Equity in UBC Pathology Governance and Care Distribution

Racism in Medicine

This month the CMAJ journal is entitled “Racism in Medicine” with the byline “its time acknowledge and address racism in health institutions”. On page 11 (authors Dryden OS, Nnorom O) the journal states: “Systemic racism (also referred to as structural or institutionalized racism) refers to “the processes of racism that are embedded in laws, policies of society and its institutions that provide advantages to racial groups deemed as superior, while differentially oppressing , disadvantaging, or otherwise neglecting racial groups viewed as inferior”.

The pathology governance structure of many pathology academic centers and their impact on care delivery have two main characteristics: 1- Sub specialization and centralization and 2- Emphasis on technology. Underrepresented in the discourse is a consideration of the effect of this on rural and First Nation communities. While the academic tradition may be striving for greater excellent in the analytical part of lab output, the part that impacts communities most is the pre and post analytical: the availability, access to, and utilization of tests, and how the results get fed back to close the loop and improve health. It is established, that providing care to communities requires a participatory relationship with empowerment and self determinism. Establishing connections and trust has major impact on the pre-and post analytical value of any lab and ultimately far greater impact on quality than the very expensive proposition of improving analytical technology. The latter is important but the former is a moral (and rational) imperative. Outsourcing of lab services and sub-specialization are intrinsically in tension with the values of community empowerment and determinism. The movement away from General Pathology has moved lab care away from communities. Predicting which lab care model (how much general versus outsourced and specialized) , delivers best care to communities is difficult and controversial. But, what is clear, is that the first step has to be connection.

inequality-related Gaps in Health Outcomes

UBC is a provincial university with a provincial mandate. British Columbia has tremendous geographic and demographic diversity. It is vital that we self examine and ask ourselves if the academy is applying its resources and capacity to benefit all people and places equally. The pandemic has brought the urgency of this consideration to a new peak. Pandemics exacerbate the impact of socioeconomic determinants on inequality-related gaps in health outcomes. We need to study things like accessibility, utility, and impact of testing in communities. We need to make ourselves more aware of peoples value systems and learn what they want for themselves and how to be good partners.

In accordance with the call of the CMAJ I think there are three things we can do:

1. Look at the politics of our academic microcosm and ensure we are doing all we can to engender equity, diversity, and inclusivity in out own environment. That we invite a plurality of voices and give all an equal seat at the table. That our pedagogy is designed to cultivate all students and not serve as a filter. That out hiring practice does not have an informal blacklist structure that punishes people who voice honestly held critique. That our workplaces are respectful. That administrative power is used justly.
2. Look at the impact of the academic structure on provincial lab care delivery models and ensure it is just and balanced. That it prioritizes the health and wellbeing of all. That it studies itself and agonizes over fair and equal care and strives to perfect this using the tools and talent of the academy. That connection, partnerships and lives saved, as a communal effort, are strived for and rewarded.
3. Integrate more studies on socioeconomic indicators and social justice into our academic content and output.

Let us acknowledge and address racism in health institutions and learn and change.