LAW ENFORCEMENT VIOLENCE IS AN URGENT ISSUE FOR PUBLIC HEALTH
The murder of George Floyd by a Minneapolis police officer on May 25, 2020 triggered local, national, and international social unrest, driven by a prevailing and well-founded sense of discrimination within communities of color all over the world, especially with regard to police violence.
1
There continues to be a pressing need for clinicians to understand the public health impacts of law enforcement violence that result in adverse health outcomes.The research is quite clear regarding the preventable racial inequities related to law enforcement violence.
2
In 2018, the American Public Health Association produced an excellent and comprehensive review of the literature, showing that law enforcement violence in marginalized communities poses a threat to public health through deaths, injuries, trauma, and stress that disproportionately affect marginalized populations.3
In the U.S., Black, Indigenous, and People of Color (BIPOC) are 2–21 times more likely to be killed by police than their White counterparts, with young male BIPOCs suffering the greatest relative losses.2
,4
,- Gabrielson R
- Sagara E
- Jones RG
Deadly force, in Black and White.
ProPublica. October 10, 2014;
https://www.propublica.org/article/deadly-force-in-black-and-white
Date accessed: June 1, 2020
5
In fact, there are inequities at every stage of a BIPOC's interaction with the police.
6
This is evidenced by increased police presence in their communities; more common deployments of militarized police units; more frequent stops, ticketing, and arrests for minor infractions; greater size of bail and severity in sentencing; more frequent sentencing to execution; and higher rates of wrongful convictions.3
,6
, 7
, 8
Finally, there are higher rates of police-mediated nonfatal violent incidents (not necessarily resulting in injuries) among BIPOC individuals as well as injuries resulting from such violence.3
,6
,9
,10
- Mooney AC
- McConville S
- Rappaport AJ
- Hsia RY
Association of legal intervention injuries with race and ethnicity among patients treated in emergency departments in California.
JAMA Netw Open. 2018; 1e182150https://doi.org/10.1001/jamanetworkopen.2018.2150
LAW ENFORCEMENT VIOLENCE IS A SYSTEMIC ISSUE WITH A HISTORICAL ORIGIN
Understanding why these disparities exist starts with a study of the origin of policing, beginning with slave patrols in the pre-Civil War U.S. Their fundamental role was the protection of slaves as property and maintenance of the racialized and violent social hierarchy, especially necessary because enslaved people greatly outnumbered slaveholders.
6
,7
This same function and spirit of policing was reflected in the enforcement of the Black Codes after the War, tolerance of and participation in the lynching of Black and Brown Americans while upholding Jim Crow laws, suppression of protest during the civil-rights era, execution of the War on Drugs, and the ongoing direct and indirect perpetuation of racialized outcomes still present today.6
,7
Currently, the evidence shows that greater exposure to policing and law enforcement violence is likely maintained by several factors, including proactive policing, especially in BIPOC communities, vulnerability of those communities, perpetuation of negative racial stereotypes, revenue generation policies, and police culture and training that promotes social dominance and heightened threat perception over community service and protection.
6
,9
,11
In particular, increased militarization of police in the spirit of improving officer safety not only fails to reduce violence against officers but also increases violence against the community, particularly BIPOC communities.6
,8
After the violence has been perpetrated, police may rely upon legal protections that shield them from accountability, both formal (qualified immunity from civil liability) and informal (judicial deference to police assertions regarding the justifiable use of force). Because of this impunity, there are approximately 1,000 people who die annually at the hands of police; yet, prosecutors have sought only 110 prosecutions and obtained only 42 convictions from 2005 until Floyd's death, of which only 5 were murder convictions.12
,13
Treisman R. Where the Chauvin verdict fits in the recent history of high-profile police killings. NPR. April 20, 2021.https://www.npr.org/sections/trial-over-killing-of-george-floyd/2021/04/20/989292294/where-the-chauvin-verdict-fits-in-the-recent-history-of-high-profile-police-kill. Accessed May 2, 2021.
Then, it is all the more extraordinary that almost a year later, the officer responsible for Floyd's death was convicted on all counts, including second-degree murder, bringing some measure of relief to his family and community. This conviction was also remarkable because he was the second officer in Minnesota history to be convicted of murder, where notably the first instance was an African American officer having shot a White woman.
