Medical Abolition: A Resolution Paper

The UCSF REPAIR Project*

Modern abolitionists see it as our mission to provide the models of community safety, security, mutual aid, and harm reduction that are needed, and to do the political education, relationship-building, and movement work to bring others into demanding transformative economic and social change for abolition.”  

- Mon M (from “Modern Abolitionists Share What Emancipation Means On Juneteenth 2020”)


Medical abolition is the application of the ethos and work of abolitionism to healthcare and medicine. Abolitionism was born in the late 18th Century in England and Europe and taken up in the early 19th Century in the fledgling United States as a social, religious and political movement to end slavery. While some believe that slavery ended in most parts of the world during the 19th Century, abolitionists argue that slavery persists in contemporary forms like mass-incarceration, plantation labor, and white supremacist capitalism. Contemporary abolitionism builds on the ideals and engagements of this mission in order to address contemporary slavery, and the legacies of slavery that persist in the forms of anti-Black racism, inequality and oppression today. These legacies are very visible in health and medicine where they undergird ongoing inequalities in relation to health statusaccess to and delivery of healthcare. 

During the second year of UCSF’s REPAIR project, the theme of medical abolition was explored in order to support the ideals and goals of eradicating the persistent legacies of slavery that appear in health and medicine, a topic of rising concern for medical professionals. After the first year of the REPAIR Project at UCSF, we produced a resolution paper on the topic of medical reparations. Building upon those insights, this resolution paper on medical abolition summarizes the year’s conceptual insights and provides a road map for abolition in health and medicine. This paper is open to the public, and was written with the goal of summarizing the academic research and community work that members of REPAIR have done. 


REPAIR’s Events 2021-2022 included:

Imagining Medical Abolition Event (recording available)

Surgery and the Potential for Medical Abolition (recording available)

Manifesting Medical Abolition: Teach-In Series

Research Workshop Series 1: When is Research Racist? (recording available)

Research Workshop Series 2: How does one Conduct Anti-Racist Research?

Reproductive Justice Teach-In

Health and Carceral Violence Teach-In


Critical Race Theory and Abolitionism

Mainstream analyses tend to present slavery in two distinct phases: 'historical' slavery as a legal institution abolished in the nineteenth century; and 'new' (Bales, 2004) or 'modern' slavery (Kara, 2017) as a separate phenomenon, which is primarily associated in the policy literature with criminality in the global South. In these ways slavery is frequently decoupled from the transnational systems that have shaped and continue to shape it. Recent global events involving the removal of statues have renewed focus not only on the historical legacies and contemporary manifestations of slavery, but their connections to transnational systems. While there is a need for education to explore historical slavery there is a pressing need to consider the contemporary slavery, and the relationships between these forms (Quirk, 2009).”

- Chris O’Connell (from “Addressing the Complexity of Contemporary Slavery: Towards a Critical Framework for Educators”) 


Abolitionism as a movement has been fashioned by activists and critical race theorists to reveal and resist the historically linked structures of state-sanctioned antiblackness*, from slavery to mass incarceration. These structures have produced a disproportionate vulnerability to premature death among Black communities. Contemporary abolitionists see their work as an effort to break the chains of anti-black subjugation that have reconstituted themselves in new forms over time. Abolitionists, in other words, see their work as an extension of the incomplete struggle to abolish slavery and its legacies.

Abolitionism today seeks to break social patterns of exclusion and harm that work unfairly against Black people and remain frequently hidden by being embedded in culture, politics, economics and other institutions as normative social and ideological structures. Put differently, antiblack violence has been normalized into everyday life in the United States – abolitionists seek to elucidate this violence, and to work against it. For instance, Ruth Wilson Gilmore calls for a recognition of the racialized prison-industrial complex that disproportionately imprisons Black men for minor crimes, making incarceration a normative, state-sanctioned, privatized for-profit growth industry. These forms of labor can be seen as an extension of the racialized extractive forms of labor seen in slavery. Liat Ben-Moshe draws on critical discourse regarding indigeneity, race, and disability to show how incarceration targets particular populations, namely disabled people and BIPOC individuals, in uneven ways, but also extends beyond the prison-industrial complex. She argues that carceral logics inform sites of structural violence including hospitals, asylums, and even multinational corporations and humanitarian non-governmental organizations. Structural violence refers to a form of violence wherein social structures or social institutions harm people by preventing them from meeting their basic needs. Although less visible, it is a lethal form of violence, which causes excess and uneven disability and death. 


“The environmental implications of modern slavery within forestry activities have wide reaching consequences for vulnerable populations, with displacement, climate change and criminal enterprises all increasing exploitation risk.”

- Bethany Jackson (from “Ending slavery by decarbonization? Exploring the nexus of modern slavery, deforestation, and climate change action”)


Related to this, an abolitionist perspective calls for a recognition of the ways in which the logics of slavery and plantation labor have continued to inform white-supremacist capitalism in the context of late liberalism. Contemporary non-livable low-wage labor jobs disproportionately hire Black citizens in the United States, again replicating modes of productivity that rely on extractive politics to generate corporate wealth. Abolitionism recognizes that political formations such as redlining, gerrymandering and unequal valuation of homes have also undermined Black socioeconomic opportunity and political representation for generations. Finally, contemporary abolition scholars call for a reinvention of criminal justice systems in order to eradicate hardened forms of racism and criminalization that have disproportionately been used to incarcerate Black people and escalate violence and homicide of Black persons by the police. 

In other words, abolitionism today calls for a radical overhaul of the institutions of privilege, economics, culture and justice – an abolishing of the systems as we know them – because as they exist now, they continue to reproduce racial inequality, harm and violence against all people, and disproportionately towards Black people. In the abolitionist perspective, it is not enough to reform a broken system. Abolition calls for the eradication of the systems that reproduce injustice, and a re-imagining of the most basic forms of racialized privilege and harm. Only this approach will create more fair systems of living that will lead to a more just society.

Abolitionist thinker and organizer Ruth Wilson Gilmore reminds us that abolition is not only about the deinstitutionalization of prisons, police, and related systems of surveillance and punishment, but that abolition is also about what we build in their place. “Abolition is about abolishing the conditions under which prison became the solution to problems, rather than abolishing the buildings we call prisons" (Gilmore, 2020). Taking an abolitionist approach requires addressing the conditions in which people feel that harm-perpetuating institutions like the police or prisons are the best option for responding to harm in their lives. An abolitionist approach necessitates building other means for preventing and addressing harm that exist beyond current ones. 

Rather than forcing individuals affected by structural violence to testify to damage, medical abolition seeks to draw attention to the structures and practices which perpetuate this harm, to work towards abolishing them, and to strengthen and amplify the voices of individuals doing justice- and transformation-driven work to provide opportunities and spaces for healing, healthcare, and medicine that do not perpetuate racist and antiblack logics. In particular, we reference community organizations like the Incarcerated Worker’s Organizing Committee, the Stop San Quentin Outbreak Coalition, and the UCSF Wraparound Project as examples of initiatives which act from an abolitionist framework.


Relevant Sources

Bales, Kevin, and Benjamin K. Sovacool. "From forests to factories: How modern slavery deepens the crisis of climate change." Energy Research & Social Science 77 (2021): 102096.

Chua C. Abolition is a Constant Struggle: Five Lessons from Minneapolis. Theor Event.2020;23(4):127-47.

Gilmore RW. Golden Gulag Prisons, Surplus, Crisis, and Opposition in Globalizing  California. Berkeley, CA: University of California Press; 2007.

Gilmore RW and Murakawa N. Covid-19, Decarceration, and Abolition [Webinar], 2020. 

Gimbel, V. N., & Muhammad, C. (2018). Are Police Obsolete: Breaking Cycles of Violence through Abolition Democracy. Cardozo L. Rev.40, 1453.

Hudson, B. (2017). Restorative justice: The challenge of sexual and racial violence. In Restorative Justice (pp. 385-404). Routledge.

Iwai, Yoshiko, Zahra H. Khan, and Sayantani DasGupta. "Abolition medicine." The Lancet 396, no. 10245 (2020): 158-159.

Leland, W., & Stockwell, A. (2021). Anti-oppressive restorative justice: Behavior analysis in alternatives to policing. Behavior Analysis in Practice, 1-5.

McDowell, M. G., & Fernandez, L. A. (2018). ‘Disband, disempower, and disarm’: Amplifying the theory and practice of police abolition. Critical Criminology26(3), 373-391.

Phelps, M. S., Ward, A., & Frazier, D. (2021). From Police Reform to Police Abolition? How Minneapolis Activists Fought to Make Black Lives Matter. Mobilization: An International Quarterly26(4), 421-441.

Spillers, Hortense J. 1987. Mama’s Baby, Papa’s Maybe: An American Grammar Book. Diacritics 17(2): 64. 

TallBear, Kim. "Caretaking relations, not American dreaming." Kalfou 6, no. 1 (2019): 24-41. 

Taneja, Anjali, Cara Page, and Susan Raffo. "Healing Histories: Disrupting the Medical Industrial Complex." Susan Raffo. September 13 (2019): 2019.


Medical Abolition

Medical abolition aims to make visible and act to unsettle the ways in which medicine and healthcare link antiblackness, incarceration and criminalization. Understanding these links requires revisiting the historical relationships between the medicalization of Black people (treating blackness itself as pathological) and the historical rise of criminalization in and through medical diagnostics, which led to contemporary practices of incarceration.


From Medicalization to Criminalization

Since the 18th century, scientists and physicians have played a central role in constructing spurious notions of Black people’s ‘biological inferiority’ that have fueled associations with criminality. Rana Hogarth describes how scientists across the Atlantic sought to find biological racial differences between Black and white people to improve plantation production. By the 20th century, the medical practices of many American physicians were saturated by notions that linked blackness with criminality and pathology. Violence and the disabling of enslaved people were intrinsic to chattel slavery and life in the plantation. Work by authors like Hortense Spillers, Saidiya Hartman, and Christina Sharpe have helped clarify these histories of violence, and give voice and understanding to them.

Racial disparities continue due to a mix of intergenerational trauma, continued exposure to racism and violence, and lack of access to health-care. These debilitating conditions were depicted in art and media in ways that made people desensitized to this violence, leading to prominent stereotypes that cast African Americans as predisposed to sexual promiscuity, and the reproduction of what they deemed “degenerate” offspring. At the same time, Eugenicist physicians determined that surgical castration, segregation, incarceration, or sterilization were necessary responses. Throughout the 20th century, statisticians, psychiatrists, and Progressive Era social reformers further solidified racial categories and established purportedly medico-scientific ideas of innate Black criminality. 

These logics of racial difference enabled patterns of harm in relation to mental health, disability, policing, and prison. Growing anxieties among white Americans about Civil Rights-era protests led some psychiatrists and journalists to describe schizophrenia as a “condition of angry Black masculinity.” Today, Black individuals with mental health issues are disproportionately subjected to police brutality. Moreover, a 2006 Bureau of Justice Statistics study reported that more than half of all prison and jail inmates experience a mental health issue, which includes 64 percent of jail inmates, 45 percent of federal inmates, and 56 percent of persons confined in state prisons. Human Rights Watch (2006) estimates the number of prisoners experiencing mental health issues to be close to 1.25 million, twice the number (in absolute terms) of people with mental health issues incarcerated in state hospitals during the peak years of institutionalization in the mid-1950s. We showcase these statistics to draw attention to the ways in which incarceration excessively targets Black people, and people who are disabled or experiencing mental illness – individuals at the intersection of these two identities face continued marginalization. The deinstitutionalization of mental health services in the mid-1970s actually led to a rise in the mass incarceration of Black persons. As Bernard Harcourt notes:

We are used to thinking of confinement through the lens of incarceration only, and to referring to the period prior to the mid-1970s as one of ‘relative stability’ followed by an exponential rise. When the data on mental hospitalization are combined with the data on imprisonment for the period 1928 through 2000, the incarceration revolution of the late twentieth century barely reaches the level of institutionalization that the United States experienced at mid-century. These findings underscore, more than anything, how much institutionalization there was at mid-century. The simple idea is that there is a continuity of spatial exclusion and confinement in the United States from the high rates of mental hospitalization in the mid-1950s to the high rates of imprisonment at the turn of the twenty-first century, and that, as a result, when we measure confinement or coercive social control for purposes of longitudinal research on crime, unemployment, education, or any other social indicator, we should use an aggregated institutionalization rate that includes both mental hospitalization and prison rates.

Similar racialization of diagnosis is seen in the history and current use of the attention deficit hyperactivity disorder (ADHD) diagnosis. Studies have shown the ‘school to prison’ pipelines, and the role of medicine within this. White teachers are more inclined to suggest referrals for diagnosis of ADHD in Black children than Black teachers, suggesting an overdiagnosis based on racism rather than on actual medical need. Even when the diagnosis is warranted, Black children are more likely than white children to be undertreated. When ADHD is undiagnosed, the consequences can be that Black children expelled from preschool at higher rates, and experience disciplinary action at higher rates. We include further sources on abolitionism and education below. 

In sum, medicine’s role in fomenting the association of blackness with criminality remains visible in far too many medical sites. Implicit racial bias in the care of people who use substances can often lead to carceral forms of care for Black people. Similarly, racialized individuals with mental health issues and cognitive disabilities are disproportionately subjected to police brutality. This legacy of criminalization continues to have real health consequences. Black people continue to be stripped of autonomy in clinical spaces, while being subjected to biased physician expertise on what is framed as helpful solutions to their life choices and health. These physicians do not always have adequate understandings of the conditions and constraints under which their patients live, because medical training does not prioritize these topics. 

Not surprisingly, given the history of experimentation and exploitation of Black patients by medical entrepreneurs and pharmaceutical researchers, Black patients are more likely than white patients to be suspicious of the expertise of their physicians. To make matters worse, hospital staff working in public emergency rooms often deny medical resources to patients based on their perceived criminality. The presence of police in public hospitals can act as a deterrent for those already impacted by surveillance and criminalization. If medical schools intend to confront antiblack racism, then they must contend with the historical associations and spurious links between blackness, pathology and criminality. A medical abolition perspective foregrounds these histories and linkages in order to address and eradicate them wherever possible. REPAIR contends that medical abolition must be enacted both in medical education and in medical practice. 

If criminalization and incarceration have been central in negatively impacting Black experiences in clinical spaces, then leaving these forces unexamined in medical education would make such efforts insufficient. As Elizabeth Hinton has written, “Understanding contemporary mass incarceration as one historical moment within a much longer and larger antiblack punitive tradition is critical.” Beyond simply thinking about the logics of criminalization, educators must heed the call of abolitionist movements to help faculty and students to think and act against those logics. Some examples of the medical abolition framework being applied concretely include removing police from hospitals, working to recognize and address how structural racism has affected the diversity of health care practitioners and needs of clinical populations, and reforming the content of medical school curriculum and training to address systemic biases that tie blackness with pathology or assume Black patients to be more likely to be criminal or aggressive.

Scholars have conceived of abolitionism not merely as a negative project that seeks the end of mass incarceration, but also as a positive project aimed at construction new institutions that promote Black and BIPOC Resilience. An emphasis on Black resilience in medical education entails offering critiques and political organizing against practices in medicine that perpetuate the association between blackness and criminality.  Following early abolitionists who challenged the institution of slavery, their contemporary counterparts recognize that ending the mass confinement of Black people is only one step in a longer road towards freedom. As articulated by Charmaine Chua, “abolitionism’s revolutionary promise is thus located not in an event, but through the participatory and radical reconfiguration of current arrangements of economic and social life.”

In sum, an abolitionist medical education entails recognizing and critically analyzing the implicit biases in medical practices that continue to link blackness with criminality and pathology in order to develop non-punitive modes of care that give Black people more autonomy in clinical spaces. 


Relevant Sources

Butler C. Blackness as Delinquency. Washington University Law Review. 2013;90(5):1335-1397.     

Constance, L. Study: Race Impacts Rating of ADHD Behavior in Black Boys. ADDitude, 2022. 

Dorr GM. Defective or Disabled?: Race, Medicine, and Eugenics in Progressive Era Virginia and Alabama. The Journal of the Gilded Age and Progressive Era. 2006;5(4):359-92.  

Fan, R. Are Black Boys Misdiagnosed With ADHD?. Medium, 2022. 

Frye, D. The Children Left Behind. ADDitude, 2022. 

Hogarth RA. Medicalizing Blackness: Making Racial Difference in the Atlantic World, 1780-1840: University of North Carolina Press; 2017.  

Metzl J. Protest Psychosis: How Schizophrenia Became a Black Disease. Beacon Press; 2011.

Muhammad KG. The Condemnation of Blackness: Race, Crime, and the Making of Modern Urban America. Harvard University Press; 2010.  

Riddle, T., & Sinclair, S. (2019). Racial disparities in school-based disciplinary actions are associated with county-level rates of racial bias. Proceedings of the National Academy of Sciences, 116(17), 8255-8260.

Strauss, V. New federal data shows Black preschoolers still disciplined at far higher rates than Whites. Washington Post, 2022. 

Suddler C. Presumed Criminal: Black Youth and the Justice System in Postwar New York: NYU Press; 2019.  











Health Disparities and Applying a Medical Abolition Perspective

To look specifically at the effects of those historical associations between blackness, pathology, and criminality, we will walk through three examples which are specifically relevant to contemporary outcomes: Penetrating Trauma and Violent Injury, Pain Management, and Kidney Transplantation. 


  1. Penetrating Trauma, Violent Injury, and Gun Violence

Penetrating trauma occurs when a foreign object pierces the skin and enters the body creating a wound. In blunt or non-penetrating trauma, the skin is not necessarily broken. In penetrating trauma, the object remains in the tissue or passes through the tissues and exits the body.  Penetrating trauma disproportionately affects Black communities, and Black and Hispanic patients are more likely to be under-triaged (Schecter, 2011). Pediatric penetrating trauma in the Bay area increased during the last decade, with Black and Hispanic children experiencing the greatest proportion of traumas (Alber, 2021). Within the lens of medical abolition, we might recognize this as evidence of a systemic bias that ties Blackness with pathology. Even if on an individual level, most physicians would not purposefully under-triage victims of penetrating trauma, looking at disparities on a community level can reveal structural biases that reinforce historical harms.

Research has shown that Black patients have worse outcomes for penetrating trauma, which can only be partially attributed to findings that show Black patients are more likely to be treated at lower-resourced hospitals. Race and insurance status each independently predicts outcome disparities after trauma (Haider AH, Chang DC, Efron DT et al, JAMA Surg 2008;143(10):945-949). Trauma patients admitted to hospitals with >20% Black patients had 45% higher odds of death (OR 1.45) and 73% higher odds of death or major complication (Glance LG et al, Health Services Research 2013; 48(5):1684-1703). In order to make sense of these disparities, we must recognize the role that the profession of medicine plays in perpetuating or ignoring the continued subjugation of or legitimization of violence against Black communities and communities of color. 


  1. Pain Management 

Racial differences in experiences of pain have historically been a popular research topic. Though medical pedagogy has shifted away from racist perceptions of biological difference and pain tolerance, research on racial disparities in the management of pain continue to reveal concerning structural issues. Considering pain management from a medical abolitionist lens additionally requires unpacking widely held assumptions in medicine about biological differences between experiences of pain on racial lines. 

Amongst patients who have lung and colorectal cancer, Black and multiracial individuals reported higher pain severity, and several studies have shown, again in both pediatric and adult populations, that black patients are more likely to receive no analgesic at all or less likely to receive adequate analgesic in the emergency department. Hoffman et al.,published in 2016, showed that amongst medical trainees, half of over 400 white medical students and residents endorsed false beliefs regarding the biological differences between blacks and white patients’ experiences of pain. They also found that that those who strongly endorsed wrong beliefs about biological differences (for example, that black peoples’ skin is thicker than white people’s skin) also reported lower pain ratings when shown photos of a black patients as compared to white patients. 

Black patients have been shown to experience more pain for the same conditions. Among 5761 Lung and Colorectal Cancer patients: Black and multiracial people reported higher pain severity than whites. (Martinez KA, et al. Journal of Pain and Symptom Management 2014;48(6):1050-1059). However, Black patients systematically receive less pain management an palliative care in hospital settings. In a study of 2298 Pediatric patients with abdominal pain, black patients were less likely to receive any analgesic (OR 0.61) or a narcotic analgesic (OR 0.38) than white patients (Johnson TJ et al, Pediatrics 2013, 132 (4) e851-e858). In another study, Black patients with isolated long-bone fractures were less likely than white patients to receive analgesics in this ED and more likely to receive no analgesic at all (57% versus 74%, P =.01) (Todd KH et al 2000 Annals of Emerg Med). 

These disparities in pain management are not limited to the emergency department. Various studies have also shown disparities in post-operative pain control, whether following appendectomies, ORIFs, or caesarian sections. White patients have historically received higher dosage of opioids following appendectomies than Black patients (McDonald DD. Res Nurs Health. 1994 Feb; 17(1):45-9.) Black and Latinx patients have received significantly less opioid analgesia than White patients following open reduction and internal fixation of a limb fractures (Burgess DJ, et al. Clin J Pain. 2013 Feb; 29(2):118-23.) Black women have been shown to be less likely to receive opioid analgesics postpartum compared to White women (Johnson JD, et al. Obstet Gynecol. 2019 Dec; 134(6):1155-1162; Badreldin N, et al. Obstet Gynecol. 2019 Dec; 134(6):1147-1153.) These disparities have been persistent and ongoing. 

A 2008 JAMA study analyzing over 150,000 pain-related visits in the emergency department showed that racial disparities in opioid prescribing have remained steady across the years. This differential opioid prescribing was consistent across different types of pain, levels of pain severity, and whether pain was the first, second or third reason for visit. Black patients were prescribed opioids at lower rates than any other race or ethnicity group for almost every type of pain visit. And while the results of this study resulted in calls for addressing this problem rather than merely documenting it, more than ten years later, these disparities continue.

In the context of the opiate crisis, black patients are perceived to be at greater risk for misuse or abuse of prescription opioids, resulting in higher rates of urine drug tests, restricted early refills, and involuntary opioid tapers (Becker WC, et al. Ann Fam Med. 2011; 9(3):219-25), despite studies that show that Black patients are less likely to die from opiate misuse than White patients (Hirsh AT, et al. American Psychologist 2020;75(6), 784–795.) Amongst stable chronic pain patients, Black patients are more likely to have their dosages reduced than are White patients (Buonora M, et al. Pain Med. 2019 Aug 1; 20(8):1519-1527), despite studies that show that prescription opioid abuse was significantly lower among Black and Latinx patients.

