By Layna Hong
When Shanti Narayanasamy was in medical school over a decade ago, she was taught to associate particular diseases with certain races, without really knowing why. It was only when she began her master’s in global health at Duke that Narayanasamy started to explore how race influences medical professionals’ practices through her current research project and thesis.
“My current work was informed by my personal confusion about race and disease,” she said. “I started to unpack these ideas myself, and really try to understand that relationship between race and genetics, race and biology, race and disease.”
Narayanasamy is on the Global Health Pathway for Residents and Fellows, which is funded by the Hubert-Yeargan Center for Global Health. Having earned her medical degree from Australian National University, Narayanasamy decided to pursue her master’s in part because of this program, which offers medical doctors a pathway into global health research.
“I did the pathway because it was a great combination of practice, research, education and a great opportunity,” she said.
Through the fellowship, Narayanasamy became interested in investigating how healthcare professionals use and approach race in their work. She said that she came to this work with little knowledge and learned a lot from a course that she took on decolonizing global health. That course also introduced Narayanasamy to her current mentor and principal investigator for her project, Charmaine Royal, the Robert O. Keohane Professor of African & African American Studies, Biology, Global Health, and Family Medicine & Community Health.
“It was an awakening, like, ‘Hang on a second, that doesn't make any sense,’” Narayanasamy said. “We’ve been taught that humans can be separated into biological races, but actually race is socially constructed and does not have a meaningful biological or genetic basis.”
Narayanasamy said that some examples of disease-race associations that she was taught included Type 2 diabetes with South Asian populations or sickle cell disease with Black populations.
“We’re taught these associations with diseases, but often, we're not given an explanation as to why they're associated,” she said.
While medical schools have begun to move away from race-based medicine in recent years, doctors trained prior to those changes still have retained these racial associations, Narayanasamy said. She realized that many of her peers were also trying to understand and unlearn what they have been taught. From there, she started developing her current project.
She is conducting her project entirely at Duke. It is a mixed-methods study that uses surveys and interviews to investigate how healthcare professionals think of race and use it in their practice. Narayanasamy said that both quantitative and qualitative data are important in what she and other researchers want to gain from this project.
“We didn't want to just ask people, ‘Do you use race in your clinical practice? Yes,’ and then leave it at that,” she said. “We wanted to kind of understand that a bit more.”
The project findings will eventually be presented to the School of Medicine. Narayanasamy hopes to have two main outcomes: to use the findings as baseline data to develop educational materials for physicians and to encourage healthcare professionals all over the world to continue having open dialogue on this topic.
“This isn't just a United States problem; this is a global challenge to thinking in science and medicine,” she said. “I think Duke has an opportunity here to lead the way and to show that we're capable of change.”
Narayanasamy said that her work is possible due to her champions, like Royal, and funding from the Global Health Institute and the Hubert-Yeargan Center. She has also received a Dean’s Research Award for Master’s Students from The Graduate School. After completing her fellowship, she hopes to continue this type of work in other global contexts.
“I'm really committed to turning our current work into those educational tools that we hope for,” she said. “I think that that’s very possible.”