June 2021: Understanding History, Shaping Our Future

Dear friends,


If you have any doubt that upstream medicine has met a pivotal moment, look at the strategic plan for racial justice and health equity released by the American Medical Association this past month.


The report marks a watershed for organized medicine—and for me personally as a physician. When I finished my residency in 2007 and sought colleagues who shared my values of equity, justice, and social medicine, I turned away from the AMA. The association had historically supported institutional forms of racism and stayed silent on critical matters of justice, so I found my home instead with other more progressive physician organizations. 


Fast forward a decade or so, and you find real change afoot. When HealthBegins first reached out to the AMA in 2018 to work together to educate more Upstreamists, we saw firsthand how the organization’s leaders were creating a new focus on equity. That same year, the AMA’s House of Delegates voted to create a Center for Health Equity. Now, the historic new strategic plan makes equity central to the association’s purpose, as it pledges bold steps to confront inequity and dismantle injustice in medicine. Those bold steps include moving upstream to address the social and structural drivers of health equity, a strategy I’m proud to say HealthBegins helped the AMA to develop. 


Perhaps the most powerful element of the AMA plan is its diligent review of the ways in which the institution itself has historically perpetuated injustice and inequity. HealthBegins had the privilege of advising and supporting AMA’s Center for Health Equity over the past year. Through that work, we witnessed how frank and thorough their institutional self-inquiry was.


That’s part of why the AMA’s plan is history in the making, for both the largest physician organization in organized medicine and many other stakeholders in healthcare and other sectors. Most importantly, the AMA’s process of examining and acknowledging its own history of injustice, through policies and practices that were either explicit or unintentional, serves as a powerful model for institutions across the country. Because we can’t shape a more just and equitable future if we don’t understand our history—including the ways in which our own institutions have denied (and still deny) justice and opportunities for health.


I’m encouraged to see and support this approach among other institutions with which we work. In South Carolina, for example, we facilitated a new statewide roadmap to improve social determinants of health and a cross-sector collaborative to improve food security—both of which explicitly center on equity and racial justice goals. Health system leaders in our Social Drivers of Health Equity Learning Collaborative are having frank, open conversations about the role their own institutions have played in either ignoring or perpetuating health inequity and racial injustice within their communities. With our support, they’re now translating that understanding into bold, demonstrable action. More and more, we’re seeing leaders in the health systems we support embrace the work to understand and challenge their institution’s own history of injustice and forge a new path.


At HealthBegins, we’re committed to helping our partners acknowledge history, clearly and boldly. It takes courage. And it’s necessary if we hope to shape our future, free from the unjust patterns of the past. 



Rishi Manchanda, MD, MPH

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