Helena Hansen, a psychiatrist anthropologist and professor at UCLA has written extensively about the racialized treatment of those who struggle with opiate addiction. For those who struggle with opiate addiction, white patients are more likely to have initial addictions to prescription opiates. White patients are also more likely to be treated with buprenorphine, a long-acting partial agonist which has been shown to be safer and less addictive than methadone. Buprenorphine has largely been made available only to patients with private insurance or who self-pay, indicating that its access falls differentially across financial lines (Lagisetty et al., 2019 JAMA). Black and Hispanic patients are still more likely to be treated with Methadone, which is highly regulated, highly stigmatized, and requires daily observation: a form of continued surveillance and an extension of carceral logics to clinical spaces. 

Racial disparities in pain management echo two Medical Abolition themes discussed earlier in this document: the embedded assumptions of biological racial difference, and the associations of blackness with pathology and criminalization. Assumptions of criminality shape the way we see Black patients in their pain control, indirectly or directly leading to disparities in pain management in acute and chronic settings. 


  1. Organ Transplantation and Racial Inequity

The pathologization of blackness continues on in contemporary medicine, often embedded in algorithms of care. While similar examples can be found across various medical specialties, we focus here on examples from organ transplantation and surgery. These structural disparities hit at every step of the pathway to transplantation: when deciding which patients are considered to be appropriate candidates for transplantation, Black patients are less likely than White patients to be referred for evaluation, to be placed on a transplant waiting list, or to ultimately undergo transplantation (16.9% vs. 52.0%) (Epstein AM et al NEJM 2000;343:1537-1544). 

Outcomes for survival of recipients of living donor kidney grafts (LDKG) are superior to recipients of deceased donor kidney grafts. However, Black patients on dialysis are less likely to receive education regarding kidney transplantation and less likely to consider living donor kidney grafts as an option (Young CJ, Kew C. Med Clin North Am 2005; 89: 1003.). Despite higher rates of end-stage renal disease, Black patients are less likely to receive a LDKG than white patients, and this disparity increases for Black patients who live in communities which are more socially vulnerable (Killian AC et al. JAMA 2021; Purnell TS et al. JAMA 2018; 319:49–61.). Additionally, these disparities have increased over time, showing that efforts to reduce LDKT disparities have been ineffective (Purnell et al., 2018, JAMA).

While there are numerous multifactorial barriers to Black patients receiving kidney transplants, including fewer donors, lower referral rates, inadequate education of recipients, there are additional barriers baked into the algorithms of care.Kidney transplantation is a clear example of the effect of race-corrected EGFR on clinical outcomes. EGFR is a blood test which measures how much blood kidneys filter each minute, or one’s glomerular filtration rate (GFR). The very criteria for waitlist eligibility, including EGFR results, also affect time to referral and transplantation on racial lines. Race-corrected GFR calculations are associated with delays kidney transplant eligibility. Research has estimated that if this correction were removed, 35% of Black patients would instantly have a GFR which makes them eligible for transplant referral (Zelnick LR et al, JAMA).

Additionally, transplant criteria often include social support criteria which disproportionately excludes members of under-resourced and Black communities. A survey of 606 clinicians involved with transplant decisions at over 200 transplant centers showed that 9.6% of patients evaluated are excluded due to inadequate support, despite 67.3% of transplant providers believing this criterion disproportionately impacts patients with low simple endoscopic scores, and so who would otherwise be great candidates for transplantation (Laden K et al Am J Transplant. 2019 Jan; 19(1): 193–203.). 

Subjective criteria of “adequate social support” leaves ample room for implicit bias and these criteria continue to be used in the determination of transplant eligibility despite meta-analyses showing that neither social support nor marital status was predictive of medication adherence or post-transplant outcomes (Laden K et al. Transplant Rev. 2018 Jan;32(1):16-28.).


  1. Applying a Medical Abolitionist Approach

Physical Trauma and Injury, Pain Management, and Organ Transplantation are just three examples of health disparities that would benefit from a medical abolitionist approach. What can we do to enact Medical Abolition around these disparities? Gun violence is a public health epidemic (or as the trending twitter hashtag claimed in 2019, #thisisourlane): firearm related mortality rates now exceed motor vehicle traffic mortality and this firearm-related mortality disproportionately affects Black and Brown communities. A commitment to patients’ physical health and to health equity includes a commitment to understanding roots of these disparities and advocating for policy and structural changes to address them. Universal insurance and equal access healthcare has been shown to eliminate or decrease historical disparities for racial and ethnic minorities including post-injury morbidity, hospital readmission, and post-discharge healthcare utilization. While such structural changes need to happen on a federal and state level, structural changes can also happen at an institutional level. Given data on worse outcomes and under-triaging of Black patients, we can examine triage processes in our own institutions and further examine racial disparities for penetrating trauma in our own communities.

