Using race and ethnicity as risk factors for health conditions is “risky business” because it embeds and normalises damage and deficiencies in Black and Brown bodies whilst conveniently ignoring the environments, structures and systems that perpetuate poor and unequal health & wellbeing outcomes.

Essentially, racial risk assessment with good intentions may encourage negative racial profiling and the use of inappropriate or delayed interventions. You cannot change an individual’s race or ethnicity, but you can challenge and change the structures which uphold or withhold good health and well-being. But do you want to?

Good intentions alone are not enough when seeking to address health inequity.

In this week’s blog, I explore the risky business of racial risk assessment, risk factors, risk markers and structural determinants of health and wellbeing.

#ReimaginingBetter

CALL TO ACTION

Race is not a proxy for genetics.

1. If you do include race and ethnicity in clinical decision algorithms and risk assessments, be sure to acknowledge and educate people using these algorithms on the impact of systemic racism on health outcomes.

2. Be curious-question the use of race & ethnicity whenever you come across it in education, research, policy and clinical practice.

3. Use evidence- screen people based on their symptoms, personal medical history, family history and lifestyle-not the colour of their skin.

4. Remember- race is a risk marker for structural determinants of health, including systemic racism. Racism is a reversible risk factor for poor health outcomes. The difference is in acknowledging the order in which to intervene on the pathway to poor outcomes.

5. Racism can have a biological impact on health through an increased allostatic load( stress response), biological weathering( wear and tear), psychological burden and behavioural adaptations.

We must teach people that health inequities result from systemic racism, not false notions of biological differences. For example, the research shows that Black, African and Caribbean women experience higher rates of postpartum haemorrhage and PPH ( heavy bleeding after pregnancy). To mitigate this, some groups have included “ Black, African and Caribbean” race & ethnicity as a risk marker in clinical screens that reduce PPH but acknowledge that increased morbidity in Black, African and Caribbean women could be due to differential treatment, e.g. delayed recognition and response to evolving PPH. Evidence shows that health workers respond differently to racially minoritised people’s pain and distress. Pulse oximeters used routinely in clinical settings miss lower levels of hypoxemia in darker skin people. Health workers may be unable to spot ‘pallor’ and other signs of anaemia in darker skin tones. Having fibroids or thalassaemias like sickle cell, which are more prevalent in Black, African and Caribbean individuals, can increase your risk of haemorrhage. Not all Black, African and Caribbean women are affected by these conditions. This is distinctly different from saying being Black, African, and Caribbean automatically makes you bleed more.

To keep people safe using risk assessment, we must specifically state the true drivers of risk and then address them. Else we will continue to treat the symptoms, not the source of the problem.

Examples of Race Correction in Clinical Medicine

Vyas DA, Eisenstein LG, Jones DS. Hidden in Plain Sight - Reconsidering the Use of Race Correction in Clinical Algorithms. N Engl J Med. 2020;383(9):874-882. doi:10.1056/NEJMms2004740