The NEJM Dips Its Toes Into ‘Antiracist’ Activism

NEJM Catalyst, an academic journal focused on “health care delivery” and a subprint of The New England Journal of Medicine, has dedicated a “special issue” specifically to topics surrounding “structural racism.”

According to the editor’s note accompanying the issue, the goal of the issue is to chart pathways, such as policy reforms, to advance “health equity” and address structural racism.

“Structural racism cannot be resolved by the actions of one individual; power imbalances between health care institutions and the communities they serve must be reset,” the note reads. “The best way to do this is to centrally involve those most harmed by racism in monitoring it and implementing viable solutions.”

These “solutions” often involve policy changes that stray outside the realm of healthcare and into politics. Additionally, the bulk of the articles reflect the view common among proponents of DEI policies and similar initiatives that the American healthcare system is fundamentally racist, and that to ameliorate racial health disparities it should be reformed. 

These reforms appear to be heavy-handed attempts to inject DEI into healthcare and healthcare education.

For instance, one of the articles, titled “Lift Every Voice: Driving Antiracist Structure, Policy, and Culture Change in the Health Care Workplace,” catalogued the efforts of the “Lift Every Voice” initiative, which intended to collect data about racism in healthcare workplaces and address it by “creating responsive antiracism policy and culture change.”

The editor’s note describes another article as highlighting efforts “to develop a culturally grounded antiracism educational program that teaches care providers how to address social injustices while caring for members of [the formerly incarcerated] population.”

In other words: training to achieve certain social and ideological goals.

Yet another article, titled “Clinic-Based Community Organizing,” is even more explicit in its calls for political change, and seeks to use the health clinic as a vehicle for such change.

“Through applying a four-step relational organizing model that emphasizes listening to lived experience, convening core teams rooted in trust and love, developing community-organizing skills, and taking collective action, the program has created change in local clinical practice and quality improvement efforts that improve conditions for systemically harmed communities,” the article description reads. “The program’s community core teams — composed of patients and community members with lived experiences of oppression — have also led local and state policy efforts on issues that reflect their health priorities, including housing and language access.”

Regardless of the merits of these proposals, it’s important to draw a distinction; it is not the purview nor the place of physicians to use clinical practice as a vehicle for political advocacy. Rather, the physician has a duty to provide the best possible healthcare for their patients.

This point is all the more true when such political advocacy is thinly-veiled DEI activism, as the editor’s note makes clear.

“While some may feel discouraged by emerging threats to health equity efforts, this special issue affirms work toward addressing structural racism,” the editor’s note accompanying the special issue reads. “The contents offer clarity that may help future efforts to dismantle unjust structures. The investments may benefit impacted communities, health care institutions, and the United States and other nations.”

Taken together, NEJM Catalyst’s “special issue” blurs the line between medicine and politics. By presenting “antiracist” activism as a necessary component of healthcare delivery, the publication elevates ideology over clinical objectivity and shifts the physician’s role from healer to social reformer. 

Calls for structural change, community organizing, and DEI-infused education programs go well beyond the responsibility of providing evidence-based care and instead transform medicine into a platform for political advocacy.