By Amber Johnson
Healing processes, such as the truth and reconciliation process, can operationalize the three components of the health justice framework — community empowerment, structural remediation, and financial and structural supports — to address the trauma of medical racism. Structural remediation and institutional change is a long and slow process; however, changing the way we interact with each other — through healing processes — can lead to swift, radical changes. Consider, for example, interpersonal racism in patient/provider health care interactions.
Interpersonal racism in patient/provider interaction can determine whether a patient’s needs are met, and can be the deciding factor between survival or death. From communication between a provider and a patient, to diagnosis and treatment, to follow-up care and pain management, the patient/provider interaction is integral to obtaining access to quality health care. When interpersonal racism is at play, the quality of care is substandard and health outcomes are negatively impacted.
Interpersonal racism is one aspect of patient/provider interaction(s) that has massive implications for health outcomes, and it is also one that hospitals and medical staff have the direct agency, resources, and time to change. But this must be done at least partially on an individual level — neither patients nor providers can eradicate racism without acknowledging the truth of the harm caused and healing from the harm.
Acknowledging the truth may be achieved through a truth and reconciliation commission (TRC), a process whereby parties who have been harmed and parties who have caused harm are able to share their experiences and revise ahistorical narratives, so that they reflect the truth and seek justice in the form of reconciliation, reparations, or some form of resolution.
At least 46 countries around the globe have utilized TRC to right past wrongs and forge a way forward. TRC has been used to address apartheid in South Africa, genocide in Rwanda, military rule in Guatemala, and indigenous child suffering in Canada. It is an important tool in healing national division and creating an environment where community members, stakeholders, policy change leaders, and those with the power to generate change can come together to invent and implement holistic solutions.
According to Brian Rice and Ann Snyder, Truth and Reconciliation Commissions (TRC) have five aims: “1) to discover, clarify, and formally acknowledge past abuses; 2) to respond to specific needs of victims; 3) to contribute to justice and accountability; 4) to outline institutional responsibility and recommend reforms; and 5) to promote reconciliation and reduce conflict over the past.”
The first step — discover, clarify, and formally acknowledge past abuses — is germane to social change because it flattens political division and shifts the focus on crafting a narrative couched in actual experience, versus a political or commercial agenda.
When social issues are aligned with political and commercial agendas, they often fall victim to accusations of propaganda, resulting in little to no social change. However, when narratives and lived experience drive the agenda for social change, humans are more likely to collaborate to end human suffering versus ignoring it or fighting against change. COVID-19 is a compelling example of why politicizing a national crisis ends in more division versus concentrated efforts to combat a common enemy.
When it comes to COVID-19, or any contagious disease, we have no choice but to work together. COVID-19 eradication requires a unified message detailing the importance of everyone wearing their masks properly, avoiding super-spreader events, and getting vaccinated if they are able to. When people refuse to do so, we fail to establish sufficient protection to eventually eliminate the threat. Because our national divides continue to spread further apart, we do not listen to each other or trust messages. In order to eradicate COVID-19, we must reconcile our differences and have access to clear, unaltered truths about our situation that people actually trust.
By first acknowledging that harm has been done and that those harms led to institutional and systematic oppression, we can forge forward to address community led solutions, justice, accountability, reform, and resolve during COVID-19 and beyond.
Utilizing a truth and reconciliation commission to address medical racism is one step in reconciling our past and establishing trust in our health care system; ensuring access to high quality, equitable health care; and eliminating barriers for marginalized communities to participate in said health care. There are major differences between the 46 countries that utilized TRC and the U.S. The other countries were facing a single, monumental event or moment in history. They relied on their governments or institutions like the United Nations to organize truth and reconciliation commissions.
In the United States, most truth commissions are the result of grassroots organizing. Additionally, the conditions leading up to contemporary medical racism cannot be traced to a single event in history or a single ideology. Instead, it is a complicated web of injustice and malpractice with ramifications as complex as the communities that experience them. Different regions suffer from different types of medical discrimination. Advocates for TRC suggest a local approach might be more effective than a national commission, because people’s conceptions of justice aren’t homogenous; therefore, smaller, direct interventions using TRC should point towards specific communities who have been harmed and their local hospitals, medical professionals, and medical administrators.
COVID-19 illuminated various health disparities and the complex facets of medical racism in ways most Americans have never witnessed. In order to re-imagine equitable health care systems, we must heal past the everyday, systemic traumas that plague our lives. TRC is a first step towards acknowledging what needs to be healed and rendering a more realistic view of inclusive, accessible and equitable health care systems.
Amber Johnson is an professor of communication at Saint Louis University, co-founder of the Institute for Healing Justice and Equity, and interim Vice President of the Division of Diversity and Community Engagement.