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Biomedical science and federal funding for scientific research are not immune to the systemic racism that pervades American society. A groundbreaking analysis of NIH grant success revealed in 2011 that grant applications submitted to the National Institutes of Health in the US by African-American or Black Principal Investigators (PIs) are less likely to be funded than applications submitted by white PIs, and efforts to narrow this funding gap have not been successful. A follow-up study in 2019 showed that this has not changed. Here, we review those original reports, as well as the response of the NIH to these issues, which we argue has been inadequate. We also make recommendations on how the NIH can address racial disparities in grant funding and call on scientists to advocate for equity in federal grant funding.

Dismantling the Overpolicing of Black ResidentsBlack residents face higher rates of remedial interventions and dismissal than do their White counterparts. Such overpolicing affects the mental health of trainees as well as their careers.

Systemic racism is a scientifically tractable phenomenon, urgent for cognitive scientists to address. This tutorial reviews the built-in systems that undermine life opportunities and outcomes by racial category, with a focus on challenges to Black Americans. From American colonial history, explicit practices and policies reinforced disadvantage across all domains of life, beginning with slavery, and continuing with vastly subordinated status. Racially segregated housing creates racial isolation, with disproportionate costs to Black Americans’ opportunities, networks, education, wealth, health, and legal treatment. These institutional and societal systems build-in individual bias and racialized interactions, resulting in systemic racism. Unconscious inferences, empirically established from perceptions onward, demonstrate non-Black Americans’ inbuilt associations: pairing Black Americans with negative valences, criminal stereotypes, and low status, including animal rather than human . Implicit racial biases (improving only slightly over time) imbed within non-Black individuals’ systems of racialized beliefs, judgments, and affect that predict racialized behavior. Interracial interactions likewise convey disrespect and distrust. These systematic individual and interpersonal patterns continue partly due to non-Black people’s inexperience with Black Americans and reliance on societal caricatures. Despite systemic challenges, Black Americans are more diverse now than ever, due to resilience (many succeeding against the odds), immigration (producing varied backgrounds), and intermarriage (increasing the multiracial proportion of the population). Intergroup contact can foreground Black diversity, resisting systemic racism, but White advantages persist in all economic, political, and social domains. Cognitive science has an opportunity: to include in its study of the mind the distortions of reality about individual humans and their social groups.

Nazism and the JournalBetween 1935 and 1944, the Journal remained all but silent regarding the heinous motives of Nazi science and medicine. What is the nature and significance of silence in the face of such oppression?

The murders of George Floyd and countless other members of the Black community by police prompted family medicine journals and professional societies to publish antiracism statements that provide actions, plans, and accountability structures to eliminate systemic anti-Black racism in medicine.1,2 Health disparities in cancer outcomes, diabetes mellitus management, and pain treatment are evidence of the results of systemic anti-Black racism in medicine.3 Other examples include exclusionary practices such as fewer patients who are Black receiving organ transplants4 and disrespect toward women who are Black5 (e.g., mistreatment during childbirth,6,7 the death of family physician Dr. Susan Moore8). Apply an antiracist equity lens and advocate for systematic changes in our society to address systemic anti-Black racism, which is a significant cause of inequities in social determinants of health and health disparities.15 Recognize that White privilege advantages some and disadvantages others, and speak out to include Black colleagues in decision-making.15 Medical students who are Black experience a lack of opportunities and more mistreatment.16 Use physician offices as pathways to opportunity and to level the playing field for students who are Black. The lack of physicians who are Black and in leadership is evidence of systemic anti-Black racism in medicine and its profound impact on decision-making.10 Influence local hospital medical staff and professional societies to actively recruit Black physicians, and encourage Black physicians to become active members and move into leadership positions.

