Institutional Racism in the Health Care System

The American Academy of Family Physicians (AAFP) recognizes that racism is a system that categorizes people based on race, color, ethnicity and culture to differentially allocate societal goods and resources in a way that unfairly disadvantages some, while without merit, rewards others. As a system, racism has been institutionalized in a way that permits the establishment of patterns, procedures, practices and policies within organizations that consistently penalizes and exploits people because of their race, color, culture or ethnic origin. The system of racism affects the attitudes, beliefs and behaviors of one individual towards another (personally-mediated) as well as how individuals perceive themselves (internalized).

The AAFP also recognizes the impact of racism within the U.S. health care delivery system, which has historically engaged in the systematic segregation and discrimination of patients based on race and ethnicity, the effects of which persist to this day. Hospitals and clinics, which were once designated for racial and ethnic minorities, continue to experience significant financial constraints and are often under-resourced and improperly staffed. These issues result in inequities in access to and quality of health care and are major contributors to racial and ethnic health disparities. While segregation and discrimination based on race and ethnicity is no longer legal today, some organizations continue to discriminate based on insurance status, which also disproportionately impacts non-white populations.

The AAFP opposes all forms of institutional racism and supports family physicians to actively work to dismantle racist and discriminatory practices and policies in their organizations and communities.

The AAFP recommends that all health care systems, hospitals, clinics and institutions adopt anti-racist policies that advocate for individual conduct, practices and policies that promote inclusiveness, interdependence, acknowledgment and respect for racial and ethnic differences. The AAFP also recommends that organizations take an active approach to dismantling racism by conducting a comprehensive critical examination of policies and procedures, empowering the development of diverse formal and informal leadership at all levels and developing a plan that increases accountability, demonstrates transparency and reorganizes power. (July 2019 BOD)