Declaring racism as a public health crisis from the lens of two Latinx student doctors [PODCAST]

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“Antiracism requires action-oriented work and calls us to ask, how will we work to become antiracist? How will we change our institutional culture and systems to become antiracist? As Latina medical students, we have seen and experienced racism in many aspects of society and have felt the need to change our institutional culture. If we act now, we will foster physician leaders adequately equipped to address health disparities. We are calling on other Latinx people, other non-Black people, and allies in medicine to go beyond these protests and commit to the journey of antiracism and health equity for all.”

Yesenia Salazar and Camila Hurtado are medical students.

They share their stories and discuss their KevinMD article, “Declaring racism as a public health crisis from the lens of two Latinx student doctors.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Yesenia Salazar and Camila Hurtado. They are medical students, and they co-wrote the KevinMD article “Declaring racism as a public health crisis from the lens of two Latinx student doctors.” Yesenia and Camila, welcome to the show.

Yesenia Salazar: Thank you so much, Dr. Kevin Pho, for having me here today.

Kevin Pho: All right. So we’ll get into your article in a little bit, but first off, I’m going to ask both of you to just share your stories and your journeys to where you are today. Yesenia, we’ll start with you.

Yesenia Salazar: I am a daughter of two Mexican immigrant parents who immigrated to the United States in the 1980s. Their vision for coming to America revolved around the American dream and providing the best education for their children, because of how limited it was in the small town of Budapero. At the age of six, we decided to settle down in a rural, low-income community in the East Bay of California, and our family values consisted of creating a good work ethic and a sense of emotional strength to persevere in life.

Racism was a topic that was never discussed at home, because it was somehow normalized for it to exist in America, and we did not know how to address this issue. All we were worried about at the time was getting food on the table and working hard to pay our monthly bills. At the age of 16, I saw the lack of, and need for, more Latino and Spanish-speaking physicians after becoming my grandmother’s interpreter during her primary care follow-up visits. Since that moment, I became interested in being the next Spanish-speaking Latina physician in my community, serving patients just like my grandmother. And I chose osteopathic medical school because of the holistic training and manipulative medicine training that we receive as osteopathic medical students.

Kevin Pho: And Camila, can you share your story and your journey to where you are today?

Camila Hurtado: So my parents were the first generation to go to college, so I attribute my achievements to my family, because my grandparents’ and parents’ generations were the ones to achieve the American dream. It was clear from the beginning that my sister and I were to prioritize education and never throw away an opportunity. We grew up, though, in a predominantly white, middle-class, conservative neighborhood, so we learned a lot about white America and, honestly, the different forms of what racism could look like.

That said, I grew up listening to the stories of my family in the Coachella Valley as farm workers, and of my mom and her work as a family physician. It took me a long time to decide on medicine, because she always warned us against the profession before the ACA took effect. But growing up with her frustrations is what makes me really passionate about our system of delivering care. I do not want to work in a fragmented system like what my mom and many others have to do. I want to work with others to make our system easy to navigate, affordable, and available to everyone, so that our families and communities can thrive.

Kevin Pho: Wonderful. So let’s transition into the KevinMD article that you co-wrote, “Declaring racism as a public health crisis from the lens of two Latinx student doctors.” Camila, we’re going to start with you. So for those who haven’t read your article that you and Yesenia co-wrote, can you just walk my audience through it and maybe share the story of why you and Yesenia decided to write it?

Camila Hurtado: The murders of Ahmaud Arbery, Breonna Taylor, and George Floyd were our call to action. We knew we had to speak out against the police brutality that disproportionately affects Black American communities. We also had to acknowledge our positionality as Latinas, as medical students, and as the VPs of policy for LMSA West. Because of our education, we are now a part of a medical community that is historically known to hurt our communities and others, but we now have the privilege, and therefore the responsibility, to speak out about why it’s important to directly address racism in medicine. So we wanted to help spread the message that racism is a public health crisis, because it is, and always has been, since this land has been colonized.

Kevin Pho: And Camila, I just want to follow up on that. So during your medical training, can you give examples of any stories of racism that you yourself have seen and experienced?