Background End-stage kidney disease continues to disproportionally impact the lives of First Nations peoples. Systemic racism is a key determinant, and manifests as differential access to determinants of health (housing, employment, access to care) and differential care. This paper discusses how different models of primary healthcare operating in rural and remote Manitoba communities results in different outcomes for patients identified as being at risk of kidney disease. Methods This study is a partnership between researchers from the First Nations Health and Social Secretariat of Manitoba and the University of Manitoba. We used health administrative data held at the Manitoba Centre for Health Policy for the period of 2006-2019, linked to the Manitoba First Nations Research File to identify First Nations. We compared rates of laboratory follow-up tests, nephrology consults, PHC visits, and hospitalizations between different models of care using a negative binomial regression model adjusted for age, sex, eGFR heat-map category, urine ACR heat-map category, and Elixhauser comorbidity index. Results We identified 12,613 First Nations people with chronic kidney disease (CKD) during the study period. First Nations individuals with CKD who reside in communities served by Nursing Stations (most remote communities) when supplemented by additional Indigenous programs were consistently more likely to receive follow-up serum creatinine (OR 1.37, 95% CI: 1.30-1.45, p <0.001), urine ACR (OR 1.22, 95% CI: 1.16-1.28, p <0.001), serum potassium (OR 1.40, 95% CI: 1.32-1.49, p <0.001) than individuals who lived in communities served by Nursing Stations alone, Health Centres, Health Offices, or Off Reserve. Conclusions Our results show that addressing the rise in premature mortality experienced by First Nations from kidney diseases require greater investments in First Nations-centric primary healthcare, that is locally managed. Additionally, off-reserve primary healthcare services must be alerted to their need to better address the needs of First Nations at risk of CKD, with more consistent follow up, referrals, and in providing culturally safe care. Finally, First Nations-led research in kidney health and primary healthcare is leading to significant improvements in outcomes, and needs to be better supported and resourced, and imbedded in a context of greater investments to improve access to all determinants of health and counter systemic racism.

Early in the COVID-19 vaccine rollout, Black adults consistently reported more hesitancy than White adults, but few studies have examined variation in hesitancy among Black adults or its associations with racial discrimination. Data were collected from Black Arkansas residents age 18 and older ( n  = 350) between July 12 th and July 30 th , 2021, as part of a larger survey of Arkansans ( N  = 1500). Participants were recruited through random digit dialing of both landline and cell phones, with oversampling of Black and Hispanic residents. Respondents reported COVID-19 vaccine hesitancy, sociodemographic information, influenza vaccination history, pandemic-related experiences, and experiences of racial discrimination. Almost half (48.9%) of Black adults in Arkansas were not hesitant towards COVID-19 vaccines, while the remainder reported some level of hesitancy. Nearly a quarter were very hesitant (22.4%), while fewer reported being somewhat (14.0%) and a little (14.7%) hesitant. Using an ordered logistic regression with partial proportional odds, we find odds of COVID-19 vaccine hesitancy decreased as age and influenza vaccination increased. Odds of COVID-19 vaccine hesitancy were 1.70 times greater for Black adults who experienced the death of a close friend/family member due to COVID-19 and 2.61 times greater for individuals reporting discrimination with police or in the courts. Within-group analysis revealed nearly half of Black adults did not report any COVID-19 vaccine hesitancy and heterogeneity among those who were hesitant. Findings suggest there may be an important link between racial discrimination in the criminal justice system and COVID-19 vaccine hesitancy among Black adults.

Of Aspirin, Preeclampsia, and RacismThe stress imposed by structural and individual racism on Black people may contribute to the development of preeclampsia. But use of race to guide prevention-related decisions could be problematic.

[...]is the direct effect of experiencing racism at the hands of institutions or individuals. Exposure over the life course, together with having to remain vigilant and the anticipatory stress of possible future racist encounters, is likely to continue affecting the mental health of people from ethnic minorities in the longer term.7 Secondly, racism can lead to ethnic inequalities in the social determinants of health. The third way that racism can damage health is through the operations of health and care systems, particularly ethnic inequalities and experiences of discrimination and racism in maternity and mental health services. The NHS Race and Health Observatory has shown that barriers to accessing NHS services for patients from ethnic minority backgrounds include lack of appropriate treatment for particular health issues; poor quality or discriminatory treatment from healthcare staff; lack of appropriate interpreting services; and delays in, or avoidance of, seeking help for health problems because of fear of racist treatment from NHS healthcare professionals.12 Lack of data on racism, ethnic inequalities, and health limit analyses.

In mental health ethics, it is generally assumed that coercive measures are sometimes justified when persons with mental illness endanger themselves or others. Coercive measures are regarded as ethically justified only when certain criteria are fulfilled: for example, the intervention must be proportional in relation to the potential harm. In this paper, we demonstrate shortcomings of this established ethical framework in cases where people with mental illness experience structural racism. By drawing on a case example from mental healthcare, we first demonstrate that biases in assessing whether the coercive intervention is proportional are likely, for example, due to an overestimation of dangerousness. We then show that even if proportionality is assessed correctly, and the specific coercive intervention would thus be regarded as ethically justified according to the standard framework, coercion may still be ethically problematic. This is because the standard framework does not consider how situations in which coercive measures are applied arise. If structural racism causally contributes to such situations, the use of coercion can compound the prior injustice of racist discrimination. We conclude that the ethical analysis of coercion in mental healthcare should consider the possibility of discriminatory biases and practices and systematically take the influence of structural discrimination into account.