Despite its science based and mission-driven underpinnings, U.S. healthcare is subject to great racial disparities. With a $10,000 grant from the Northern New York Library Network, faculty at Clarkson University in Potsdam, NY, are undertaking a new program called “Reckoning with Race and Racism in Healthcare and Medicine” to help local healthcare practitioners and students better understand the ways that racial biases determine health outcomes. The project will offer Clarkson’s community—doctors, nurses, physician assistants, physical and occupational therapists, healthcare workers and healthcare students—opportunities to learn about the effects of racial biases on healthcare, past and present.

The funds will sponsor a course for continuing education, relevant workshops and the purchase of multiple copies of books such as Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present and A Terrible Thing to Waste: Environmental Racism and Its Assault on the American Mind, both by Harriet A. Washington.

“This project is directly addressing a big gap in our book collections,” noted project Health Sciences Librarian and project colead Mary Cabral wrote. “We are purchasing about 120 new titles in print to support the workshops, that will be available to borrow by anyone in the north country community.” Some of the books focus specifically on racism in healthcare; others explore racism in America at a broader level.

Project colead Stephen T. Casper, medical historian and history professor, told LJ why he considers it essential. “I think there were clear gaps at Clarkson University in how we thought about our own role in the delivery of health education on race and racism in medicine,” he said. “There’s a vast literature on economic, environmental, social, and cultural determinants of health. Much of that writing by researchers and clinicians has recognized that social and environmental injustice perpetuates poor health outcomes. What I wanted to do was show people all of the great scholarship on this point, and I wanted to help people think more about the way our rural environment equally has poor population health experiences and outcomes.”

It is vital for libraries to participate in social justice issues, explained Cabral, citing the American Library Association’s (ALA) current plan for action, Libraries Respond: Black Lives Matter, as a source of inspiration. “Librarianship is a very white profession,” she said, noting that those in the field with white privilege must be part of productive change. Libraries, she continued, are “a safe place to figure out what we don’t know, with resources to learn from and people to guide research and investigation. This is true of addressing racism and, in this case, addressing racism in healthcare.”

The project is currently underway. Cabral told LJ, “The in-print collection has been purchased, cataloged, and is on display for browsing and borrowing.” Casper has received external approval for the continuing medical education credit. “That will pave the way toward getting continuing education credit for occupational and physical therapists,” he told LJ. “We have made about 90 percent of the progress necessary to run the pilot course. Just a few things to do before we start advertising for it.”

OPENING UP THE CONVERSATION

Cabral feels that the library’s location will make it an effective place to offer “Reckoning with Race and Racism in Healthcare and Medicine.”

“The library is seated in the Lewis School of Health Sciences, which was recently recognized by the New York State Association for Rural Health for its regional and statewide impact on the rural health workforce,” she said, noting that many of the health sciences faculty are also clinicians in the area. “It feels advantageous to host this project at the Clarkson Health Sciences Library, offering a space to explicitly and intentionally talk about race and systematic injustices and encourage dialogue among current and future practitioners, with the aspiration to proactively and deliberately move our community toward racial justice in healthcare.”

History Instructor Phillip White-Cree, a member of the Mohawk of Akwesasne Saint Regis Mohawk Tribe, and Clarkson’s coordinator of Indigenous community support and outreach, has contributed suggestions to the list of titles on Indigenous research and methodologies for purchase. “I have a few colleagues who are medical research professionals, and I had some light discussions with them,” he told LJ. “My idea follows the example of [writer] Elizabeth Cook-Lynn, that laws and policies that contribute to oppression must be acknowledged, challenged, and then criticized. So ideally…ensure the collection can be a starting point of information and begin discussions on how to challenge the practices that have contributed to the historical and current medical issues. Then move towards building better practices in medicine moving forward.”

White-Cree grew up with a unique view of healthcare. “Parts of my family are professionals, especially in the medical field,” he explained. “They had navigated their own medicine professions with the injustices that medicine had [done to] Indigenous and other groups. This is what I can contribute, to help validate those who know of these traumas and inform those coming into the profession.”

Casper envisions more to the project beyond collection development. “I also need to start to work on building up awareness with local stakeholders,” he said. “Launching a continuing education curriculum has tons of moving parts, and doing so requires careful methodical and detail-oriented steps…. This particular subject is also a difficult one for many people.”

The program is not without challenges, including “the debate on libraries as neutral organizations,” Cabral noted. “I personally think Yes, in terms of unbiased access to resources that offer a multitude of viewpoints, and offering space for diverging opinions; but a solid No to sitting quietly while misinformation is propagated and to being indifferent to injustices.”

She added, “Vulnerability feels like an obstacle, too. Tackling something this weighty leaves us open to judgement and criticism, which can also feel like a threat to our support and funding, resources that are already often lacking. But I think this discomfort is part of what it means to do the work of anti-racism in this country.”

Despite these concerns, she has also received positive reactions to the project. “I am delighted by the response of faculty who stop by while I’m unpacking all the books that are arriving,” she said in December, “and find[ing] out how strong their interest is in this and their eagerness to talk about these issues.”

Cabral has considered how she will measure the project’s success: “On the surface I think by metrics and anecdotally—number of people who attend and where they are coming from (geographically, professionally, educationally), the level of conversation and kinds of questions that are addressed, the circ stats in the new book collection, how many people come back for more than one workshop, requests for future workshops,” she said. “The CE [continuing education] component also has evaluation built into the process. More importantly, I’d love to somehow capture any domino effect of what people take back into their work in treating patients and engaging in potential research,” adding that she is not sure how to measure an increase in cultural humility from historically white-led fields and the accompanying change in healthcare outcomes this could affect. “That is a bigger question, and perhaps lends itself to another grant!”“

Casper hopes to receive good feedback as well. “I have also wanted to talk with other researchers nationally about how they have created warm and comforting spaces for challenging dialogues,” he said. “I anticipate that the first class will have a small pool but as word gets around about the experience, the numbers will grow in each section.”

He looks forward to adding the project’s resources to the rural healthcare outreach available in New York State’s north country, he told LJ. “I’m a historian of medicine and I am passionate about helping people understand the history and sociology of medicine, particularly in rural environments that struggle with challenges created by inequity and disparities.”