What is The REPAIR Project?

REPAIR is an acronym. It stands for REParations and Anti-Institutional Racism.

A three-year initiative

The REPAIR Project is a three-year initiative designed to address Anti-Black Racism in science and medicine. It recognizes that long-standing racial inequities in health, health care institutions and scholarship are a result of systemic race-based violence and racism in society as a whole, and seeks to open conversation and promote efforts to rectify and eliminate these problems. In Faces at the Bottom of the Well, legal studies scholar and civil rights activist Derek Bell (1993) reminds us that discussions of injustices experienced by Black Americans continue to distill and serve as a guide for ending racial injustice for other groups. Our initiative starts the conversation with themes emergent from the Black Lives Matter Movement and works outward to problems that are nested in larger institutional medical and health care structures, including race and cultures of carcerality, and the implicit racial biases of scholarly practices of science, medical research and clinical practice. 

An ongoing process of healing

Following the lead of generations of African American activists, we explicitly make reference to the notion of reparations as a prerequisite for addressing the centuries of persistent harm visited upon Black communities in the United States. We humbly pursue this project of “repair” with the acknowledgement that short and medium-term efforts of restitution and reform are, in the words of Fred Moten (2016), incapable of fully healing the intergenerational social wounds left by these harms. Rather, we understand this initiative as contributing to a broader institutional and national effort aimed at instituting an ongoing process of healing, including permanent vigilance to ensure that harm is ceased and prevented from happening again. We bring forth “repair” with the acknowledgement of new and emerging social theory that troubles the concept of repair in contexts where notions of a pre-harm status might not exist to return to, and where technologies of repair leave marks or lead to new forms of harm themselves. This acknowledgement includes the ways that critical disability studies scholars who have long-critiqued distinct but interrelated concepts such as repair, rehabilitation, and cure in biomedical contexts (Puar 2017; Taylor 2017).

An open space for critical engagement

Each year the initiative will focus on one strategic theme that is meant to educate, elaborate and unite communities toward the goal of creating enduring reform and repair over legacies and ongoing racial inequalities in health and medicine. Resources will be allocated to a variety of activities that fall under the strategic theme. Our mission is not to deliver remedies as prescriptive modes of pedagogy but rather to open space for critical engagement in shaping fields of scholarship, teaching and medical practice that alter the present and shape a better future.  As such, each theme is crafted as an open conceptual field, as problem spaces that need defining, refining and deliberation and that provide opportunities for action. The themes proposed are not set in stone, but are a starting point for discussion and engagement.

 

Strategic Annual Themes

Year One: Medical Reparations

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?

Year Two: Medical Abolitionism

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?

Year Three: Decolonizing the Health Sciences

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.