Black Patients Matter in Neurology Race, Racism, and Race-Based Neurodisparities
Black Patients Matter in Neurology Race, Racism, and Race-Based Neurodisparities
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DOI：
10.1212/wnl.0000000000200830
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发表时间：
2022-07-19
期刊：
影响因子：
9.9
通讯作者：
Hamilton, Roy
中科院分区：
文献类型：
--
作者：
Robbins, Nathaniel M.;Charleston, Larry;Hamilton, Roy
生活在美国的黑人在多种神经系统疾病中遭受着不成比例的发病率和死亡率。尽管普遍观念与此相反，“种族”是一个社会定义的概念，几乎没有遗传有效性。因此，神经病学中的种族健康不平等（“神经差异”）并不是种族之间生物学差异的结果。相反，种族主义和相关的健康社会决定因素是神经差异的根源。迄今为止，许多神经科医生忽视了种族主义作为神经系统疾病的根本原因，进一步加剧了这一问题。结构性种族主义在当前的神经病学实践和政策中很大程度上被忽视，它通过过度贫困、劣质医疗保险以及获得神经病学和预防性护理的机会较差等中介因素推动了神经差异。人际种族主义（隐性或显性）以及神经学研究、劳动力进步和医学教育中相关的歧视性做法也会加剧神经差异。如果不了解种族主义（而不是生物种族）如何导致神经差异，神经科医生就无法履行照顾黑人患者的专业和道德责任。在我们对神经病学中的种族、种族主义和基于种族的差异的回顾中，我们强调了当前关于各种神经系统疾病的神经差异的文献，并将种族主义作为根本原因。我们讨论为什么所有神经科医生在道德和专业上都有义务积极推动反种族主义的措施。最后，我们呼吁神经科医生个人和专业神经病学组织应采取行动，以减轻种族主义并努力实现神经病学的健康公平。
Black people living in the United States suffer disproportionate morbidity and mortality across a wide range of neurologic conditions. Despite common conceptions to the contrary, "race" is a socially defined construct with little genetic validity. Therefore, racial health inequities in neurology ("neurodisparities") are not a consequence of biologic differences between races. Instead, racism and associated social determinants of health are the root of neurodisparities. To date, many neurologists have neglected racism as a root cause of neurologic disease, further perpetuating the problem. Structural racism, largely ignored in current neurologic practice and policy, drives neurodisparities through mediators such as excessive poverty, inferior health insurance, and poorer access to neurologic and preventative care. Interpersonal racism (implicit or explicit) and associated discriminatory practices in neurologic research, workforce advancement, and medical education also exacerbate neurodisparities. Neurologists cannot fulfill their professional and ethical responsibility to care for Black patients without understanding how racism, not biologic race, drives neurodisparities. In our review of race, racism, and race-based disparities in neurology, we highlight the current literature on neurodisparities across a wide range of neurologic conditions and focus on racism as the root cause. We discuss why all neurologists are ethically and professionally obligated to actively promote measures to counteract racism. We conclude with a call for actions that should be implemented by individual neurologists and professional neurologic organizations to mitigate racism and work towards health equity in neurology.