HOPA Keynote Speaker Addresses Structural Racism in Pharmacy

Lakesha M. Butler, PharmD, BCPS, diversity and inclusion coordinator and clinical professor at Southern Illinois University Edwardsville, discussed causes of health inequity and how pharmacists can prevent and mitigate them to improve patient outcomes.

Systemic racism, implicit bias, and how they adversely affect certain patient populations were addressed in a keynote speech Wednesday at the virtual Hematology/Oncology Pharmacy Association Annual Conference 2021. Speaker Lakesha M. Butler, PharmD, BCPS, diversity and inclusion coordinator and clinical professor at Southern Illinois University Edwardsville, also discussed causes of health inequity and how pharmacists can prevent and mitigate them to improve patient outcomes during the John G. Kuhn Keynote Lecture, “Dismantling Structural Racism in Pharmacy.”,1,2

Pharmacists take an oath to consider the welfare of humanity and relief of suffering as their primary concern; however, Butler noted that some communities and patients disproportionately experience social detriments of health based on structural racism, which is often perpetrated by implicit bias as well as other behaviors and policies.1

According to Butler, recent literature have discussed how health care providers have implicit biases—negative associations—but don’t necessarily know that they have them. Although individuals oftentimes go into health care fields, such as pharmacy, with the goal of helping people, she said studies are finding that “we all have implicit biases.”2

“Implicit bias can result in minority patients being prescribed less pain medications or being delayed diagnostic testing, resulting in health care disparities,” Butler said.2

Referring to 2020 as “the year of 2 pandemics,” Butler discussed the relationship between COVID-19 and racism as a timely example of health disparity. In addition to high-profile social justice issues centered on racism, Butler said the COVID-19 pandemic has shined a light on systemic racism and how health care is impacted.2

“Racism is far from being novel or new. COVID [-19] has shown us that we have quite a way to go,” Butler said.2

CDC data presented by Butler show disproportionate COVID-19 statistics for populations in the United States, comparing people of color compared to the White population. The statistics are as follows:2

  • The Black and African American population have reportedly had 2.6 times higher cases, 4.7 times higher hospitalizations, and 2.1 times higher deaths from COVID-19 than White Americans.
  • The Native American and Native Alaskan population have had 2.8 times higher cases of COVID-19, 5.3 times higher hospitalizations, and 1.4 times the number of deaths from the virus.
  • The Hispanic and Latino population has had 2.8 times higher cases, 4.6 times higher hospitalization, and 1.1 times higher number of COVID-19 deaths.
  • Asian Americans have had 1.1 times higher cases, 1.3 times higher hospitalizations, and showed no increase above the White population in the number of deaths.

In her presentation, Butler addressed the history of racism in the United States, such as inequitable policies, that have negatively affected Black Americans and other non-White populations, as well as modern practices that may perpetrate racism. Racism has often led to social determinants of health.

According to Butler, social determinants of health are a set of 6 environmental conditions that have a profound impact on death rates and life expectancy for all conditions, including cancer and COVID-19. These environmental conditions are economic stability, access to a quality education, health care access and quality, neighborhoods, social and community context, and access to healthy food.1

Health care providers, including pharmacists, need to dig deep to identify social determinants for each patient, Butler said. She compared each patient case to an iceberg, in which only a small portion is seen above the water.2

“If we stay on the surface, we’re doing our patient a disservice. We must reflect on and examine what we don’t know below the surface,” she said.2

Hundreds of years of systemic racism in the United States, including enslavement and Jim Crow laws, have led to many social determinants that may affect an individual’s health today, and may preclude a patient from obtaining prescribed medications and visiting health care providers.2

Using a patient case as an example of what providers might encounter, she addressed a man with hypertension, asthma, and other medical conditions. Subpar housing, such as living near a toxic waste facility, may be contributing to his asthma, she said. The man’s hypertension could be caused by racial profiling or other social stressors that are not typically seen by the White population. Lack of access to healthy foods also plays a role in patients’ health.2

According to Butler, more than 80,000 individuals die each year in the United States because of health disparities. Data have also shown that Black men have more than 30% higher risk of prostate cancer compared with White men, and Black individuals are 3 times more likely than non-Hispanic White individuals to experience kidney failure.2

In closing her keynote address, Butler discussed steps for dismantling structural racism. Recognizing and believing that racism is structural and systemic, understanding how social determinants of health affect patients and how care providers can educate themselves are several steps. She said providers also need to identify and address personal biases.2

“We all need to look inward, at our own beliefs, biases, and socialization,” Butler said.1

Another way to help dismantle structural racism is to not only bring minority individuals to the table, but also ensure their voices are heard. “Equity breaks down barriers so that their voice is amplified,” said Butler.2

Providers can also actively work against racism by practicing anti-racism and being an ally to minority patients. “An ally is a disrupter and an educator,” said Butler.2

“It’s important for us to speak up and speak out against injustices. Not saying anything, not addressing injustice is complicity,” she concluded.2


  1. HOPA Addresses Health Equity Head On with Conference Keynote Entitled “Dismantling Structural Racism in Pharmacy” [news release]. March 31, 2021. Accessed April 14, 2021. https://www.hoparx.org/images/hopa/about/Press-Room/PressRelease_HOPA_Butler_DismantlingRacism_FINAL_2021_03_31.pdf
  2. Butler LM. Dismantling structural racism in pharmacy: our individual and organizational responsibility. Presented at: Hematology/Oncology Pharmacy Association Annual Conference 2021; virtual. April 14, 2021.