13
Yet, even before the court provided this rare fulfillment of justice, the common conversation around police violence had moved far past the individual responsibility of the bad apples in law enforcement and is now demanding redress of the systemic factors that have constructed, tolerated, and perpetuated disproportionate law enforcement violence in BIPOC communities.Treisman R. Where the Chauvin verdict fits in the recent history of high-profile police killings. NPR. April 20, 2021.https://www.npr.org/sections/trial-over-killing-of-george-floyd/2021/04/20/989292294/where-the-chauvin-verdict-fits-in-the-recent-history-of-high-profile-police-kill. Accessed May 2, 2021.
9
,11
Data that show vicariously adverse physical and mental health effects because of police violence correlate to a transition from a paradigm of individual victimization by individual police to one of community victimization.1
,14
, 15
, 16
In other words, the genesis of racialized policing does not lie with the lone officers but with the fundamental characteristics and historical function of the system of policing as a whole.LAW ENFORCEMENT VIOLENCE REPRESENTS ONLY ONE ASPECT OF SYSTEMIC RACISM
As humans and as clinicians, we cannot help but mourn the cruel and needless loss of Floyd's life and the knowledge that the structure of policing that killed him remains a danger to so many others. However, one must look beyond the attention currently paid to law enforcement violence to see a myriad systemic force that disproportionately damages the public health of racial and ethnic minorities. A full accounting of the social determinants of health reveals “mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice” constituting structural racism in all its varied and insidious forms.
17
Clinicians have a special responsibility to understand structural racism as a public health issue, not least because the ultimate outcomes of structural racism lead to their offices and even hospitals.15
,17
Medicine and public health systems are a good place to start; they are also replete with examples of racialized systemic forces leading to rights violations and poorer outcomes for BIPOC communities. Clinicians must acknowledge their stewardship over systems that have permitted or even celebrated many human rights abuses. Well-studied examples include the unconsented collection and reuse of Henrietta Lacks’ cancer cells, the forced and covert sterilization of Native American women (and more recently of asylum seekers at the U.S.–Mexico border), and the intentional infection of mentally disabled children with hepatitis.
18
, 19
, 20
, 21
Additional instances include the works of Marion Sims (surgically experimented on enslaved Black women without anesthesia), Taliaferro Clark (led the Tuskegee Syphilis Study), and Dr. Bruce Jessen and James Mitchell (psychologists that designed, ran, and participated in the Central Intelligence Agency detention torture program)—individuals whose actions, although abhorrent, were promoted and excused by a racist system.22
, 23
, 24
Even now, despite the racialized outcomes that are persistent in medicine, there are influential leaders and communicators who fail to understand its existence and therefore its consequences.25
Medicine's rocky history with race is fueled by the erroneous presumption that differential outcomes based on race are because of a biological phenomenon rather than of the social construct of racism. The unintended consequence of this fallacy yielded clinical algorithms weighted by race that ultimately perpetuated the same systemic biases, otherwise known as race-based medicine. One of the most notable examples of this effect is with estimated glomerular filtration rate, which is overestimated in African Americans and consequently leads to delays in receiving transplantation in chronic kidney disease.
26
,27
These same sorts of systemic effects are also observed in clinicians’ implicit biases regarding BIPOC patients, which impact medical decision making and clinician–patient communication.28
, 29
, 30
Specific examples of downstream racial inequities from bias are observed in provision of pain control, infant mortality rates, misdiagnosis rates, among many other clinical outcomes, including importantly all-cause mortality.17
,22
,31
,32
It remains unsurprising that the healthcare community has failed to earn the trust of BIPOC patients despite physicians being a highly trusted resource in general.- Benjamins MR
- Silva A
- Saiyed NS
- De Maio FG
Comparison of all-cause mortality rates and inequities between Black and White populations across the 30 most populous U.S. cities.
JAMA Netw Open. 2021; 4e2032086https://doi.org/10.1001/jamanetworkopen.2020.32086
22
,24
,33
CLINICIANS HAVE A RESPONSIBILITY TO ADDRESS SYSTEMIC RACISM THROUGH INDIVIDUAL ACTION
Disparate outcomes for patients and communities are counter to the ethical responsibility of clinicians to promote health. Clinicians are well positioned to impact social justice because of their generally trusted role, social status, and personal resources available to address systemic racism through individual action. Pursuit of justice and fulfillment of the social contract providing clinicians with these resources, powers, and privileges demand response to these issues by all means necessary. Thus, it is likely that the primary remaining barrier to action is clear guidance.
