Time for Action: Tackling Structural Racism
In 1964, while a freshman at Harvard University, Peter Orris helped register voters during Freedom Summer, arriving in Holmes County, MS, just after the murders of volunteers James Chaney, Andrew Goodman and Michael Schwerner. In the PBS series “Eyes on the Prize,” Dr. Orris, who was jailed for 10 days that summer, said his parents instilled in him that one of the important lessons of being Jewish was identification with people who suffered oppression and discrimination. Forty-five years later, Tasha Dixon came to the Chicago Medical School through the Chicago Area Health and Medical Careers Program (CAHMCP), created by a 1978 state legislative mandate to increase the number of qualified minority applicants and matriculants to medical and other health professional schools. When the program lost CAHMCP funding five years ago, RFU stepped into the gap and continues to fund it in its entirety.
Tasha Dixon, MD ’13, MPH, is family medicine lead physician at Martin Luther King Jr. Outpatient Center and clinical assistant professor at Charles R. Drew University of Medicine and Science in Los Angeles. As a Los Angeles County COVID spokesperson, Dr. Dixon has been featured in public service announcements on radio and local and national television. Her primary professional interests include women’s health, urban/underserved medicine and public health, and resident well-being and engagement. As a National Health Service Corps Scholar, Dr. Dixon has a strong desire to contribute to the field and make a difference in the community. While at RFU, where she was named Outstanding Student Female Leader in 2009 and 2010, Dr. Dixon earned a certificate in Women’s Health in 2009.
Distinguished CMS alumnus and civil rights activist Peter Orris, MD ’75, MPH, FACP, FACOEM, is professor and chief of occupational and environmental medicine at the University of Illinois Hospital & Health Sciences System. A longtime attending in internal medicine at Stroger Hospital in Chicago, Dr. Orris has served in numerous capacities in support of environmental health and medical ethics, including for Health Care Without Harm and Chicago Physicians for Social Responsibility. A founding member of Physicians for a National Health Program, he is the recipient of a Lifetime Achievement Award for Excellence in Global Health.
Dr. Orris: It’s important to define what we mean when we talk about racism. I recommend Camara Jones, MD, MPH, PhD, former president of the American Public Health Association, who developed a theoretic framework for understanding racism on three levels: institutionalized, personally mediated and internalized. Dr. Jones defines structural racism as “when public policy, institutional practices, and other social and economic structures combine to perpetuate inequity between people of different ethnic groups.”
“Structural racism... when public policy, institutional practices, and other social and economic structures combine to perpetuate inequity between people of different ethnic groups.”
Dr. Dixon: I trained at Harbor–UCLA Medical Center, a safety-net hospital in Los Angeles County, a first stop for immigrants from Mexico with serious health issues. It’s been really hard to see their reluctance to come in for care, their fear around immigration status and deportation. They have been hit really hard by COVID. They’re waiting until they’re really sick to seek care. We’ve also seen COVID hotspots in our correctional system, the largest in the world, where the population is 53% Latinx and 29% African American. My work at the Martin Luther King Jr. Outpatient Center in southern L.A., on the border of Compton and Willowbrook, puts me smackdab in the middle of the community I have always wanted to serve.
Dr. Orris: COVID is forcing the question, “How do we serve the communities most at risk?” That brings us back to the structural racism of minority communities being most at risk and having the most comorbidities, which manifests, I think, our lack of a national health system that can provide care to everybody. We're treating working people with environmental exposures at UIC and Stroger Cook County. Because of the distribution of dirty industries — those that harm the environment — in poor communities and racial minority communities, the preponderance of our patients are primarily African American but also immigrant groups, often Latinx. And now we’re seeing workers in the gray economy, people often working without papers who are exposed and frequently not covered by legally required workers’ compensation, or who are applying for Social Security disability benefits and have been turned down.
