Avenue Q, the 2004 Tony Award-winning Broadway musical, compels us to confront difficult truths in society. I wonder how well this story and, specifically, “Everyone’s a Little Bit Racist” would resonate in our current fractured political climate. In recent years, health care has received challenges from both within and without to begin to address many of society’s greatest problems. Since December 2014, medical trainees nationwide have called on medicine to actively address issues that affect health, specifically to dismantle racism and take a stand against issues, such as policy brutality.¹ This call was the boiling point after decades of agitation. Scholars, such as Gloria Ladson-Billings, Ibram Xolani Kendi, and Eduardo Bonilla-Silva, have also challenged us to build an equitable and just society by focusing on creating policies that dismantle systemic oppression.

To meet these calls to action, the Council has begun to strategically outline SGIM’s commitment to anti-racist principles. In order to ensure we have a shared mental model, we worked to define our terminology and agreed upon the following:

• Diversity: SGIM is committed to promoting diversity expressed in myriad forms. Some examples include diversity as defined by race and ethnicity, gender and gender identity, sexual orientation, socioeconomic status, language, culture, national origin, religious commitments, age, (dis)ability status, and political perspective.
• Equity: SGIM is committed to reviewing policies to ensure no unearned or earned disadvantage. We are committed to ensuring our leadership, award, and committee structures are accessible to all and to developing systematic approaches to prevent and respond to harassment and discrimination. Equity recognizes that each person has different circumstances and allocates the resources and opportunities needed to reach an outcome. Our member and our advocacy continue to work in health equity, focusing on our vision of “A just system of care in which all people can achieve optimal health.”²
• Inclusion: SGIM is committed to ensuring that all members feel their differences are welcomed, that different perspectives are respectfully heard, and that every individual feels a sense of belonging and inclusion. We continue to work on promoting diversity because we know that this generates a vibrant climate of inclusiveness where everyone can participate and engage in a meaningful way. No one person can or should represent an entire community.
• Anti-racism: SGIM is committed to opposing acts of racism, white supremacy, and oppression in our society, in other people, and in ourselves. This includes the ways in which we all perpetuate racism with our behaviors and/or inaction in the face of structural racism and oppression. We will collect data and follow metrics to ensure we are committed in action and policy.

To ensure alignment with our mission and vision as noted in last month’s Forum,³ we must not only focus on diversity, equity, and inclusion within SGIM but also work to change the structure and functions of the society. Our focus is on health and health care and most specifically we must reflect on our own SGIM culture, values, and structures to be more anti-racist in structure and action.

As you know, the Council convened the SGIM Anti-Racism Workgroup to review the annual plans of the committees and commissions to ensure that anti-racism work is a part of their DEI efforts and to make recommendations regarding the charge to committees and commissions as they do their work as well as make recommendations for how the Society can adopt an anti-racism strategy.³ Workgroup members include Rita Lee (Chair), Monica Lypson (President, SGIM), Eric Bass (CEO, SGIM), Chavon Onumah (Health Equity Commission), Cornelius James (Education Committee), Carol Bates (JGIM), Himali Weerahandi (Research Committee), Elizabeth Jacobs (Health Policy Committee), Naomi Waltengus (Staff Liaison, SGIM), and Erika Baker (Project Management Director, SGIM).

The workgroup further defined Anti-racism for SGIM as the “intentional action focused on addressing the policies, procedures, and structures that perpetuate historical and ongoing injustices and disparities. Our diverse group of stakeholders agreed to begin this work with an anti-racism and an anti-oppression lens to address intersecting identities.”⁴ The workgroup then proceeded to make a series of recommendations, named Opportunities for Action, to Council for deliberation. These opportunities were in the areas of Annual Meeting Oral Presentations, Awards, Membership, Leadership/Council, Committees & Commissions, Career Development, and Mentoring Programs.

To illustrate one of the Opportunities for Action, the following recommendations to Council from the Anti-racism Taskforce relate to Membership to ensure:

• Intentional outreach to recruit members from historically Black colleges and universities (HBCUs). This action would focus our outreach efforts to institutions with a commitment to justice as well as those potential members who might have been marginalized by lack of outreach and inclusive practices in the past.
• Intentional outreach to recruit members from Federally Qualified Health Centers (FQHCs). With consideration of a discounted registration fee to the annual meeting to bolster conference attendance. In this case, our goal is to include general internists who serve underserved communities. The addition of these clinicians to our learning communities would demonstrate community engagement and support patients. If it is financially feasible, SGIM should consider and acknowledge the limited access to resources for staff travel in these organizations.
• Intentional collection of member demographics with inclusion of multiple dimensions of diversity and breadth of options (e.g., more categories of race and ethnicity that allows differentiation beyond Asian; sexual orientation; gender identity; ability status, etc.).

Encouraging members to update their profiles and demographics is in many ways critical to all our Diversity, Inclusion, and Anti-racism activities. Currently, we are missing race and ethnicity data for ~12% of our members. We must know more about the identities of the members so we may better serve our membership. We also recognize we must be transparent in sharing how this information will be used. While much progress has been made to collect this information, we will continue to work with the Membership Committee to hone our membership demographics and consider this iterative work. As noted in our Membership Diversity and Inclusion Initiative we are committed to change that supports all our members.

These are just a few of the recommendations to emerge from the workgroup. As additional recommendations are finalized, reviewed, and digested by Council, we will share them with all of you.

“Everyone is a little bit racist,” but we can all lean in to systematically remove structural barriers and must consider changing long-standing policies that historically oppressed minoritized members and communities. This is our work towards a “Just System of Care in which all people can achieve optimal health.” This is what makes me proud to be a member of SGIM!