm).