The strategic theme for year one is “Medical Reparations: Addressing the Ongoing Legacies of Slavery in American Medicine.” Increased awareness of the legacies of slavery have prompted discussion of the need for reparations, a small step toward repair for centuries of harm to Black Americans.  The theme for this year is an exploration of the legacies of slavery that are intertwined with both histories and ongoing forms of medical racism. This includes early experimentation on slave communities and continues through to today in forms of scientific racism (from Tuskegee to race-based diagnostic models and race-based disparities in health care access). Systematic racial divides in access to critical health services, medicines and technologies perpetuate health inequalities that call for repair. In medical education, long-standing structural barriers, a hostile environment, and not-so-hidden racist admission practices have impeded black enrollment for decades. The concept of medical reparations asks: What is the legacy of medical racism that provokes discussion of the need for reparations? How have the legacies of slavery been reproduced in medicine in ways that are ongoing in relation racial injustice? What would it mean to rectify and repair these harms in the form of reparations? What might these reparations be?

What can we in the health sciences do to untangle the current interdependencies between medicine and carceral regimes? Mass incarceration, as a system consistently shown to reproduce health inequalities at the individual, family, and the community level, arises from a culture of surveillance, distrust and selective care. The entanglement of police with hospital security, as we see at SFGH, and mental health response, is not only symbolically hostile to many Black and brown patients, but can be actively harmful, resulting in violent uses of force and restraint. At this very moment, physicians are joining the front lines of a movement for mass compassionate release of prisoners because the pandemic has revealed how quickly sickness spreads inside overcrowded, underfunded cells. More insidiously, it can even seep into clinical practice, unwittingly criminalizing and pathologizing those already marginalized within the space of health care. If the surveillance of blackness, as Simone Browne has argued, is fundamental to our social fabric, how might the biomedical sciences be complicit?  How can we think about health as a fundamental part of freedom, and orient our research and clinical tools towards new, emancipatory models of care? What role can health care providers play in rethinking systems of community safety without security and policing? What examples of this are available from history, as well as community efforts across the U.S. under the call to defund the police? Why do activists call for abolition rather than using the language of carcerality? What collaborative opportunities can be built between healthcare providers, community members and patients to create safe spaces for healing for everyone?

In year three, we are concerned with going deeper into the questions of  how racism can get coded into biomedicine and social sciences of health, beginning with the history of medical research and tracing the threads of harm all the way to the bedside in clinical practices that often unwittingly reproduce bias and injustice. Decolonization refers to the global reach of white supremacy as an entrenched and often invisible ideological system linking ideas about rationality, civility, right and vitality onto phenotypic hierarchies ordered primarily by skin color – ideas that were and are spread through imperialism and its modern day equivalents. These modes of thinking and organizing continue to shape how group difference is defined and how differences are made to matter, producing unequal exposures to harm and implicit and explicit forms of discrimination.

Decolonization recognizes that slavery went hand in hand with imperialism and that both knowledge and knowledge production can be scripted by racial hierarchies that were born in the era of colonization and continue to exclude and efface empirical knowledge and evidence of harm experienced by those defined as colonial others. As we move forward in thinking critically about race-inflected science, our project hopes to add lessons from recent race theory that draw the connections between scientific knowledge production and clinical attunements to undoing the damage of colonial harm, always inviting the question of not just who benefits but also whose data and whose conception of evidence matter?  Our inquiry in the third year seeks engage these questions in the spirit of rigor and with an eye to applications and results as collaborations between the social and biomedical sciences in order to craft a decolonized, race-sensitive science of medicine health, and then to consider how that knowledge and knowledge production are best translated for clinical care.