Racism kills. Kevin Ahmaad Jenkins, a lecturer in health policy at the School of Nursing and the School of Social Policy and Practice at the University of Pennsylvania tweeted “Black folks are not at risk because we’re Black. Black folks are at risk due to the underlying comorbidities and social circumstances that shape that Black experience.” Jenkins went on to make the point: “When I talk about, we are at risk because we’re Black, it’s not race that puts us at risk…it’s racism.”
The COVID-19 pandemic, coupled with the deaths of black Americans like George Floyd and Breonna Taylor at the hands of police, have sparked reflection and outrage across the country and within the health community. Multiple health and medical groups have called out racism as a public health issue, including AcademyHealth, the American Medical Association, the Association of American Medical Colleges, the American Public Health Association, and the Centers for Disease Control and Prevention.
Several have launched initiatives to reduce racism, improve health outcomes, and drive meaningful change. Some of these changes are continuations of earlier efforts. As many have noted, however, change does not happen immediately.
Frustrated with the pace of progress today, several health organizations and medical schools are looking at creative new ways to make an impact. This includes looking to lessons from the art world.
Learning to Look Before Making Judgments – The Visual Arts Already Have a Place in Medical Education
There is growing literature on the power of the arts to help heal, to help frame difficult conversations, and to help people see things from other perspectives. Medical schools first noticed this connection years ago.
Learning not only to look, but to see, is a fundamental skill physicians and all health providers, must hone. Rather than relying solely on lab tests and technology to make a diagnosis, Dr. Irwin Braverman, professor emeritus of dermatology at Yale, figured out (during grand rounds in 1998) that teaching medical students to describe a work of art helped them more accurately describe what they were seeing. Dr. Braverman, working with Linda Friedlaender, curator of education at the Yale Center for British Art, started one of the first art seminars for medical students at Yale and found that “his intuition was correct: Students who took his course were 10 percent more likely to pick up on important details in their patients.”
The idea caught on. Dr. Joel Katz, director of the internal medicine residency program at Brigham and Women’s Hospital helped develop a nine-week course in 2003 called “Training the Eye: Improving the Art of Physical Diagnosis” for first and second-year students.
An article in the New York Times outlined key components of the course.
In one session, students study a limestone sculpture that appears different when viewed from various angles. They then observe the breathing patterns of patients with respiratory illnesses in different positions to determine if the problem lies in the muscles, spine, lungs, or somewhere else altogether. In another session, students scrutinize John Singer Sargent’s ‘El Jaleo,’ a large painting that portrays a dancer in motion. Afterward, they examine patients with gait issues and assess their balance, stance, and step. Students who took the course made 38 percent more observations on visual skills examinations of patients than those who didn’t.
Learning to See: Using the Arts to Expose Racial Bias
A new program at the University of Alabama at Birmingham (UAB) School of Medicine is continuing the legacy of Dr. Braverman in an effort to combat racism by using works of art. The School of Medicine, in collaboration with the University’s Abroms-Engel Institute for Visual Arts and the Birmingham Civil Rights Institute, has launched a new course to “train students to diagnose figures in famous paintings. Why? It’s a surefire way of exposing their biases and assumptions.”
The impetus behind this specific course has been to address the conversations around racial and other biases in health care, especially as they have “reached new heights amid the COVID-19 pandemic.” Dr. Stephen Russell, an associate professor of internal medicine and pediatrics at the university developed the course and explained, “Art gives the majority of medical students something that is outside of their personal and perhaps cultural educational experience…and allows then to learn strategies for observation in something that is familiar, which is the clinical exam room.” The original class, based on Dr. Braverman’s work at Yale, has been updated and expanded by Dr. Russell in order to “focus specifically on biases and what Dr. Russell calls the ‘tolerance of ambiguity.’…The pandemic has taught us that you have to move forward when the answer is not fully known.”