To date, there is a lack of clear expectations and resources for clinicians to be aware of and to react to systemic racism. Most training around the race for clinicians has been framed as cultural competence, but the education of cultural differences fails to address historical and contemporary direct and peripheral traumas that derive from structural racism.
15
,24
,34
,35
There are also gaps in resources regarding social justice and advocacy as well as guidance for clinicians to engage in these practices.36
Clinician training and expectations should instead demand that clinicians and leaders initiate change by actively becoming antiracists.37
Antiracism is essentially a practice of working actively to identify, challenge, and reconstruct systemically racist systems, policies, and beliefs to remove barriers to and promote racial equity. Therefore, Ibram X. Kendi explains that “an antiracist is someone who is supporting an antiracist policy by their actions or expressing an antiracist idea.”Beyond only raising further attention to these topics, this commentary aims to provide a list of clear, discrete actions for health professionals to push back against the systemic racism in health systems and society. Several ways in which clinicians can improve this systemic issue can be done at the individual, organizational, and community levels (Table 1, Table 2, Table 3).
39
, 40
, 41
, 42
, 43
, 44
, 45
It would be impossible for this list to detail each recommendation adequately, but these recommendations provide a series of guideposts with a common theme: (1) work to educate yourself; (2) reframe explanations for clinical outcomes using the social determinants of health rather than referring to cultural, racial, or ethnic differences; and (3) use your knowledge to educate others, restructure systems, and remove barriers to care and leadership for BIPOC communities.Table 1Individual Actions to Address Law Enforcement Violence and Systemic Racism
| Action domain | Specific actions |
|---|---|
| Clinical antiracism | |
| Individualized care | Provide equally competent care for all patients and individualized to each patient. 22 |
| Patient barriers/resources | Investigate and document all potential barriers to healthcare engagement within the SDH, such as education, transportation, financial, lodging, disability, or healthcare distrust; do not assume the availability of patient resources necessary to adhere to treatment recommendations. 39 , 40 , 41 |
| Patient labels | Avoid common patient pejoratives that bypass consideration of true barriers to care, such as difficulty, noncompliance, malingerer, frequent flyer, lack of motivation, or supratentorial, and redirect to the SDH. 42 |
| Language barriers | Assure adequate interpreter services for non-native English speakers; become proficient in the appropriate use of interpreter services. 41 |
| Systematic biases | Research and modify clinical practice on the basis of the ways that treatment algorithms (e.g., spirometry, GFR, hypertension, pharmacology) ignore or even perpetuate systemic disparities. 27 ,37 |
| Compassionate listening | Partner with your patient; trust, believe, and validate their experiences; recognize your own distrust, resistance, or bias when hearing the experience of a BIPOC patient. 30 ,34 |
| Personal development | |
| Fund of knowledge | Seek to understand antiracism and work to practice antiracism; seek to better understand systemic racism and its studied impacts on the lives of patients. 37 , |
| Historical context | Review historical racial exploitation in medicine, including scientific eugenics, the Tuskegee Syphilis studies, Marion Sims, Henrietta Lacks, or the marginalization of traditional birth workers, and consider where those vestiges remain. 18 , 19 , 20 , 21 , 22 , 23 , 24 |
| Media engagement | Consume the media created by Black and POC professionals and artists. |
| Self-direction | Do not rely on Black and POC acquaintances to educate or provide validation of your personal progress. 43 |
BIPOC, Black, Indigenous, and People of Color; GFR, glomerular filtration rate; POC, People of Color; SDH, social determinants of health.
Table 2Organizational Actions to Address Law Enforcement Violence and Systemic Racism
| Action domain | Specific actions |
|---|---|
| Interpersonal (peer) antiracism | |
| Tough conversations | Do not shy away from conversations with peers about racial inequities and their true causes. 44 |
| Reframe stereotypes | Identify interpersonal assumptions on the basis of race and reframe to define causes on the basis of SDH. 44 |
| Educational sessions | Organize educational sessions on the basis of literature or topics related to racial equity. 35 ,37 |
| Racist wordplay | Avoid the use of colloquial phrases that have racial origins (e.g., guru, powwow, grandfather clause, uppity, spirit animal, kosher). |
| Institutional antiracism | |
| Inclusive hiring | Advocate for improved equity and diversity in hiring practices. 17 ,45 |
| Community partnership | Recommend increased partnership with underserved populations and the community organizations that represent them; orient outreach to issues relevant to community concerns. 3 ,40 |
| Improved access | Actively seek out community groups that are not currently included in care provision or outreach; increase access and availability for underrepresented groups. 40 ,41 |
| Minority taxation | Ensure that institutional inclusion/diversity efforts do not demand more work from BIPOC colleagues. 43 |
| Educational antiracism | |
| Inclusive representation | Promote diverse representation among leadership, faculty, and trainees and support inclusive recruitment efforts. 45 |
| Evaluation bias | Modify evaluation processes that may favor applicants who reflect the characteristics of the evaluators. 17 ,28 |
| Education bias | Identify implicit bias within curricula that may be perpetuated through medical education. 26 ,45 |
| Inclusive curriculum | Demand a curriculum, including training on the SDH, racial equity, and antiracism. 37 ,41 ,44 |
BIPOC, Black, Indigenous, and People of Color; SDH, social determinants of health.
Table 3Community Actions to Address Law Enforcement Violence and Systemic Racism
| Action domain | Specific actions |
|---|---|
| Promote public health | |
| Injury surveillance | Advocate for a required national mandatory surveillance system for accurately reporting police-mediated injuries to civilians. 3 ,39 |
| Research support | Pursue and support research and education funding to increase the awareness of and explore solutions for violence, systemic racism, and implicit bias. |
| Use your wallet | |
| Compensation privilege | Acknowledge the privilege of healthcare professional compensation relative to other professions. |
| Financial support | Provide financial support to organizations focused on social justice or health equity, preferentially to those directly serving underserved communities. |
| Network privilege | Encourage colleagues, family, and friends to contribute to your preferred organizations. |
| Use your voice | |
| Social capital | Contact individuals in positions of power, such as hospital directors, funding organizations, legislators, or community leaders to support antiracist initiatives and organizations; base your recommendations on those being pursued by advocacy groups. |
| Social advocacy | Promote legislative action to name systemic racism as a public health crisis and vote for politicians who will support health equity and antiracist policies. |
| Media engagement | Engage medical and nonmedical media sources to describe lessons learned, racism impacts on practice, or personal social justice experiences. |
For a more broad overview of these extremely complex topics, here is a suggested reading list of books that is not comprehensive either in terms of racial groups or in subject matter, but nonetheless, a good place to start (in author alphabetical order because these are all equally relevant):
- 1Michelle Alexander—The New Jim Crow: Mass Incarceration in the Age of Colorblindness;
- 2Ta-Nehisi Coates—Between the World and Me;
- 3Robin DiAngelo—White Fragility: Why It's So Hard for White people to Talk about Racism;
- 4Roxanne Dunbar-Ortiz—An Indigenous Peoples’ History of the United States;
- 5Cathy Park Hong—Minor Feelings: An Asian American Reckoning;
- 6Ibram X. Kendi—How to Be an Antiracist;
- 7Harriet A. Washington—Medical Apartheid: The Dark History of Medical Experimentation on Black Americans From Colonial Times to the Present;
- 8Isabel Wilkerson—Caste: The Origins of Our Discontents; and
- 9Isabel Wilkerson—The Warmth of Other Suns: The Epic Story of America's Great Migration.
ACKNOWLEDGMENTS
The authors would like to thank Dr. Thomas Kottke (HealthPartners Institute) and Dr. Margaret Nolan (University of Wisconsin Center for Tobacco Research and Intervention) for their review of this manuscript and contributions to the editing process.
The information presented in this paper is that of the authors and does not reflect the policies or positions of the institutions by which they are employed.
This information has been previously presented within the HealthPartners Institute and at the Central States Occupational and Environmental Medicine Association 97th Annual Spring Seminar.
No financial disclosures were reported by the authors of this paper.
CRediT AUTHOR STATEMENT
Marcus D. Rushing: Conceptualization, Data curation, Investigation, Supervision, Writing - Original Draft, Writing - Review & Editing. Andre Montoya-Barthelemy: Conceptualization, Data curation, Investigation, Supervision, Writing - Original Draft, Writing - Review & Editing. Fozia Abrar: Conceptualization, Writing - Original Draft, Writing - Review & Editing. Eduardo M. Medina: Conceptualization, Writing - Original Draft, Writing - Review & Editing. Helen Popoola-Samuel: Data curation, Investigation, Writing - Review & Editing. Zeke J. McKinney: Conceptualization, Data curation, Investigation, Project administration, Supervision, Writing - Original Draft, Writing - Review and Editing.
