Mount Sinai medical alum: Staff must ‘recognize their own complicity in a racist health system’

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Medical students at the Icahn School of Medicine at Mount Sinai claim the U.S. health care system is mired in segregation and is prepared to "shine a light on the injustices of racial segregation in health care" with a new curriculum they developed.

The curriculum seeks to address "segregated care," which they explain is manifested by "health insurance inequities," according to an article published in the American Medical Association (AMA) Journal of Ethics. The student-led curriculum model created a framework based on New York City and the Mount Sinai Health System.

The authors explain that care is therefore segregated by insurance status, which in effect, impacts racial groups.

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An example the authors use is that in New York non-elderly Black adults are more likely than their White counterparts to be enrolled in public insurance options like Medicaid.

Public insurance eligibility restrictions are another example of segregated care.  

The article goes on to say, "Furthermore, public insurance eligibility restrictions—including for undocumented patients, for patients with incomes less than 50% of the federal poverty level, and for adult patients without dependent children—restrict Black Americans from coverage at nearly 2 times the rate of White Americans. While insurance status is fluid, the available statistics clearly demonstrate that segregating care by insurance status is de facto racial segregation."

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The authors believe that it is their ethical responsibility as medical professionals to "ensure justice in the allocation of medical resources," which requires "nonjudgmental regard and equal treatment for all with similar medical needs." 

Icahn medical students conclude that while medical professionals may give the same care to all of their patients, insurance that segregates patients by race, class, and "associated proxy markers" will result in unequal treatment.

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Thus, Icahn medical students and faculty collaborated to develop a student-led curriculum to provide "extracurricular peer-to-peer education about segregated care." The effort is an extension of the Segregated Student Care Workgroup established in 2014.

An abstract of the article that details the curriculum says "US health care is segregated by insurance status and de facto by race; however, traditional models of medical education do not teach students about segregated care, and the authors know of no examples in the literature problematizing segregated care in medical education." 

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The abstract stated: "To fill this gap, this article describes a student-led effort to disseminate peer-to-peer segregated care education at a single-site, large academic health system in New York City. It also provides educational resources that other student-advocates can adopt to drive curricular inclusion efforts at their own institutions."

Icahn School of Medicine at Mount Sinai alumni said that health care staff must "recognize their own complicity in a racist health system" in a piece they edited titled "A Call for Health Care Desegregation."

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"There is no one answer to how to promote desegregation. Segregated systems are deeply entrenched in how we learn medicine and deliver care and in how profit incentives tend to exacerbate inequity. The act of dismantling racism in health care requires all health care staff to recognize their own complicity in a racist health system—despite the fact that they did not create it." authors Icahn Mount Sinai alums Denisse Roja Marquez, MD, MPP, and Hazel Lever, MD, MPH wrote in an article published in the AMA Journal of Ethics.

According to a press release, Marquez and Lever "describe their aim to use the publication to open an academic dialogue on segregated care while underlining their view of shared responsibility."