Upending the structural racism that pervades society must start with having candid conversations about what racism is and to what extent it exists in institutions and among individuals, Harvard social psychologist Robert Livingston, PhD, told attendees at Learn Serve Lead 2021: The Virtual Experience, the AAMC’s annual meeting, on Monday, Nov. 8.
“There are a lot of people in the United States who deny the existence of racism, at least against people of color,” Livingston said during a session entitled "Becoming Part of the Solution: Seeking and Speaking the Truth About Racism," facilitated by Kirk Calhoun, MD, president of the University of Texas at Tyler. In fact, he added, studies have shown that many White individuals wrongly believe that they are the victims of racial discrimination.
But dismantling racism must first start with acknowledging it, and the only way to do that is to start talking about it, even if those conversations are difficult, said Livingston, referencing his 2021 book, The Conversation: How Seeking and Speaking the Truth About Racism Can Radically Transform Individuals and Organizations. “People have to get comfortable with being a little uncomfortable,” he added. “That’s how you know you’re having a conversation that’s worthwhile.”
In a talk interspersed with personal stories from his childhood as well as examples from his work helping police departments and corporations understand and address biases among their ranks, Livingston shared his road map — what he calls the PRESS model — for making progress toward racial equity.
PRESS stands for problem awareness, root cause analysis, empathy, strategy, and sacrifice. And in a nod to his audience of physicians, scientists, medical students, and other leaders in academic medicine, Livingston spoke of the stages as if the conversation were about a medical problem.
“Many organizations want to jump straight to solutions. You show up on the first day as a consultant, and they say, 'Just tell us what to do,'” he said. “That would be akin to someone showing up at the doctor’s office and saying, 'Just write me [a prescription for] some pills'” without doing an exam or conducting any tests to discover what’s really wrong.”
The P in PRESS, therefore, is problem awareness: Is there a problem and what is it?
The next stage is root cause analysis: An institution’s leaders or an individual might sense that something is wrong, but they’re unsure exactly what’s causing it. “Some people think racism is the product of a few rotten apples, a few bad actors. … They fail to see the systemic components that are baked into our laws and into our society,” he said. “So if you misdiagnose what racism is or what’s causing it, then you’re not going to have a long-term solution. You’re just going to be treating the symptoms.”
The stage after that is empathy or concern: “Once you know there’s a problem and you know what’s causing it,” you must care enough to want to make changes.
The final two stages are strategy and sacrifice. “Sacrifice often involves less pain than people think,” he added. “Are you willing to invest the time, the effort, the energy, the resources to getting it done?”
Organizations and leaders often assume they must give up fairness and quality in order to increase racial equity, Livingston said. “I challenge both of those assumptions. In fact, increasing diversity increases fairness and increases quality — and not only quality but performance. There’s a lot of research that shows that creativity, innovation, [and] profit go up as the diversity quotient increases.”
In his conversation with Dr. Calhoun and his responses to questions from the audience, Livingston went on to discuss the differences between equity and equality: “Equality is treating everyone the same. “Equity is treating people differently but in a way that makes sense,” meaning that some people have advantages — either through family or social networks, or through wealth and privilege — and that helping those who don’t have those advantages can help level the playing field.
And he encouraged the audience to begin to make changes as individuals and as leaders of institutions — even if those changes are only incremental. “You can’t do everything at once,” he said, adding that “everyone’s contribution is meaningful and important.”