Socioeconomic Disparities and Structural Racism in Medicine

We stand at a critical and precarious moment in the United States—a time of profound political polarization where the very principles of diversity, equity, and inclusion (DEI) are under direct attack. Across the nation, legislative and institutional efforts are working to dismantle decades of hard-won civil rights advancements, threatening to roll back progress and silence conversations essential to justice and equity.

Now more than ever, those of us who hold privilege through our education and professional standing have a moral obligation to speak out. In the field of medicine, where the stakes are quite literally life and death, advocating for these principles is not optional—it is essential.

Healthcare has long been a reflection of the broader social and political landscape. To ignore the erosion of diversity, equity, and inclusion efforts in this moment is to accept the perpetuation of health disparities, systemic bias, and the ongoing marginalization of vulnerable populations. We must stand firm in our commitment to equity and inclusion, ensuring that medicine evolves not only as a science but as a force for social justice.

While many of us in the field understand the importance of this, the system in which medicine was built often prides itself on being a meritocratic system, where hard work, intellect, and dedication are seen as the primary determinants of success. This belief inherently disregards the profound impact of socioeconomic inequities and systemic racism that shape who gains access to medical education, who thrives within it, and who is marginalized or pushed out. These structural barriers have real-world consequences, not only for aspiring medical professionals but also for patient outcomes.

One of the most tragic and illustrative examples of how these systemic failures manifest is the case of one of our very own physicians, Dr. Susan Moore, a Black family medicine physician who died from complications of COVID-19 after being subjected to racially biased medical care. Her death underscores the urgent need to confront the deeply ingrained disparities in both medical education and clinical practice.

The Case of Dr. Susan Moore: A Tragic Illustration of Systemic Racism

In late 2020, during the height of the COVID-19 pandemic, Dr. Susan Moore contracted the virus and was admitted to Indiana University Health North Hospital. Despite her medical training and professional credentials, she experienced what countless Black patients have reported for decades—her symptoms were dismissed, her advocacy for her own care was ignored, and her suffering was minimized.

In a viral Facebook video, Dr. Moore detailed how her white physician questioned her reported symptoms, refused to provide adequate pain medication, and discharged her prematurely despite her deteriorating condition. In her own words, she stated:

“This is how Black people get killed—when you send them home and they don’t know how to fight for themselves.”

Despite being a highly educated physician capable of articulating her symptoms and clinical needs, she was labeled as “combative” and “difficult,” falling prey to long-standing racist tropes about Black women being angry or uncooperative (Harris-Perry, 2011). Dr. Moore was discharged from the hospital and later died from complications related to COVID-19. Her death became a national symbol of how systemic racism persists in healthcare systems, regardless of a patient’s social or professional status.

Structural Racism and Professional Gatekeeping

Dr. Moore’s death exemplifies how respectability politics and narrow definitions of professionalism function as tools of exclusion. Despite being a credentialed physician, her self-advocacy—behavior that would likely have been celebrated in a white male counterpart—was reframed as unprofessional and disruptive. In this way, the culture of medicine often punishes marginalized individuals for asserting their needs and challenging authority structures (Osseo-Asare et al., 2018).

This gatekeeping is not limited to patient care; it pervades medical education and professional advancement. Minority trainees frequently report having to navigate similar dynamics, where voicing concerns about inequity or speaking out against discriminatory practices results in negative evaluations, stalled career progression, or exclusion from research and mentorship opportunities (Gravlee, 2020).

The Emotional and Professional Toll of Structural Inequity

The consequences of these systemic barriers are not only physical but deeply emotional. Experiencing constant invalidation and having one’s lived reality dismissed creates an emotional tax known as racial battle fatigue (Smith et al., 2011). For Black women in particular, the combination of racism and sexism—often referred to as misogynoir—results in compounded psychological stress and health disparities.

In healthcare settings, this means that even when marginalized individuals overcome extraordinary odds to enter the medical profession, they are often left to navigate hostile environments that undervalue their experiences and undermine their contributions. This emotional labor goes unacknowledged in discussions about resilience, which often celebrate endurance without recognizing the conditions that necessitate it (Jackson & Cothran, 2003).

Conclusion: An Urgent Call for Structural Change

Dr. Susan Moore’s death must serve as a call to action for the medical community. It demonstrates that structural inequities are not abstract policy issues—they have life-or-death consequences. Addressing these disparities requires more than diversity statements or unconscious bias trainings; it demands a complete restructuring of how medicine defines professionalism, assesses competency, and supports marginalized trainees and patients.

Medical institutions must move beyond performative inclusion efforts and commit to systemic reforms that center equity, amplify marginalized voices, and hold individuals and institutions accountable for the disparities they perpetuate. Only through such efforts can medicine fulfill its ethical mandate to “do no harm” and become a truly just and equitable profession.

References

Goldstein, A., & Sellers, F. S. (2020, December 24). A Black doctor died of COVID-19 weeks after accusing hospital of racist care. The Washington Post. https://www.washingtonpost.com/health/2020/12/24/susan-moore-black-doctor-racism/

Gravlee, C. C. (2020). Systemic racism, chronic health inequities, and COVID‐19: A syndemic in the making? American Journal of Human Biology, 32(5), e23482. https://doi.org/10.1002/ajhb.23482

Harris-Perry, M. V. (2011). Sister Citizen: Shame, Stereotypes, and Black Women in America. Yale University Press.

Jackson, P. B., & Cothran, M. (2003). Black women’s mental health and wellness: Examining the effects of racism and social support. African American Research Perspectives, 9(1), 35–50.

Osseo-Asare, A., Balasuriya, L., Huot, S. J., Keene, D., Berg, D., Nunez-Smith, M., & Boatright, D. (2018). Minority resident physicians’ views on the role of race/ethnicity in their training experiences in the workplace. JAMA Network Open, 1(5), e182723. https://doi.org/10.1001/jamanetworkopen.2018.2723

Smith, W. A., Hung, M., & Franklin, J. D. (2011). Racial battle fatigue and the miseducation of Black men: Racial microaggressions, societal problems, and environmental stress. The Journal of Negro Education, 80(1), 63–82.