Camila Hurtado: Something that can be a little bit frustrating is the fact that it occurs again and again in our medical textbooks: that certain races, usually Black Americans and African Americans, are seen as the ones to have, or of course are disproportionately affected by, certain diseases, one of them being cardiovascular health, another one being preeclampsia. And oftentimes, what’s difficult is that those statistics are never put in the context of the larger, broader systemic issues that are occurring. Every time we read about that, it again reinforces that race is the issue, when in fact it’s actually racism that is.

And this has a real consequence in health, in the classroom, because, first of all, that message is repeated to our classmates and, of course, to our faculty members. And even though it’s something they may not directly believe in, in terms of race having certain genetic differences, it is something that perpetuates in a way that is, I would say, subversive, if not very real.

And so, to go into another example, what we find as well is that when we talk about these issues and bring up the issues in curriculum, we find that, you know, we have to repeat them multiple times to our students and to our faculty members, and in our example, to our dean. And yet, you know, because this issue is personal, it’s also emotional, so it has an emotional tax. It also taxes our time and our energy. And then usually, we’re also asked to give recommendations of how to change the system, when that’s really not what we came here to do, nor our field of expertise in this particular sense.

Kevin Pho: So Yesenia, what examples of racism have you seen or experienced during your medical training so far?

Yesenia Salazar: Yeah, thank you. So I can answer that by just giving a little bit of background on what I’m passionate about. I’m currently passionate about how racism has just been historically seen. We’ve seen this throughout historic times, and there have been a lot of injustices seen in the medical community, and also, this is why I was motivated and excited to write this op-ed with Camila and declare racism as a public health crisis.

But in the medical community, we talk about the health of a population, where we study the epidemiologic prevalence and incidence of a disease, and it is unethical to blame marginalized communities for their health when they have been discriminated against for hundreds of years. For example, Black and brown communities are targeted by big soda companies, and areas such as California’s Central Valley have one of the nation’s highest rates of childhood obesity. Overall, 48.3 percent of fifth graders are overweight or obese, compared to 40.3 percent throughout California. And California’s Central Valley is a place where there is very minimal access to clean water, and a lot of people end up buying soda because it’s cheaper, and therefore increase their chances of developing diabetes.

So I believe that medical education should not be focusing on this behavioral approach to health, but rather addressing the social determinants of health on an individual and population level, to address the root cause of why we see higher rates of heart disease, cancer, and even deaths in the COVID-19 pandemic in Black American and Latino communities.

Kevin Pho: Camila, when you say that racism is a public health crisis, what exactly does that mean? What would you like to see done that you’re not seeing right now?

Camila Hurtado: Right, so Yesenia and I came together, and we came up with what we think needs to happen, so I can start, and then Yesenia can end. So first, we want to see the medical community address our exploitive history of people of color: to recognize the failings of our systems, reflect on our current practices, and change our policies to prevent further harm. Second, we must incorporate an anti-racist framework into the medical curriculum, led by qualified experts in the field, to teach that racism, not race, leads to disproportionate health outcomes.

Kevin Pho: So just to follow up on that, Camila, by changing the medical curriculum, by introducing anti-racist courses, are you talking about adding new curriculum, or are you thinking about fundamentally changing what you have? So what exactly do you mean by that?

Camila Hurtado: So I think it’s important to do both. First of all, it’s important to assess how we teach that material. So whenever we’re talking about a certain problem, like a certain disease, or the physiology of our body, pathophysiology in particular, I think it’s important to relate it to the bigger context of what we’re looking at. So when it comes to our curriculum changes, we need to focus more on the issues that are relevant and based on correct science.

So we know that redlining is an issue and has been for decades. And as an example of that, we know that African Americans are put into communities, pushed into communities, that are underfunded and deprioritized. That is what leads to asthma, because they’re exposed to certain toxins in the air that other communities aren’t. And so those kinds of topics are what we need to talk about when it comes to the pathophysiology of asthma and why it’s more prevalent among African American communities that live in low-income neighborhoods. It’s not useful for us to continue the wrong science that perpetuates the belief that African Americans have worse lung capacities, because in the end, it’s bad science, and it continues to underequip us with the tools and the knowledge that we need to actually change things.

Kevin Pho: And Yesenia, I’m going to ask you that same question. So when we talk about declaring racism as a public health crisis, what does that mean to you?

