Race is a sociopolitical construct, not a biological truth. The real determinants of health are structural factors such as zip code, environmental pollution, and access to resources.
Originally published in Scalawag.
The Classroom of Assumptions
Throughout my early medical education in the Deep South, race was ever-present, shaping the way we were taught to diagnose, treat, and even perceive human beings. It wasn't just a footnote; it was the lead. At medical schools across the country, we were trained to introduce patients starting with their race: "An 82-year-old Black female presents with…" as if the race descriptor was a biological diagnostic tool in itself.
Our lecture slides often oversimplified the complexity of human life into neat, racialized boxes. Clinical "risk factors" were organized by skin color, and certain diseases were described as if they only belonged to specific groups. The reality was that the actual forces shaping risk, often a person's zip code, the air they breathed, or the structural barriers to resources, were often left out of the conversation. At the time, I didn't have the real understanding and confidence to push back. Race was presented to us as an objective, biological truth rather than the sociopolitical construct it is and has always been.
The Question of "Why?"
The atmosphere shifted when I began training on the West Coast. The tone around people we cared for and their treatment plans felt different; it was more inquisitive about the status quo. As trainees, we were encouraged to question the medical tools we used. Why was race in this equation? Who did this algorithm serve?
Patients, too, wanted answers that reflected their individualized realities rather than monolithic assumptions of communities, and I found myself doing some reflecting. Was this shift a change in me, a transformation of the healthcare system? Or was it simply finding a better understanding of the communities I was serving? It became clear that we were collectively moving from "race-based" medicine, which treats race as an underlying cause, to "race-conscious" medicine, which recognizes race as a social category that impacts health through the complexity of structural determinants of health.
The Power of Questioning: From the Environment to the Clinic, and Tools of Inequity
This shift became especially apparent in my early clinical training and practice. I remember caring for several patients with sickle cell disease; on several occasions, patients asked me, with genuine curiosity, why they were prescribed hydroxyurea, a medication that's also used for chemotherapy. Although the treatment was medically necessary, there was frustration with feeling they were not fully informed about the medication and its purpose. They had done their own research, rightfully so. They weren't being "difficult"; they were being diligent.
This tradition of questioning can be powerful. I think often of Gloster, Mississippi. For years, residents of the community there raised alarms about environmental pollutants long before any government or health group took note (at least publicly). They knew their air quality was tied to the industrial emissions of wood-pellet plants. They didn't need a double-blind study to tell them their lungs felt tight as a result of resulting asthma exacerbations; they had the evidence of their own lived experience. In Gloster, the community organized because they understood that the right to breathe is the most fundamental form of healthcare. Taking this a step further, are the diagnostic tools we use in clinical care ready to take on the consequences of environmental exposures people we care for clinically already know exist?
There are medical tools and devices that can be helpful in evaluating and improving lung function in people, like spirometry, but even this is shaped by bias. While the spirometer is a tool used to assess lung function, historically, the software used equations to "correct" lung function downward for Black patients. This was at least partially based on 19th-century myths, suggesting that Black people naturally had lower lung capacity. This "correction" often led to the underdiagnosis of chronic lung diseases in the very people most exposed to industrial pollution.
To move toward race-conscious care, we must address the reality of our diagnostic tools. For more than at least seven decades, medicine has used race-based algorithms that create deeply inequitable outcomes.
Another example is the estimated Glomerular Filtration Rate (eGFR). For years, kidney function was calculated as "better" for Black patients based on the assumption that Black people monolithically have higher muscle mass. This "adjustment" meant that Black patients often had to be "sicker" to qualify for a kidney transplant or a specialist referral. In the rural South, where diabetes and high blood pressure are often preventable, these delays in care didn't just cause inconvenience; they've caused higher rates of morbidity and mortality. The removal of race from the eGFR equation in 2021 only happened because patient advocates and clinicians forced the issue onto the national stage.
The Mississippi Model of Resistance
Despite the hurdles, Mississippi is modeling what community-led health can look like. The Jackson Heart Study, the largest investigation into cardiovascular health in Black Americans, has succeeded because it is rooted in the community. It didn't just take data; it gave and continues to give back. It even supported the creation of the Museum Trail, a protected green space in Jackson that allows residents to exercise and gather safely.
Similarly, Walk With a Doc events in states like Mississippi take doctors out of the sterile, hierarchical environment of the exam room and put them in city parks to partner with the community. When you are walking side-by-side with your physician, the power dynamic shifts. The conversation becomes about life, not just symptoms.
Progress in the Face of Neglect
We often hear about Mississippi's failures, but we rarely hear about its self-empowering defiance. The Mississippi State Department of Health's 2025 Report Card shows something remarkable: opioid deaths, teen birth rates, and HIV/syphilis rates are declining. Our school vaccination rates remain some of the highest in the country, third in the country with over 97 percent for kindergarteners.
This progress is the result of community health workers and advocates doing the heavy lifting in a state that is often structurally neglected. We face hospital closures and the unfortunate partisan government-led refusal to expand Medicaid, leaving our rural neighbors throughout the state miles away from the nearest ER. Yet, as State Health Officer Dr. Dan Edney noted, our national health ranking is finally moving upward. He stated: "While that new ranking shows promise, our goal is to not only get us off the bottom of national rankings, but to take us out of the conversation and become a model for how things can change."
Conclusion: Toward a More Honest Medicine
When we stop treating race as biology, healthcare becomes more honest. We stop using racial categories to mask our failure to provide clean air, healthy food, and accessible clinics. Race-conscious medicine is not a trend; it is a movement towards our equitable country. It is an acknowledgment that the Black Southern experience is not a "risk factor," but a testament to survival and an untapped source of public health wisdom.
By centering the knowledge of communities that have been navigating underfunded systems for generations, we can finally build a healthcare landscape that doesn't just treat the body, but honors the person.
Denise Powell, MD is a pediatrician in Mississippi; she completed medical school at the University of Mississippi Medical Center and pediatric residency at the University of California San Francisco as part of the Pediatric Leaders Advancing Health Equity program. As a multi-generation Mississippian, she is passionate about improving healthcare access in rural America, increasing health literacy through primary care, and preventing the implications of environmental injustice.
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