New study reviews evidence of racism in emergency medicine, sets research agenda

In 2021, the Society for Academic Emergency Medicine (SAEM) held a consensus conference, "From Bedside to Policy: Advancing Social Emergency Medicine and Population Health," which included identifying priority areas for future research and implementation science related to race, racism and antiracism in emergency medicine (EM).

In an effort to identify and summarize existing research and set the agenda for EM research in these topic areas, researchers from institutions across the country, including Boston University Chobanian & Avedisian School of Medicine, conducted a literature review of articles that addressed how race and/or racism affect emergency medical care, including access, utilization, treatment, outcomes, patient experience or provider experience in the emergency department.

"Although more overt forms of racist rhetoric are less likely to be observed in the 21st century, many treatments and guidelines in use today were developed based on research that conceptualized race as biological rather than a social construct," explained corresponding author Emily Cleveland Manchanda, MD, MPH, assistant professor of emergency medicine.

Among their findings:

• EM and adjacent fields have extensively documented racial inequities in access, utilization, diagnosis, treatment and outcomes over the course of many decades. Despite this, very few studies have explicitly studied racism or anti-racism in EM in any capacity.

• The majority of included studies were observational. Methods for reporting racial and ethnic inequities varied between studies, and many did not clearly report methods of collecting racial and ethnic data.

• Of the 187 studies included in the literature review, only six evaluated an intervention aimed at reducing racial inequities.

According to the researchers, key research priorities were informed by this review and refined through a robust consensus process that included input from community organizations around the country. The research agenda presented in this article provides a roadmap for addressing and eliminating racism and other systems of oppression in emergency medicine.

"While the harmful consequences of racism in emergency medicine have been well documented in nearly every facet of our literature, the research agenda proposed in this study will help us move beyond identifying the problem and toward developing solutions that get at the root causes of racial health inequities."

"In particular, we identified an urgent need for researchers to focus on developing evidence-informed interventions to address and eliminate racism and other systems of oppression in health care," added Cleveland Manchanda, who also is assistant program director of the Ravin Davidoff Executive Fellowship in Health Equity at Boston Medical Center and the Director for Social Justice Education and Implementation at the American Medical Association.

These findings appear online in the journal Academic Emergency Medicine.