Addressing the caste system in U.S. healthcare in the era of COVID-19
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(2020) 19:184
COMMENTARY
Open Access
Addressing the caste system in U.S. healthcare in the era of COVID-19 Karthik Sivashanker1,2* , Cheri Couillard3, Jennifer Goldsmith4,5, Normella Walker2 and Sunil Eappen6 Abstract In healthcare, we find an industry that typifies the unique blend of racism, classism, and other forms of structural discrimination that comprise the U.S. caste system—the artificially-constructed and legally-reinforced social hierarchy for assigning worth and determining opportunity for individuals based on race, class, and other factors. Despite myths of meritocracy, healthcare is actually a casteocracy; and conversations about racism in healthcare largely occupy an echo chamber among the privileged upper caste of hospital professionals. To address racism in healthcare, we must consider the history that brought us here and understand how we effectively perpetuate an employee caste system within our own walls. Keywords: Health, Equity, Racism, Caste
Main text The COVID-19 pandemic and resurgence of Black Lives Matter amidst continued police killings of unarmed Black men and women, have led us to a historic moment. We are collectively grappling with the recognition of structural racism that pervades our society, and with the significance of systems that normalize and elevate whiteness while diminishing black and brown experience. This awakening is also happening in hospitals across the country. In healthcare, we find an industry that typifies the unique blend of racism, classism, and other forms of structural discrimination that comprise the U.S. caste system—a framework from Pulitzer-prize winning author Isabel Wilkerson that describes the artificially-constructed and legally-reinforced social hierarchy for assigning worth and determining opportunity for individuals based on race, class, and other factors. To address racism in healthcare, we must consider the history that brought us here and understand how we effectively perpetuate an employee caste system within our own walls. * Correspondence: [email protected] 1 Department of Quality and Safety, Brigham and Women’s Hospital, Boston, USA 2 Department of Diversity, Inclusion, and Experience, Brigham and Women’s Hospital, Boston, USA Full list of author information is available at the end of the article
The creation of caste in the U.S
In codifying U.S. slavery in the 1700’s, a privileged elite created racist policies and practices to preserve a system of wealth and social inequality, establishing concepts of ‘white’ and ‘black’ formally in US law. Rich and poor whites alike were conferred a special status, while blacks were relegated to slavery. Thus, the elite class reduced the risk of poor whites from uniting and rebelling in common cause with Black enslaved peoples. From Reconstruction forward, racism has defined and influenced almost all of our social and economic policies in one way or another—from housing, education and employment discrimination, to mass incarceration, medical experimentation, lynchings, mob violence, and stat
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