Though it is not our focus here, it is important to also name that there is an infant mortality crisis disproportionately affecting Black people. More information on the role of gender and race in health disparities can be found at the Black Women’s Health Imperative, the Chicago Birthworks Collective, and the UCSF Preterm Birth Initiative. For each of these examples we have discussed, and beyond, we ask: What would a medical abolition framework call for? Structural issues require structural changes: protocols for pain control and pain management across patient populations may mediate existing disparities in analgesic prescription to prevent personal biases regarding assumptions of criminality to affect pain management. What would it look like to take into account different forms of social support that may not resemble the traditional, nuclear family? How can we imagine forms of healthcare that do not assume that certain patients, such as Black or poor patients, will not take medications as required? How can we make structural changes to our referral and evaluation practices so that we stop perpetuating punitive models of care via the surveillance and policing of people deemed worthy or unworthy of medical resources? Medical abolition may give us a framework from which to begin to answer such questions. 


Relevant Sources

Alber DA, Journal of Surgical Research 2021; 257:486-492.

Schecter S, American Association for the Surgery of Trauma 2011.

Chaudhary MA et al. “Universally insured, equal access healthcare”. Surgery 2018 164(4), 651-656. 



How might these ideals be taken up in relation to healthcare, medicine, and medical education?

REPAIR notes that student activism on the UCSF campus has demonstrated the willingness and commitment to depathologizing and decriminalizing medical care. The White Coats for Black Lives movement and the UC Must Divest and Cops off Campus are examples of student-initiated activism that have had enormous impact in raising awareness of how much more needs to be done in this area. In addition to this activism, REPAIR also recommends:


Draw on the expertise of humanities and social science scholars. The social sciences and humanities are fundamental for critically interrogating scientific theory and practice in light of a long history of racialized medicine and health care disparities. Fortunately, this contention has been heeded by leaders across UCSF. With the support of administrators in the university’s Graduate Division, two of the REPAIR Project’s Steering Committee graduate student members have taught mini courses examining the Black experience and carceral legacies in science and medicine. Through these courses, students in medicine and basic sciences engage with growing research on antiblack medicine and medical abolitionism. Additionally, the REPAIR Project’s curriculum committee is working with leaders across UCSF’s schools to promote the integration of this important body of work into new and existing coursework.


Learn from and support abolitionist medicine campaigns. Like many medical schools, UCSF has witnessed a surge of student activism to confront antiblack racism. In 2014, UCSF medical students organized a group called White Coats for Black Lives that is now a national organization with more than thirty chapters. In 2016, a group of UCSF clinicians and medical students formed the Do No Harm Coalition, which has organized several campaigns to challenge police violence and reform security at UCSF hospitals. In 2020, as the COVID-19 pandemic placed individuals incarcerated in California prisons, jails, and detention facilities at increased risk, UCSF medical students partnered with the Stop San Quentin/ California Department of Corrections and Rehabilitation Outbreak Coalition to form a Public Health Working Group. This group drew upon medical and public health expertise at UCSF to advocate for decarceration statewide. These initiatives should be recognized not merely as important political campaigns, but also as pedagogical resources. Student-led campaigns often serve as important sites for horizontal education that engage with topics often excluded from official curricula. The REPAIR

Project has organized a series of teach-ins with White Coats for Black Lives that provide a space for student-led reflection on issues related to racial justice. Administrators should find ways to support such grassroots efforts.


Support groups on campus and in the community doing relevant workUCSF has a number of initiatives, a few of which we will describe here. GLIDE’s healthcare training program “Healers at the Gate” aims to interrupt patterns of discrimination and harm inflicted upon BIPOC patients and families on the UCSF campus by bringing healthcare professionals face-to-face with people impacted by homelessness, substance abuse, racism, and other systemic injustices that occur in the Tenderloin neighborhood of San Francisco. The Black Health Initiative at UCSF seeks to better partner with the Black community of the San Francisco Bay Area to build non-transactional partnerships which amplify Black voices not traditionally heard at UCSF, and to build a pipeline of future Black healthcare workers, providers, and researchers. Many additional examples, including the code CARE support program, are not described in detail here, but are arising around UCSF’s network and should be buoyed through funding, administrative support, and programmatic provisions. 


Support, collaborate with, compensate and learn from groups and individuals modeling abolitionist healing elsewhereChanging Frequencies, run by activist-scholar Cara Page, is an abolitionist organizing project that works to disrupt harms and violence from the Medical Industrial Complex through memory-based healing. Other examples of organizations with abolitionist missions geared towards health, health-care, and healthcare education include the Healing Histories Project,Abolitionist FuturesAbolitionist Teaching Network, the Network to Advance Abolititonist Social Work, South Bay Abolitionist Collective (@sba.collective), and Critical Resistance


Approach abolitionism with a spirit of creative innovation. As Dylan Rodriguez suggests, abolitionism is “a radically imaginative, generative, and socially productive communal (and community-building) practice.” In this vein, we call on educators to see their role as facilitators of student-led efforts to move medicine beyond its carceral logics. Dismantling biases and violences perpetuated by medical school curricula will also require producing new curricula that recognize the association between blackness and criminality in medicine, and which seek to dismantle the carceral components of the medical system. For example, health-care practitioners should be taught to advocate for alternative models of conflict resolution and escalation in hospital spaces, which do not reproduce the entanglements of medicine and carcerality.  


