Personal Reflection on Black History Month and the Lingering Legacy of the Flexner Report
by Patrick O. Gee, Sr., PhD, JLC, Chair of the Kidney Health Initiative Patient and Family Partnership Council
February 2024
As the community commemorates Black History Month, it is crucial to reflect on the enduring impact of historical events on the health disparities faced by African American communities. One such historical turning point was the Flexner Report of 1910, which has a lasting influence on institutional biases within the healthcare system, particularly concerning the African American community's struggle with kidney diseases.
The Flexner Report, commissioned by the Carnegie Foundation, aimed to assess the quality of medical education in the United States and Canada. While it led to significant advancements in medical education and practice, its recommendations also inadvertently perpetuated deep-seated racial biases and systemic inequalities within the healthcare system. The report's emphasis on scientific rigor and standardization reinforced discriminatory practices that marginalized African American medical professionals and limited access to quality healthcare for African American communities.
The repercussions of the Flexner Report are particularly evident in the realm of kidney diseases, which disproportionately affect African Americans. African Americans are three times more likely to progress to kidney failure compared to their white counterparts (National Kidney Foundation). Furthermore, they are less likely to receive kidney transplants and experience higher mortality rates while receiving dialysis treatment. These disparities are rooted in a complex web of historical, social, and institutional factors, most of which can be traced back to the legacy of the Flexner Report.
A lingering legacy of the report is the underrepresentation of African American healthcare professionals within the nephrology specialty. The report's narrow criteria for medical education accreditation and emphasis on prestigious, well-funded institutions perpetuated the exclusion of historically black medical schools, significantly limiting opportunities for African American physicians to specialize in nephrology. The resulting scarcity of African American nephrologists has led to both a lack of culturally competent care and a shortage of role models for aspiring African American medical professionals.
Moreover, the Flexner Report's impact on the healthcare infrastructure has exacerbated disparities in access to kidney disease treatment options for African American communities. The consolidation and closure of many African American hospitals and medical institutions eroded healthcare resources in predominantly black neighborhoods, further limiting access to preventive care, early intervention, and specialized treatment for kidney diseases.
The enduring impact of the Flexner Report underscores the urgent need to address institutional biases within the healthcare system and advance health equity for African American communities living with kidney diseases. Efforts to diversify the medical workforce, promote cultural competency training, invest in healthcare infrastructure in underserved communities, and ensure equitable access to the latest innovations are crucial to addressing the systemic inequalities perpetuating disparities in kidney disease outcomes and achieving true health equity.
As we honor the legacy of Black history and resilience, it is imperative to recognize and confront the historical forces that continue to shape the health outcomes of African American communities. The legacy of the Flexner Report serves as a poignant reminder of the enduring struggle for health equity and the imperative need to dismantle institutional biases within the healthcare system. By acknowledging these historical injustices and working towards meaningful change, we can strive to ensure that every individual, regardless of their race or background, has equal access to the latest innovations and the highest standard of care for kidney disease and beyond.
For more information on the Flexner Report, view the link here.