The New Hampshire Medical Society, along with the New Hampshire American Academy of Pediatrics, New Hampshire Psychiatric Society, New Hampshire American College of Physicians, New Hampshire Academy of Family Physicians, oppose House Bill 544, “An Act relative to the propagation of divisive concepts.”
This bill defines and prohibits the dissemination of certain divisive concepts related to sex and race in state contracts, grants, and training programs.
From a public health standpoint, there is clear evidence that inequities and disparities disproportionately affect people of color and women. We need to learn about these topics in trainings in order to address them and create true health equity in New Hampshire. If we can’t talk about the facts, we can’t solve the problem.
There is an extensive body of evidence in the medical literature, and broad acceptance in the medical community, that racism and sexism have negatively impacted the health and well-being of people of color and women throughout the history of this country.
In fact, many of the country’s medical associations have recognized that racism is a public health crisis. COVID has shown us irrefutable differences in health outcomes between race and sex categories in New Hampshire. This is further described in the governor’s COVID-19 Equity Response Team Initial Report and Recommendations (July 2020). We must be able to understand and address these differences, known as health disparities.
Training physicians, and other health care providers, to understand the impacts of racism and sexism on health is imperative to their ability to care for patients and improve health outcomes. Additionally, as physicians we cannot be limited in our ability to treat diseases; not being able to train doctors on racism/sexism and its effects on health outcomes is tantamount to saying doctors can’t learn about treating COVID or cancer. As physician scientists, we must practice evidence-based medicine to best care for our patients. Rather than serving as “divisive concepts,” regular training on racism and sexism in medicine is integral to understanding how to improve the health and well-being of all Granite Staters.
Health disparities impact the economy as well. This is evidenced by this month’s BusinessNH Magazine cover story highlighting “Racial Inequity in Health Care.” The reporter reached out to the N.H. Medical Society to begin her investigation reflecting the recognition that understanding these concepts is important for the business sector. Additionally, a healthy workforce is necessary for a vibrant economy. An American Hospital Association brief states that “health disparities amount to approximately $93 billion in excess medical care costs and $42 billion in lost productivity per year” and describes the vital “connection between health equity and value,” as “improvements in health equity can provide tremendous value to patients, hospitals and the health care delivery system.”
While we wholeheartedly concur with the statement in HB 544 that no one should be judged “by their color, race, ethnicity, sex, or any other characteristic protected by federal or state law,” it is also crucial to acknowledge that prohibiting these important trainings would rob physicians of their ability to inform and treat their patients. It is our obligation to practice medicine with impartiality, regardless of our patients’ gender and/or background. In order to do so, research has demonstrated that regular training on unconscious bias positively impacts physician-patient interactions and patient experiences within the health system.
Furthermore, if we don’t fully understand the social determinants of health and how the structural determinants of racism and sexism impact health, we cannot fully inform our patients in their medical decision-making. Censorship of our ability to accurately teach, assess, and treat patients is against our Hippocratic oath. This applies especially for state-funded health entities, including federally qualified health centers, community mental health centers, and New Hampshire Hospital, which serve a disproportionate number people of color and women in our state.
The medical profession in the Granite State acknowledges and supports a patient’s right to make their own decisions that are fully informed, regardless of the physician’s personal beliefs. We strongly oppose anything that would censor physicians’ freedom of speech for patients to make informed decisions. We further affirm that the government should not interfere in the doctor-patient relationship. Thus, there is no place for government to legislate trainings that impact physicians’ ability to care for people.
Understanding the impacts of racism and sexism on health is fundamental to our practice of medicine and public health in New Hampshire. Regular trainings help improve clinical and public health outcomes in both the private and public sectors. They help to promote a free and fair economy. And they help physicians support individuals in making better informed health decisions. Finally, they help to ensure that the government and health and health care organizations work for everyone because we all fare better when we all are well.
Passage of this legislation would jeopardize the significant progress we have made in the Granite State in considering and understanding health disparities that are directly attributable to racial and gender inequities. It would therefore undermine public health initiatives and make it more difficult to improve the health of all citizens of this great state.
We strongly urge the House Executive Departments and Administration Committee to vote Inexpedient to Legislate on HB 544.
(Dr. L. John Klunk is immediate past president of the New Hampshire Medical Society. Dr. Marie-Elizabeth Ramas is president elect of the New Hampshire Academy of Physicians and a council member of the New Hampshire Medical Society. Trinidad Tellez is a medical doctor.)