To bring this vision to fruition will involve direct engagement with campus abolitionist organizations and campaigns to determine how criminalization of blackness in society deeply affects their health and physician-patient relationships. Medical education must be shaped by community non-punitive initiatives. For example, abolitionist group Critical Resistance determined that a healthcare system that is accessible, robust, and collective should include amongst other things the elimination of medical co-pays, providing frontline health workers with proper equipment, and free accessibility to medicines, vaccines, and treatments. With these recommendations, we implore medical educators to draw on abolitionism to understand anti-racism as creative innovation.


Abolitionism may appear to be a challenging concept to include in medical education curriculum. But, without drawing from this critical framework and the resources it affords, anti-racist educational efforts will remain limited in their ability to address a key mechanism by which antiblackness has been constituted—through the fusion of criminalization, pathologization, and racialization. Given the central role that science and medicine have played in perpetuating and legitimizing Black subjugation, the abolitionist tradition provides an important alternative framework with which to contest anti-black racism in medical education. As calls for reparations for historical harms committed by the medical profession against Black and Indigenous people grow in strength, abolitionism provides a novel way to conceive of redress. The REPAIR Project has found in abolitionism a source of creativity for a socially-just medicine. We encourage our colleagues in other institutions of medical education to engage with this important lineage. If experts in medicine are truly committed to doing no harm to those they care for, they must recognize how medicine in the United States has perpetuated harm towards Black bodies. By recognizing its complicity in antiblack racism, dismantling practices of care that cause harm, and cultivating a generative relationship with community efforts, American medical education can perhaps for the first time offer Black people the space to truly heal.


*We believe that the orthographical consensus is presently to capitalize “Black” when writing about African American and other African-Descended communities. We capitalize when writing of specific populations and use lowercase when evoking the questioning frame of blackness/antiblackness as open-ended sites of theoretical contestation.


Additional Sources

Ben-Moshe, L. (2020). Decarcerating disability: Deinstitutionalization and prison abolition. U of Minnesota Press.

Harcourt, B. (2006). From the Asylum to the Prison: Rethinking the Incarceration Revolution. Texas Law Review, Vol. 84, p. 1751, 2006; U Chicago Law & Economics Olin Working Paper No. 277; U of Chicago Public Law Working Paper No. 114.

Kirby, Richard A., and Mallori D. Thompson. "A Decarcel Cadence: Neurologic Music Therapy as an Abolitionist Project." Conn. L. Rev. 53 (2021): 681

Nelson C. Racializing Disability, Disabling Race: Policing Race and Mental Status. Berkeley J Crim L. 2010;15(1).

Parsons, A. (2018). From Asylum to Prison: Deinstitutionalization and the Rise of Mass Incarceration after 1945. University of North Carolina Press.


Resolution document written/compiled by Vincanne Adams PhD, Professor of Medical Anthropology, UCSF; and Bri Matusovsky, PhD Student Medical Anthropology, UCSF-UC Berkeley; with edits, revisions, and contributions from the REPAIR Steering Committees Fall 2021 – Spring 2022 and Fall 2022 – Spring 2023.

Contributors to REPAIR (Fall 2021- Spring 2022): Aimee Medeiros PhD, Assistant Professor of History of Health Sciences, UCSF; Aude Bouagnon PhD, MD Candidate, UCSF; Bri Matusovsky, PhD Student Medical Anthropology, UCSF-UC Berkeley, Bonnie Wong MSc, MD/PhD Candidate in Medical Anthropology, UCSF-UC Berkeley; Carlos Martinez MPH, PhD Candidate in Medical Anthropology, UCSF-UC Berkeley; Jay Zussman, MD/PhD Student, UCSF; Kara Zamora MA, PhD Student in Medical Anthropology, UCSF-UC Berkeley; Kelly Knight PhD, Professor of Medical Anthropology; Liz Dzeng MD/MPH/PhD, Assistant Professor of Medicine, UCSF; Lina Khoeur, MD Candidate, UCSF; Lorraine Pereira, Research Assistant, UCSF; Vincanne Adams PhD, Professor of Medical Anthropology, UCSF; Zoe Samudzi, MSc/PhD, Assistant Professor, Rhode Island School of Design (RISD).