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An Honest Look in the Mirror - Cultivating a Culture of Equity in Surgery.

J ames Baldwin, one of the most pivotal literary figures of the 20th century, poignantly wrote in 1962 at the peak of the Civil Rights Movement, ‘‘Not everything that is faced can be changed, but nothing can be changed until it is faced.’’ It is hard to imagine that almost 60 years later, we find ourselves in the midst of a public health crisis – juxtaposed between a global pandemic, unmasking the longstanding failure of our health system to adequately treat persons of color, and widespread social upheaval from police killings of Black citizens. The culmination of these timely events reflects a history of racism and discrimination that has permeated US society, but more acutely reveals how pervasive systemic racism still is in 2020. A truth we need to face with no qualifications. Surgical care in the United States is no exception. The 2002 Institute of Medicine Report ‘‘Unequal Treatment’’ comprehensively exposed the prevalence of racial disparities in the US health care system, highlighting race as an independent predictor of receiving low quality care across a spectrum of diseases. The IOM report ignited prolific research on surgical disparities over the past few decades. However, almost 20 years after the IOM report, there is no evidence that racial disparities in surgery have been eliminated; in fact our understanding of what drives racial disparities remains sparse. How can we revamp the academic surgery platform to ensure we are not in the same position twenty years from now? Racism in surgery is not a historical vestige; it is a current reality. Boyd and colleagues recently highlight this essential failure of recognizing and naming the explicit role that racism plays in exacerbating health disparities, ‘‘despite the abundance of scholarship on racial inequity, preeminent scholars and the journals that publish them, routinely fail to interrogate racism as a critical driver of racial health inequities.’’ The article further highlights explicit bias in disparity literature that often postulates unmeasured biological factors as a driver of racial differences in health outcomes – despite a lack of robust evidence supporting this hypothesis. Despite the evidence for racism as a mechanism of health disparity, Boyd and colleagues highlighted how rarely the words ‘‘racism,’’ ‘‘institutional racism,’’ ‘‘systemic racism,’’ and ‘‘structural racism’’ seem in racial disparities articles, let alone are interrogated as a mechanism of disparate outcomes. Additional assertions targeting patient mistrust as a driver of disparities and not a consequence of systematic mistreatment, ignore our culpability in the process and further emphasize the need to restructure our framework for investigating