Just Medicine: A Cure for Racial Inequality in American Health Care

With Just Medicine, Dayna Bowen Matthew provides a critique of the contemporary healthcare system and a reflection on the long legacy of racial discrimination in the US, with a focus on healthcare and civil rights. The book emerges from a socio-historical context shaped by the long history of racial exclusion and systemic inequity that continues to manifest in modern institutions, despite the progress made during the Civil Rights Movement (a protest movement organized by Black American citizens fighting against segregation and discrimination that lasted from 1954 until 1964).

As Matthew notes in Just Medicine, the exclusion of African Americans and other racially marginalized groups from unbiased healthcare access is historically interlaced with the legacy of slavery, segregation, and discriminatory policies. Throughout centuries, hospitals were segregated, Black patients often received substandard care, and medical experimentation on Black bodies without consent was widespread. Matthew’s emphasis on implicit bias in Just Medicine reflects the ways in which these historical patterns of discrimination have evolved into more subtle but still pervasive forms of exclusion and unequal treatment. Even after the landmark Civil Rights Act of 1964 and Medicare in 1965, which included provisions against racial, gender, and nationality-based discrimination, studies that Matthew cites at length in her book demonstrate that the US healthcare system has continued to perpetuate racial disparities, albeit in less overt ways.

Matthew’s argument that implicit bias is a structural issue, rather than merely an individual failing, connects directly to the socio-historic development of institutional racism. After the legal dismantling of Jim Crow laws, racial discrimination persisted in more covert forms, which Matthew identifies as unconscious or implicit bias. These biases are embedded in the fabric of healthcare institutions—a direct outcome of the historical marginalization of people of color. Like Ibram X. Kendi argues in How to Be an Antiracist, racism is the “marriage of racist ideas and racist policies that produces and normalizes racial inequities” (17-18). As Matthew shows at length, racist policies and racial inequities continue to have tragic effects on the lives of BIPOC patients, even though racist ideas are no longer expressed overtly. Structural racism is reinforced through policies that fail to address these biases, resulting in significant health disparities. Matthew’s focus on the pervasiveness of implicit bias highlights how unconscious or covert discrimination has endured through legal and institutional mechanisms.

Matthew’s call for legal reforms that address implicit bias within healthcare, such as her proposals to amend Title VI of the Civil Rights Act, can be seen as a continuation of the civil rights struggle, now focused on tackling the more insidious forms of discrimination that have replaced overt racism. Furthermore, Matthew situates her analysis in the context of the broader socio-historic struggle for racial justice, emphasizing that healthcare disparities cannot be resolved without addressing the underlying social determinants of health, such as housing, education, and employment. These issues are connected to the systemic racism that has persisted across generations. By calling for structural and legal reforms, Matthew highlights the need to confront the legacy of racial inequality in a comprehensive manner that acknowledges both the historical roots and the present realities of racial injustice in healthcare.