“Health Equity Tourism” Does More Harm Than Good for Racial Disparities in Medicine

Following the National Institutes of Health (NIH) announcement that it would provide $100 million in health equity research funding after the COVID-19 pandemic and the murder of George Floyd placed a spotlight on severe racial and ethnic disparities in the U.S., researchers are clamoring for grants to publish papers on the topic. However, a STAT investigation found that many of these researchers have little to no background or training in health equity research – and are often white and already well-funded. In dozens of cases, white researchers were found to be building on the work of Black and brown researchers without citing them or offering to include them as coauthors or on grants.

For instance, in August, the Journal of the American Medical Association (JAMA) published a special themed issue on racial and ethnic disparities in medicine. Of the five research papers published in the issue, none had a Black lead or corresponding author, and only one had a Hispanic lead author.

The gold rush for health equity research funding presents a threat to Black researchers’ careers. Newcomers to health equity research may be taking opportunities away from scientists of color in one of the few areas of academic medicine where they have historically worked and led by taking cuts of the still limited funding directed toward health equity research. “It all comes down to the tenure system. If we’re not getting funded, we’re not going to get promoted,” said Whitney Sewell, PhD, MSW, a lecturer in population medicine at Harvard Medical School who studies HIV prevention in Black women.

Additionally, scientists who are new and unskilled in the field of health equity may be producing low quality work that could underestimate or inaccurately report disparities. One such study, published by JAMA Network Open in June, indicated that COVID-19 death rates were higher in Black patients than white patients because they were more likely to be treated at poorer-performing hospitals.

Jorge A. Caballero, MD, a San Francisco Bay Area anesthesiologist and cofounder of Coders Against COVID, told STAT that the study contained major data gaps that may have minimized true disparities. The paper did not consider ethnicity and grouped Hispanic patients with white patients, most likely shrinking the disparity in mortality between white and Black patients. Patients who did not have six months of continuous insurance coverage in 2019 were excluded, meaning the paper was more likely to exclude Black people, who tend to be less likely to have stable health coverage.

“These are just glaring deficiencies that are obvious to BIPOC subject matter experts,” said Dr. Caballero. “On the one hand, you don’t want to discourage the work, but this particular paper could do more harm than good,” he said. “It makes it seem like the disparities aren’t as pronounced as they really are.”

Source: STAT, September 23, 2021.