Critical Race Theory and claims about structural racism in American society are infiltrating medical care and education. There is a major effort in medical education today to indoctrinate students and resident physicians into Critical Theory. This is, in my view, a deeply misguided approach.
The issues raised by Critical Race Theory are real but I believe that the diagnosis is deeply flawed. The question we face is: How can we protect medical education and practice from this latest iteration of Marxism, and at the same time work to improve deficiencies in education and medical care that Critical Race Theorists correctly point out?
Undeniable Structural Problems
It is undeniable that there are structural problems in medicine. Many of these problems impede good medical care, especially for poor and minority patients. An impoverished black person in Chicago’s South Side is unlikely to get the same quality of medical care that a wealthy white person in Cambridge, Massachusetts, gets. But race is not the only factor — Oprah Winfrey has access to better medical care than a poor white man living in a trailer park in Appalachia.
Let’s look at some of the other structural problems at play in substandard medical care:
- Poverty plays a huge role in substandard medical care. Rich people get better care, generally, than poor people do. Money buys access to care. Of course wealth tracks with race to some extent. But cause-and-effect relationships between race and wealth are complex, as I’ll discuss below.
- Crime is a terrible problem for many minority Americans, especially in inner cities. Not only are murder, rape, and assault not good for anyone’s health but high crime rates create a cascade of dysfunction. I am talking about things like overwhelmed hospitals and businesses giving up and closing down. Those lost businesses cost jobs and deprive local residents of needed goods and services. Schools where delinquency is rampant impede good education. Law-abiding citizens who have money and opportunities flee, leaving those who have no place to go. Living in a war zone is bad for their health.
- Gangs are a plague in many of our inner cities,. They not only perpetuate violent crime but inculcate a culture of intimidation and corruption that erodes the social fabric of a neighborhood and thus contribute to poor health and poor medical care.
- Drug abuse is an obvious healthcare catastrophe, linked of course to poverty, crime, and gangs. There are few things more highly associated with poor health than drug addiction, and rampant drug abuse degrades the quality of life and the quality of health care in a community.
- Abortion is undoubtedly that most dramatic example of structural racism in our country. Black children in the womb are aborted at two and a half times the proportion of black Americans in society. Black women have 474 abortions for every 1,000 live births — the highest rate for any group in our country. In New York City, a black child in the womb is more likely to be aborted than to be born alive. This mass homicide of unborn black children costs incalculably more innocent black lives than police misconduct or substandard medical care. For example, in 2011, 360,000 black babies were aborted, compared with 287,072 black deaths from all other causes. Black lives, like all lives, matter, and the abortion industry, which has a long history of racist and eugenic motives, clearly targets black children.
- Riots, arson, and looting are catastrophic for the communities in which they occur, and most of those communities are black. The recent Black Lives Matter-inspired George Floyd riots cost $2 billion in damage, caused scores of deaths and thousands of injuries, and decimated major parts of 140 American cities. These riots destroyed the neighborhoods, jobs, and healthcare infrastructure of millions of minority Americans.
- Bad government is a severe and chronic problem for millions of Americans. The governments of many if not most of our major cities — where a large portion of black Americans live and get their healthcare — are mired in corruption and incompetence, resulting in dysfunctional hospitals and government services. This is catastrophic for healthcare, which depends on honest, accountable leadership and public policy.
- A lack of jobs accompanies many of the problems I’ve talked about above — corruption, crime, and riots destroy local economies and drive out businesses, leaving residents with no chance for employment, which means they are all the more likely to have problems getting good health care.
- Bad public education is everywhere in many American cities and minority children suffer immensely because of it. Poor educational systems and inadequate healthcare systems go hand-in-hand.
- Welfare dependency has been catastrophic for poor families, not only because of the disincentive to work inherent to government dependency but because the government replaces the family’s breadwinner and makes him (traditionally the father) not only superfluous to the family’s support but an impediment to it. Eligibility for welfare benefits often depends on the absence of a family breadwinner. Welfare paid families to discard fathers, husbands, and breadwinners. Unsurprisingly, they did just that.
Racial discrimination is obviously a problem in America, but Critical Race Theory generally overstates its impact and downplays the impact of the myriad other problems that impair the quality of healthcare for many Americans.
Structural racism exists in America — affirmative action is perhaps the clearest example — but amid structural poverty, structural crime, structural drug abuse, an epidemic of abortions of minority children, civil unrest, bad and corrupt government, structural unemployment, chronic welfare dependency, and an educational system in shambles, structural racism likely plays a very small role in our problems.
The Perennial Motives for Sin
Critical Race Theory advocates assert, of course, that all of these other structural problems are caused by structural racism, but that is dubious. Greed, hate, envy, lust, and pride — the perennial motives for sin — are obviously at the core of our social breakdown. Murder, rape, robbery, gang membership, etc., have many causes, but racism is obviously only remotely related, where it is a cause at all.
It is noteworthy that policies hawked by Critical Race Theory advocates — handcuffing and defunding the police, fostering welfare dependency, encouraging racial hatred and resentment — are just those policies that have generated dysfunctional cities. Chicago, Baltimore, and Detroit and the panoply of violent corrupt municipalities in which so many black Americans live and (too often) die much too soon are bastions of leftist politics. That’s highly congenial to Critical Race Theory but not at all congenial to actual betterment of the lives and health of their citizens.
More the Consequence than the Cause
Structural racism is, I think, more the consequence of societal dysfunction than the cause. The catastrophic social and economic policies hawked by leftists are a major cause of what structural racism there is in America. Impoverished corrupt dangerous cities cast a pall on minority Americans, giving millions of other Americans the impression that minority Americans are violent and dysfunctional. For example, the continuously televised Black Lives Matter-inspired George Floyd riots — night after night of wanton arson, looting, and murder — horrified and terrified hundreds of millions of Americans. Cities set in flames by rioters inspired by peddlers of Critical Race Theory obviously did not serve to ease racial animosity and foster racial comity. Hate and fear breed more hate and fear.
There are myriad structural problems in our society that impair healthcare. When we account for structural crime, structural corruption, structural misgovernment, structural educational failures, and the like, structural racism recedes as a cause. Ironically, many of these societal failures across generations can be laid at the feet of ideologues and political grifters such as Critical Race Theory advocates who run America’s blighted cities and hawk leftist remedies.
We need to address these societal and medical problems. A good place to start would be to hold to account the leftists who now, ironically, claim to be the solution to the very problems they have caused.
Cross-posted at Mind Matters, published by Discovery Institute’s Walter Bradley Center for Natural and Artificial Intelligence.