REFERENCES
- Justice for George Floyd and a reckoning for global mental health [Erratum in: Glob Ment Health (Camb). 2020 Sep 28;7:e25].Glob Ment Health (Camb). 2020; 7: e22https://doi.org/10.1017/gmh.2020.17
- Trends in U.S. deaths due to legal intervention among Black and White men, age 15-34 years, by county income level.Harv Public Health Rev (Camb). 2015; 3: 1-5
- Addressing law enforcement violence as a public health issue.American Public Health Association, Washington, DCPublished November 13, 2018
- Deadly force, in Black and White.ProPublica. October 10, 2014;https://www.propublica.org/article/deadly-force-in-black-and-whiteDate accessed: June 1, 2020
- Risk of police-involved death by race/ethnicity and place, United States, 2012-2018.Am J Public Health. 2018; 108: 1241-1248https://doi.org/10.2105/AJPH.2018.304559
- War on drugs policing and police brutality.Subst Use Misuse. 2015; 50: 1188-1194https://doi.org/10.3109/10826084.2015.1007669
- Why police kill Black males with impunity: applying Public Health Critical Race Praxis (PHCRP) to address the determinants of policing behaviors and “justifiable” homicides in the USA.J Urban Health. 2016; 93: 122-140https://doi.org/10.1007/s11524-015-0005-x
- Militarization fails to enhance police safety or reduce crime but may harm police reputation [published correction appears in Proc Natl Acad Sci U S A. 2021;118(27):e2109160118].Proc Natl Acad Sci U S A. 2018; 115: 9181-9186https://doi.org/10.1073/pnas.1805161115
- Stop, frisk, and assault? Racial disparities in police use of force during investigatory stops.Law Soc Rev. 2018; 52: 960-993https://doi.org/10.1111/lasr.12366
- Association of legal intervention injuries with race and ethnicity among patients treated in emergency departments in California.JAMA Netw Open. 2018; 1e182150https://doi.org/10.1001/jamanetworkopen.2018.2150
- What exposes African Americans to police violence?.Harv Civ Rights-Civil Lib Law Rev. 2016; 51: 160-186
- Protests spread over police shootings. Police promised reforms. Every year, they still shoot and kill nearly 1,000 people.The Washington Post. June 8, 2020;
Treisman R. Where the Chauvin verdict fits in the recent history of high-profile police killings. NPR. April 20, 2021.https://www.npr.org/sections/trial-over-killing-of-george-floyd/2021/04/20/989292294/where-the-chauvin-verdict-fits-in-the-recent-history-of-high-profile-police-kill. Accessed May 2, 2021.
- Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study.Lancet. 2018; 392: 302-310https://doi.org/10.1016/S0140-6736(18)31130-9
- Police violence and the built harm of structural racism.Lancet. 2018; 392: 258-259https://doi.org/10.1016/S0140-6736(18)31374-6
- Collateral damage: the health effects of invasive police encounters in New York City.J Urban Health. 2016; 93: 42-67https://doi.org/10.1007/s11524-015-0016-7
- Structural racism and health inequities in the USA: evidence and interventions.Lancet. 2017; 389: 1453-1463https://doi.org/10.1016/S0140-6736(17)30569-X
- Surgical sterilization, regret, and race: contemporary patterns.Soc Sci Res. 2015; 50: 31-45https://doi.org/10.1016/j.ssresearch.2014.10.010
- Ethical criteria for human challenge studies in infectious diseases.Public Health Ethics. 2016; 9: 92-103https://doi.org/10.1093/phe/phv026
- Beliefs and preferences for medical research among African-Americans.J Racial Ethn Health Disparities. 2016; 3: 74-82https://doi.org/10.1007/s40615-015-0117-8
- Acall to investigate and prevent further violations of sexual and reproductive health and rights in immigration detention centers.American Public Health Association, Washington, DCPublished November 13, 2018
- Beyond misdiagnosis, misunderstanding and mistrust: relevance of the historical perspective in the medical and mental health treatment of people of color.J Natl Med Assoc. 2007; 99: 879-885
- From Nuremberg to Guantanamo Bay: uses of physicians in the war on terror.Am J Public Health. 2018; 108: 36-41https://doi.org/10.2105/AJPH.2017.304154
