Using Medicine and Sociology to Tackle Structural Racism in Health

MCL Profile

By Liz Dzeng

Liz Dzeng, MD, MPH, PhD, remembers sitting in her post-graduate sociology courses at the University of Cambridge wondering how to participate in the conversations around her. Medical school and residency left her feeling deeply unfulfilled. She was on the verge of quitting the profession. She sensed that a sociology PhD could help restore her energy and engagement with medicine. But first she had to learn to retrain her mind to see medicine from two distinct intellectual perspectives.

“I had learned one way of thinking, the scientific way. But I was ignorant about social science and politics and intellectual conversations around these topics,” Dzeng says.

At Cambridge, Dzeng received some of her most valuable education outside the classroom from her peers. They were intellectually curious and thoughtful. “In medicine you need to memorize facts. At Cambridge, I met people who were curious about the world, conversant around politics and wanting to engage in philosophical and sociological conversations,” Dzeng said.

She began to study the nature of knowledge and how it’s produced, especially with reference to its limits and validity. “In medical school you’re taught there is one right answer. There is a need for some intellectual arrogance. If you are cutting into an organ, for example, you must feel certain that is the right thing to do.” However, the certain answers in medicine seemed incompatible with the world view she encountered in sociology. She recognized the tension between scientific thinking in which there is one right answer and a sociological imagination that acknowledges reality is open to multiple interpretations.

Medicine has trouble accepting the social sciences because of this difference in how knowledge is understood and constituted. For Dzeng, however, sociological training allows her to question more deeply. It allows her to see and understand that not everything lends itself to one right scientific answer. “Race is an excellent example of that. It was presented as scientific fact when it isn’t,” Dzeng says.

Dr. Dzeng wants to understand how systemic racism across the life course impacts end-of-life care among older Black adults. This work builds on her long-standing interest in equity. It focuses on how Black-white disparities in end-of-life care connect to structural racism.

Her work involves community-based participatory research. She is using in-depth life course interviews and deep engagement with medical and community field sites to understand and center the perspectives of those most impacted by her research. She is partnering with a Community Advisory Board (CAB) of Black community members to co-design and guide the research. CAB members bring their lived experience and perspectives to the project. She will be interviewing older Black adults who have experienced structural racism, clinicians who have cared for patients near the end-of-life, Black community leaders, hospital staff, and hospital leaders. Through this work, Dzeng hopes to open a window on what structural racism looks like and how it impacts Black Americans’ lives.

As Dzeng develops her ambitious work on structural racism and end-of-life care, she is simultaneously working on related research projects. The COVID-19 pandemic is another arena in which she sees an opportunity for clinicians to learn about the value of social science in medical practice. Throughout the pandemic, Dzeng notes there were many different perspectives on the disease, the vaccine and what people count as facts. Different groups of people also have different ways of thinking about public health, medicine and their interpretation of reality.

The project on structural racism also builds on interviews Dzeng has conducted with clinicians. In this research, she explores clinicians’ understanding of how institutional cultures impact the intensity of end-of-life care. This information is essential to reduce the provision of non-beneficial life-sustaining treatments near the end of life. She is incorporating human-centered design principles in her work with clinicians. Together, they will co-design systems-level interventions to mitigate non-beneficial high-intensity treatment. 

Dzeng is hopeful that in the future, clinicians will embrace both medical and social scientific traditions. Making both a part of medical culture, particularly during residency training, will foster acceptance of non-positivist ways of understanding illness and caring for pa