Although the UAB program is relatively new, Dr. Russell and his colleagues are gathering survey data on pre-and-post-coursework to evaluate the students’ understanding of how the intersection of art and medicine can identify their implicit biases. The self-reflective data will help researchers understand how this, and similar programs, can enhance observational skills and increase insights about differences in lived experience. With the explosion in telehealth, electronic health records, and the resulting changes in the doctor-patient relationship, Dr. Russell stressed “this is an area ripe for additional research.” One particularly salient area for research might be a comparison of students’ reactions to patients whose racial and ethnic identities differ from their own.
While the arts help shine a light on implicit biases at the individual level, as well as at the health systems level, the art world, like the rest of society, also reflects systemic racism and structural inequities. There are many lessons learned from this emerging teaching method that have relevance to those in the field of health services research.
What Museums Can Teach Health Care about Dismantling Structural Injustice During a Pandemic
Yesomi Umolu, director and curator of the Logan Center Exhibitions at the Reva and David Logan Center for the Arts, University of Chicago, was artistic director of the 2019 Chicago Architecture Biennial. In response to the COVID-19 pandemic and racial violence, Umolu authored a piece on June 25, 2020, in Artnet News entitled, “On the Limits of Care and Knowledge: 15 Points Museums Must Understand to Dismantle Structural Injustice.”
…Today’s imperative to attend to the most vulnerable and disenfranchised in society while dismantling white supremacy has unsurprisingly exposed the limited knowledge on these subjects among the public, private enterprises, and civic institutions—including museums. This not knowing—due to lack of information, misinformation, or willful ignorance—seems to underpin the carelessness with which we have thus far tackled systemic racism and structural injustices in our society. We therefore find ourselves in a crucial period of learning.
The points made by Umolu have relevance for those in the health field concerned about structural racism and bias. Consider her museum-related contextualization below as published in her article and the ways each could apply to health services research:
- Museums are built on the ideological foundation of being repositories of knowledge and spaces of care in service of civic society in the western world.
- Museums have always been exclusionary, and for the privileged. They were built for the betterment of the western subject and society at the expense of the other.
- If museums amass knowledge and care for things (author’s note: substitute the word people for things), then we must ask ourselves, in the midst of the social upheavals and global health pandemic of recent days, months, and year, for whom do they do this?
- The answer is obvious. The statements from museum leaders in recent days starkly reveal this in so far as they have identified the need to better serve communities of color through all aspects of their work all the while educating their (yet to be diverse) boards, staff and audiences on the importance of anti-racism.
- To acknowledge the limits of your knowing and caretaking is an important step.
- But before moving forward, it is important to understand that to seek to make amends, repair, reconcile, and build for the future on broken foundations is a difficult and potentially dangerous path.
- The task of the moment is not to seek to welcome the other and the excluded into these fragile spaces, i.e., filling quotas and exacting hastened inclusion policies without making any other changes to institutional culture or structure.
- The task is to commit to practices of knowing and care that critically interrogate the fraught history of museums and their contemporary form, uprooting weak foundations and rebuilding upon new, healthy ones.
- Let us know and care for the other, ourselves, and society at large in equal measure, without prejudice. Let us know and care about bodies and their politics.
It’s not hard to replace “museum” with “health services research” or “health care” in each of these bullets. In doing so, what insights do we gain, and what actions might these lessons prompt?
The arts can help us see, analyze, and address racism and bias in new ways. Learning from other fields and disciplines in this way is a critical component of AcademyHealth’s Paradigm Project.
“We cannot continue to do what we have always done and expect to make progress to root out systemic racism in our communities and health systems,” said Dr. Lisa Simpson, President and CEO of AcademyHealth. “The Paradigm Project was built on the idea that we needed to step back and reimagine how we do our work to drive innovation and have a greater impact.”
Artists, in collaboration with health care experts, are drawing out some of those potential policy solutions. Learning from others is a key component of what the Paradigm Project aims to do, and these case studies help us ‘see’ the work in a new way. The parallel epidemics of systemic racism and COVID-19 have made it impossible to look away.