- The Tuskegee Study of Untreated Syphilis: a case study in peripheral trauma with implications for health professionals.J Gen Intern Med. 2020; 35: 322-325https://doi.org/10.1007/s11606-019-05309-8
- JAMA editor is placed on leave after controversial podcast on structural racism.BMJ. 2021; 372: n851https://doi.org/10.1136/bmj.n851
- Eradicating racial injustice in medicine-if not now, when?.JAMA. 2020; 324: 451-452https://doi.org/10.1001/jama.2020.12432
- Hidden in plain sight – reconsidering the use of race correction in clinical algorithms.N Engl J Med. 2020; 383: 874-882https://doi.org/10.1056/NEJMms2004740
- Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities.J Gen Intern Med. 2013; 28: 1504-1510https://doi.org/10.1007/s11606-013-2441-1
- Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review.Am J Public Health. 2015; 105: e60-e76https://doi.org/10.2105/AJPH.2015.302903
- Implicit bias in healthcare professionals: a systematic review.BMC Med Ethics. 2017; 18: 19https://doi.org/10.1186/s12910-017-0179-8
- Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.Proc Natl Acad Sci U S A. 2016; 113: 4296-4301https://doi.org/10.1073/pnas.1516047113
- Comparison of all-cause mortality rates and inequities between Black and White populations across the 30 most populous U.S. cities.JAMA Netw Open. 2021; 4e2032086https://doi.org/10.1001/jamanetworkopen.2020.32086
- Health information needs, sources, and barriers of primary care patients to achieve patient-centered care: a literature review.Health Inform J. 2016; 22: 992-1016https://doi.org/10.1177/1460458215602939
- The trauma of racism: implications for counseling, research, and education.Couns Psychol. 2005; 33: 574-578https://doi.org/10.1177/0011000005276581
- Beyond cultural competence: critical consciousness, social justice, and multicultural education.Acad Med. 2009; 84: 782-787https://doi.org/10.1097/ACM.0b013e3181a42398
- Physicians’ social responsibility.Virtual Mentor. 2014; 16: 753-757https://doi.org/10.1001/virtualmentor.2014.16.09.oped1-1409
- Moving towards anti-racist praxis in medicine.Lancet. 2020; 396: 451-453https://doi.org/10.1016/S0140-6736(20)31543-9
- How to Be an Antiracist.One World, New York, NY2019
- Police brutality and Black health: setting the agenda for public health scholars.Am J Public Health. 2017; 107: 662-665https://doi.org/10.2105/AJPH.2017.303691
- Ensuring access to quality health care in vulnerable communities.Acad Med. 2018; 93: 1271-1275https://doi.org/10.1097/ACM.0000000000002254
- Health and Public Policy Committee of the American College of Physicians. Envisioning a better U.S. health care system for all: reducing barriers to care and addressing social determinants of health.Ann Intern Med. 2020; 172: S50-S59https://doi.org/10.7326/M19-2410
- Race, ethnicity, and culture in the medical record: implicit bias or patient advocacy?.Acad Psychiatry. 2019; 43: 532-536https://doi.org/10.1007/s40596-019-01035-9
- Majority taxes—toward antiracist allyship in medicine.N Engl J Med. 2020; 383: e23https://doi.org/10.1056/NEJMpv2022964
- Race and gender differences in medical student perspectives on social determinants of health education: a single-institution survey study.Adv Med Educ Pract. 2021; 12: 587-595https://doi.org/10.2147/AMEP.S300447
- Academic medicine and Black Lives Matter: time for deep listening.JAMA. 2020; 324: 435-436https://doi.org/10.1001/jama.2020.12532
Article info
Publication history
Published online: October 17, 2021
Identification
Copyright
© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc.
User license
Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) | How you can reuse 
Elsevier's open access license policy
Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0)
Permitted
For non-commercial purposes:
- Read, print & download
- Redistribute or republish the final article
- Text & data mine
- Translate the article (private use only, not for distribution)
- Reuse portions or extracts from the article in other works
Not Permitted
- Sell or re-use for commercial purposes
- Distribute translations or adaptations of the article
Elsevier's open access license policy