Yesenia Salazar: Declaring racism as a public health crisis means to me that we are not providing equal quality of care to communities of color, specifically Black Americans and Latinos. We have to be able to not necessarily judge by their behavior. We have to be out there asking them more questions about where they live and what type of environments they’re living in, kind of what Camila mentioned. A lot of these communities have just been suppressed, and we haven’t even gone out there and done a lot of evidence-based research where we can find a solution for their health and provide them with better resources. A lot of them don’t have access to health care, and some of them, most of the Latino communities, have high rates of undocumented immigrants. So all of these social aspects of their lives contribute to their health, and I think it’s really, really important that as future physicians, future doctors, we can also look into that aspect of their health and, as future physicians, also incorporate that into our practices.

But in terms of declaring racism as a public health crisis, we in the medical community, I wanted to make sure that we invest in, and create, a new system for academic medicine, by investing in research focusing on interventions that will address racism on a systemic level. For example, with more research, we can address these issues and keep our institutions accountable in medical education. And also invest in underrepresented medical and pre-medical students, because they are coming from these communities, and they will have the background and the expertise of why racism exists in their communities. And also, hiring and promoting faculty of color is very, very important as well, because this will not only help improve our diverse physician workforce, but help with the retention of Black and Latinx medical students.

Kevin Pho: We’re talking to Yesenia Salazar and Camila Hurtado. They are medical students, and they co-wrote the KevinMD article “Declaring racism as a public health crisis from the lens of two Latinx student doctors.” Now I’m going to ask both of you for your take-home messages that you want to leave with the KevinMD audience. Yesenia, I’m going to ask you to go first.

Yesenia Salazar: Yeah, I would like to quote my mentor, Maria Santos: “Physicians call themselves leaders everywhere except in politics.” And this is something that needs to change, because we have seen how powerful the voice of physicians can be at the policy table when it comes to advocating for their patients and the community they serve. For example, Dr. Elena Rios, the founder and CEO of NHMA, is now leading one of the largest national organizations that is dedicated to empowering Hispanic physicians to be leaders who will help eliminate health disparities and improve the health of Hispanics. And also, even as medical students, we can make a difference by being part of organizations like LMSA or SNMA, and we can advocate that race is only a social construct and not a biological construct.

Kevin Pho: Camila, what is your take-home message that you want to leave with the KevinMD audience?

Camila Hurtado: Right. I think it’s also important that we all support the Black Lives Matter movement. First and foremost, Black Americans are disproportionately impacted by systemic racism, and it will require all of us to eliminate racist practices. And in changing the system, we will all benefit, because our well-being as a community and larger society is all connected. Nothing makes that more obvious right now than COVID. Also, as a Chicana, or a Mexican American, I feel like I owe it to the people that came before me to support BLM. The Chicano movement and the Black Power movement worked a lot together and stood for Black-brown unity. They understood how closely our issues were connected and how powerful we could be when working together. So I think it’s really important we continue their work.

And then the last message we would like to communicate is the need for more underrepresented students in medicine. The UCLA Latino Policy and Politics Initiative calculated that it’ll take California’s medical schools 500 years to close the Latino physician gap, based on the current trends. So looking nationwide, there are only 5.8 percent Latino physicians, despite making up 16 percent of the U.S. population. Likewise, there are only 5 percent Black physicians, despite the fact that Black Americans are 13.4 percent of the population.

Then when we look at medical school, the percentages are worse, if not the same. So for the academic year of 2018 to 2019, the AAMC reported that 7.1 percent of their acceptances were Black American, 6.2 percent were Latinx, 0.2 percent were Indigenous, and 0.1 percent Pacific Islander. And we know also that faculty is really important for mentorship and retention of underrepresented minority medical students, but again, according to the AAMC, only 5.5 percent of medical faculty were Latinx and 3.6 percent were Black American. So the numbers speak for themselves. We need more underrepresented medical students and physicians in the future if we want to provide adequate, if not only adequate but high-quality, care to our patients, especially if we want to focus on patient-centered care.

Kevin Pho: Yesenia and Camila, thank you so much for your time and insight, and thanks again for being on the show.

Yesenia Salazar: Thank you.

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