In a year uniquely marked by death, despair, and hardship, the senseless and public murder of George Floyd continues to reverberate and catalyze change across Minnesota and throughout the country. As MMA leaders, we recognize this week’s one-year anniversary of his death. We also want to take this moment to hold ourselves accountable by sharing a few highlights of the MMA’s work over the past year to advance health equity, a core organizational priority.
In the immediate aftermath of that painful and difficult week in 2020, the MMA acknowledged being among organizations that arguably spent more time studying the health disparities that plague our state and not enough time and resources identifying and combatting the root cause – systemic racism. After taking the time to listen to physicians – members and non-members – the MMA Board reaffirmed three primary areas of focus for the organization: 1) diversifying the physician workforce; 2) alleviating social impediments to health; 3) changing the culture of medicine.
Diversify the Physician Workforce
Concerted efforts to diversify the physician workforce are not new. Yet, according to a recent analysis, Black, Hispanic, and American Indian/Alaska Native students remain underrepresented among medical school enrollees compared with the U.S. population and without significant change since 2009, the year the Liaison Committee on Medical Education (LCME) first required medical schools to work to improve the diversity of medical school enrollees. According to data from the Minnesota Department of Health, Minnesota mirrors the U.S. in terms of underrepresentation of Black, Hispanic, and American Indian/Alaska Native physicians. We note a similar failure to move the needle on education disparities in K-12 education, recognize the connection to later educational attainment, and support efforts starting with pre-K to improve outcomes.
The MMA is concentrating its work in this area in two ways:
1) Supporting mentorship opportunities/programs that expose youth to science and medical careers.
2) Understanding the structural and institutional racism and biases that limit workforce diversification at all stages of physician training and licensure.
Alleviate Social Impediments to Health
All physicians have witnessed the limits of their ability, clinically, to improve the health of their patients. Common estimates suggest as much as 80 percent of a person’s health can be attributed to considerations beyond the clinical space – such as personal behaviors (e.g., diet and exercise), social and economic circumstances (e.g., income, education, social support), and/or environmental factors (e.g., housing, air quality).
The origin of the MMA, in 1853, is largely a testament to an individual physician’s limits and the potential of physicians, collectively, to improve the health of the public. As such, the MMA has long worked to address the “social determinants of” or, the more empowering, “social impediments to” health.
Historically, much of MMA’s public health advocacy has focused on personal behaviors and environmental factors – consider seat belt and helmet laws, alcohol excise taxes, smoke-free workplace and restaurant laws, to name just a few. While such work will continue, the physician input we received convinced the Board to expand its reach to additional factors, namely safe and stable housing, and the health effects/trauma associated with police interactions. The MMA Public Health Committee is now working to refine specific policy interventions for which medicine’s voice can be most beneficial. The September 2021 MMA Annual Conference will further explore these issues and we welcome your input.
Change the Culture of Medicine
As we listened to physicians last year, one dominant theme was the desire that the culture of medicine become more explicitly anti-racist. That means not only the culture of physician practices and systems, but also the culture of organized medicine within the MMA.
In November 2020, the MMA delegation to the AMA successfully introduced and created new AMA policy that calls on the AMA to work to end the use of race as a proxy for biology, genetics, or heredity when treating patients, yet recognize that race does have an influence on health outcomes because of racism and systemic oppression. MMA also offered two educational programs in 2020 – one with David S. Jones, MD, PhD, Harvard University, on the history of and arguments for challenging the use of race in clinical algorithms, and one with faculty from the University of Minnesota examining race-based medicine using eGFR as a model for change. The MMA has also dedicated new staff resources to our health equity work and, thanks to generous funding from UCare, is developing new tools and resources to help physicians manage their internal/unconscious and explicit biases, which are shown to impact care delivery and patient health. 1
Looking internally, the MMA has engaged a graduate student in the History of Medicine program at the University of Minnesota to assist us in conducting an examination of our own 168-year history. This effort will document the ways in which the organization failed to embrace diversity, perpetuated racism, and/or impeded health equity. We look forward to sharing the results of this analysis as we work to reconcile with our past for a brighter future.
Finally, we have borrowed from our surgical colleagues and established a “Health Equity Time Out” to embed a culture of health equity in all our policy and decision-making processes. We urge consideration of this approach by other physician leaders as one way to establish a strong diversity, equity, and inclusion foundation in the organizations or teams they lead.
There remains much more work to do but we are excited about our progress, our direction, our new investments, and our unique ability to bring all Minnesota physicians together to make Minnesota the healthiest state for all. Thank you for your partnership and commitment to advancing this work with us.
Marilyn Peitso, MD, MMA President
Edwin Bogonko, MD, Board Chair
Janet Silversmith, CEO
1 See, for example: Williams DR, Mohammed SA. Racism and Health I: Pathways and Scientific Evidence. Am Behav Sci. 2013;57(8):10.1177/0002764213487340. doi:10.1177/0002764213487340. Mate KM, Wyatt R. Health Equity Must Be a Strategic Priority. NEJM Catalyst; Jan. 4, 2017.