I spent 15 years as chair of the Institutional Review Board at Cook County Hospital, a public system in Chicago, reviewing the ethics of human research, which involved constant discussion around race and class. It’s an absolute fascination for me — race and the social construct around race in this country. We’re discovering that race is almost entirely a social construct. Your program is famous for its impact in communities of color and more broadly Los Angeles County as a whole. Is this a setting through which you can impact structural and institutional racism?
“We're starting to recognize police brutality and gun violence as public health issues. So, no, we're not police; no, we're not politicians – but how do we bring that into health and medicine?”
Dr. Dixon: I wholeheartedly agree on the need for universal care and discussion around structural racism, the causes that fuel it and how to overcome the barriers it creates. Our residents at Harbor, as busy as they are, just organized a seminar on police brutality and knowing and protecting our rights. We’re starting to recognize police brutality and gun violence as public health issues. So, no, we’re not police; no, we’re not politicians — but how do we bring that into health and medicine? When we see someone who has suffered a gunshot wound, or is being charged with murder or who has been to jail, we need to understand the structural factors that underlie those realities. Our interns participated in a foundation block where they have the opportunity to explore the social determinants of health. Additionally, our residents, in collaboration with community activists and a civil rights attorney, recently held a webinar titled “Reclaiming Our Rights,” designed to empower and educate the community. At Harbor–UCLA Medical Center, during my residency, we held seminars for the community; we passed out cards on what to do if there’s a knock on your door. Both programs where I trained and currently train residents are intentional about providing the facts and figuring out as a group how we can continue to overcome issues of structural racism.
Dr. Orris: I am interested in why you chose your residency program. Harbor–UCLA is not just any safety-net hospital, and its family practice residency is not just any program. It has a 40-year history of commitment to not only the Latinx community and the African American community in Los Angeles, but a very strong emphasis on the interface between public health and prevention and curative medicine.
Dr. Dixon: I was looking for a program that was very social-justice oriented, very oriented to helping the people. I wanted a program that practiced what it preached. I grew up in inner-city Dallas where, at the time, health care was not the best. I was raised by a single mom, a nurse who worked nights in labor and delivery at Parkland, the public hospital in Dallas County. I saw her commitment and the difference she made, and I saw that same commitment at Harbor through the services and free clinics and other innovative things they were doing, and in their multicultural healthcare workforce.
Dr. Orris: What about the question of critical mass? Did the number of women, specifically women of color, play a role in your thinking? What do you say to students who have to make these choices among a variety of programs related to those questions?
Dr. Dixon: Black women in medicine are unicorns. There are not that many of us. The program director at the Harbor–UCLA Family Medicine Residency Program was a very grounded Latina, and the residency was one of the most diverse that I experienced when applying and remains one of the most diverse in terms of recruitment. There were 11 ethnic minorities, including three Black women, in my class of 12.
Dr. Orris: How did that make a difference?
Dr. Dixon: I just felt more at home. It was a good mix of cultures. It taught me how to care for my patients. It taught me how to appreciate my patients and their cultures and what they’re going through, and what they’ve been through. I came into the program more close-minded: a Southern girl who lived in the Chicago area for a few years. My residency really opened my eyes to a whole new world. Even now I am in awe. The program just recruited four African American males, which was amazing. I do recruiting for our residency program — the Charles R. Drew University Family Medicine Residency Program, now in its third year. Our current intern class of eight is all minorities, with a diverse mix of ethnicities and cultures within the entire program.
Dr. Orris: We want to talk to your residents about occupational and environmental medicine.
Dr. Dixon: That’s a great idea. I’m pushing the mission and values of really wanting to go back and help our communities. Between what I learned at CMS, my postgraduate training at Harbor–UCLA and my current practice at Martin Luther King Jr. Outpatient Center, I have really been able to hone those skills and reach back to my advisees and mentees.
Judy Masterson is a staff writer with the RFU Division of Marketing and Brand Management.
Please note, any group photo that does not feature physical distancing or mask wearing was taken prior to the State of Illinois issuing such guidelines. RFU has policies in place that require these and many other safety measures.