Morgan Simko, MPH
Marketa Wills, MD, MBA
Andrey Ostrovsky, MD
The backdrop of 2020 is consumed by formidable imagery: the impact of COVID-19 on mental health, physical health, and the economy; streets flooded by protests calling for racial justice and police accountability; and manifestations of racism in our healthcare systems. The latter, while seemingly omnipresent in the past year, is far from newly understood. Art has previously captured ugly truths about racism in medicine, such as the violence and reactivity depicted in Robert Colescott’s Emergency Room (1989). Today, artist Clifford Owens contextualizes racial injustices in the times of COVID-19 in his exhibition, Skully, at CPM’s gallery location in Baltimore, Maryland. His art, much like others by Black artists, can reveal health disparities to medical professionals, creating space for conversation and progressive action.
Performance Art as Storytelling
Clifford Owens is a rising Black artist, born and raised in Baltimore, who creates performative pieces for his audience. Important to the function of his performance art is the ability for his audience to discuss the performance afterwards, creating a shared, living history of the art as it was experienced. In the height of the COVID-19 pandemic, Owens created Untitled (Hand) using his hands, a pouch, photo paper, and a small flashlight. Owens reached into the pouch containing unexposed photo paper, moving the flashlight across the paper, and imprinting the surface that recorded the punctures, creases, and gestures of the light. Owens then hand developed the photo paper in a darkroom. The resulting ghostly images of Owens’s hand coming in and out of view behind the dark lines reveal the impact of racism on Black lives and their health.
Owens’s Art as a Statement about Justice and Health
The image of Owens’s hand behind the dark bar-like grid is symbolic of Black men’s disenfranchisement in America, trapped within a criminal justice system that, much like the intentional yet blind strokes of the flashlight that contain the hand, was created to keep Black men within. The system’s control over Black bodies grew increasingly evident during the past year, when the murders of and violence against Black people propelled a national conversation on race in America, and protests ensued.
The chilling presentation of Owens’s hand as “white,” which in developing photo paper is evidence of an absence of light, might suggest that shadows have been cast upon Black lives not only as a result of the continued racial injustice and police brutality, but also as they endure a higher prevalence of COVID-19 and its social harms. Early in the pandemic, it was evident that people of color, particularly Black people, who had higher rates of comorbidities, lived in densely populated urban settings, and held jobs that kept them in contact with the public, were put at greater risk for contracting the virus and experiencing more serious outcomes.
Owens’s clever use of the photogram at the peak of the COVID-19 pandemic resembles the radiographs that clinicians see when COVID-19-induced acute respiratory distress syndrome “whites out” the X-ray as the patient takes their last breath. As Black individuals screamed, “I can’t breathe,” in protests, their brothers and sisters who contracted the virus experienced the literal damage to their lungs from COVID-19.
The photogram also resembles an X-ray that is difficult to interpret, a result of overexposure or patient movement, with blurred lines and a loss of nuanced detail. If not reconducted, such an X-ray could mean the difference between providing adequate health care to patients, and misdiagnosis or death. Oftentimes, health diagnoses are missed in Black patients as a result of a lack of detail, caused for a variety of reasons, including Black patients’ pain not being believed– based on false beliefs that date back to times of slavery– and a lack of their representation in medical studies.
Much like the flashlight elicits images of bars that trap Owens’s hand, the pouch itself appears to swallow his arm. The COVID-19 pandemic is all-consuming in the way that it inches into every aspect of life; racial disparities in not only health care access but also in housing, food security, and educational and technological resources have been heightened by the pandemic.
Evidence-based Practices to Address Racism in Medicine and Improve Health
Clifford Owens’s Untitled (Hand) captures the climate of COVID-19 and America’s heightened awareness of racial inequities, two moments in history that called for communal action and bold policies that invested in people. Even in the struggle and darkness of the art, the subject knows a more hopeful future exists outside of the bars. Medical professionals, in choosing to recognize this hope, can take steps to care for their patients by reducing racism in medicine with the following three strategies.
Build Trust. Distrust exists between providers and Black patients in part because, historically, Black people’s rights have been violated to advance science (most prominently in the story of Henrietta Lacks and the Tuskegee Study); furthermore, they have reaped little benefit from the medical advances their bodies supported. One way to build trust among Black patients is to increase their interactions with Black providers. It is also productive for providers to recognize patients’ race as a contributing factor to their personal lived experiences and encounters with systemic racism in medicine. It is known that race is not a risk factor; racism is. Much like monitoring other risk factors, such as high blood pressure and obesity, a patient’s health will not necessarily improve immediately. Rather, gradual progress can be made towards healthier lives, and when this increase in health happens at the population level, disparities diminish.
Invest in Black physicians and schools that teach them. Medical professionals at academic medical institutions conduct research that is shared with the community and decision-makers, influence the way in which physicians view their field, and contribute to a culture of what is and is no longer acceptable for standards of practice. Academic leadership has control in hiring, compensation, and research funding and have the ability to form task forces, complete with representation of those with lived experience in the relevant topics, to create an anti-racist agenda at the institution. Through these and other roles, medical professionals have significant power to lead boldly in anti-racism practices, policies, and teachings.
Medical schools have the unparalleled task of teaching medical students how to be a good doctor, instilling in them not only the knowledge needed to diagnose and treat disease but also the interpersonal skills to connect with patients and earn their trust. Teaching students to treat all risk factors, including racism, will help students succeed in these areas. Medical schools must also do more to specifically support Black applicants and students, in an effort to bring their experience to the classroom and the patients they serve.
Put more emphasis on preventative care. Medical schools and their employees who strive to reduce health disparities might also recognize the nation’s shortage of primary care providers, and take steps to encourage students to apply into that specialty. An obvious benefit of having more PCPs in medical settings is a greater emphasis on preventative care.
Another component to increasing access to preventative care is to ensure insurance coverage is accessible. The Affordable Care Act of 2010, which insured 20 million Americans, effectively eliminated the gap in coverage that previously existed between white individuals and every other racial group. Still, there were 28.9 million Americans under age 65 in 2019 who remain uninsured, and until they can get coverage that is accessible and affordable, health inequities will remain.
Physicians Can Benefit from Art
Clifford Owens creates art to bring a shared knowledge to his audience. Perhaps if COVID-19 and the murders of Breonna Taylor, George Floyd, and Ahmaud Arbery told Black stories in a way that awakened America, particularly white America, Black art that shares stories of injustices can do the same, long after the media coverage ends and COVID-19 cases decrease.
There is a special place in this movement for the actions of medical professionals who have influence in their own institutions and the way in which they personally practice medicine. The evidence-based strategies of building trust, investing in Black physicians and schools that teach them, and focusing on preventative care are a good place to start, and are far from being an exhaustive list of progressive action. One more strategy that should also be considered: learn from art. Engage with art. Recognize how its complexities make it the perfect medium for discussing racism in medicine.
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