“Antiracist efforts must be embraced by all neurologists”: Study led by Dartmouth Health neurologist states racism to blame for unequal health outcomes for Black Americans

Nathaniel M. Robbins, MD
Nathaniel M. Robbins, MD

Across the United States, Black people face disproportionate negative health outcomes in numerous areas compared to white people. This includes neurology: Black Americans suffer excessive morbidity and mortality compared with white Americans, including poor outcomes across a range of neurologic conditions. While historically, it was believed that health inequities in neurology, or “neurodisparities,” can be because of difference in race, it is now understood that race is a socially-defined construct with little genetic validity.

A new study led by neurologist Nathaniel M. Robbins, MD, at Dartmouth Hitchcock Medical Center (DHMC), recently published in the journal Neurology, found that neurodisparities in the Black community are the result of structural racism in the field of neurology. Robbins and his research team, which included DHMC neurologist James L. Bernat, MD, state that neurologists are ethically and professionally obligated to actively counteract racism, and issued a call for neurologists and neurologic organizations to fight racism and work towards health equity in neurology.

“Understanding that neurodisparities stem largely from racism is a first step,” Robbins said. “Neurologists must then understand the clinical, ethical, and professional reasons why we are obligated to move beyond awareness and toward active antiracist countermeasures.”

Compared with white patients, Black patients have poorer access to neurologic care and worse outcomes in areas including stroke, epilepsy, Parkinson’s disease, dementia and headache, the article states. In addition to these high rates of neurologic disease and disorder, Black Americans are also underrepresented in neurologic research, the neurologic workforce, and in academic leadership positions.

Robbins and his co-researchers urge fellow neurologists to take several steps in order to be actively antiracist in their practice. They include rejecting the concept of “color blindness,” as it encourages ignoring transgressions and disparities Black people face; embracing the trained ability to identify upstream structural drivers of health, also called structural competency; identifying and fixing policies that encourage unequal delivery of care; and striving to improve critical self-awareness of their own identity in society and the associated advantages and disadvantages.

The study also addresses how antiracist practices can be applied in neurologic practice, education, research and policy.

“Black Americans have been subject to inequity and injustice since their ancestors were first forcibly brought to this continent,” Robbins said. “As neurologists, it is our role to provide all of our patients with the best care possible. When it comes to marginalized groups like the Black community, active antiracism is critical to providing the best care. The neurology community has a duty to break down neurodisparities, and antiracist efforts must be embraced by all neurologists.”

This study was funded by the Swigart Clinical Ethics Fellowship through the Geisel School of Medicine at Dartmouth. Read the full article in the journal Neurology.

About Dartmouth Health

Dartmouth Health, New Hampshire's only academic health system and the state's largest private employer, serves patients across northern New England. Dartmouth Health provides access to more than 2,000 providers in almost every area of medicine, delivering care at its flagship hospital, Dartmouth Hitchcock Medical Center (DHMC) in Lebanon, NH, as well as across its wide network of hospitals, clinics and care facilities. DHMC is consistently named the #1 hospital in New Hampshire by U.S. News & World Report, and recognized for high performance in numerous clinical specialties and procedures. Dartmouth Health includes its Dartmouth Cancer Center, one of only 51 National Cancer Institute-designated Comprehensive Cancer Centers in the nation, and the only such center in northern New England; Dartmouth Health Children’s, including the Children’s Hospital at Dartmouth Hitchcock Medical Center, the state’s only children’s hospital and clinic locations around the region; member hospitals in Lebanon, Keene and New London, NH, and Windsor, VT, and Visiting Nurse and Hospice for Vermont and New Hampshire; and more than 24 clinics that provide ambulatory services across New Hampshire and Vermont. Through its historical partnership with Dartmouth and the Geisel School of Medicine, Dartmouth Health trains nearly 400 medical residents and fellows annually, and performs cutting-edge research and clinical trials recognized across the globe with Geisel and the White River Junction VA Medical Center in White River Junction, VT. Dartmouth Health and its more than 13,000 employees are deeply committed to serving the healthcare needs of everyone in our communities, and to providing each of our patients with exceptional, personal care.