'Race-norming'—also called 'race correction,' 'ethnic adjustment,' and 'race adjustment'—refers to the adjustment of medical test results or medical risk assessment algorithms based on a patient's race. The practice, however, can and often does include additional factors such as age, assigned sex at birth, and pain tolerance.
Race-norming is believed to have been integrated into clinical risk assessment tools in 1981. Similar to the 'soft-bigotry of low expectations,' the practice is predicated on othering BIPOC communities, and most adversely affects Black people.
The Historical Roots
The use of race in medicine has deep and troubling roots. Much of what we 'know' about racial differences in health comes from research conducted during slavery—research that sought to justify the brutalization of Black bodies by claiming they were fundamentally different from white bodies. That Black people felt less pain. That Black lungs worked differently. That Black bodies could endure more.
These pseudoscientific claims were never true. But they persist in medical education, in clinical practice, in the algorithms that determine who gets care and who doesn't. They persist because they serve a purpose: they allow the healthcare system to provide inferior care to Black patients while claiming to be objective.
The Harm of Race-Based Medicine
When algorithms adjust for race, they often result in Black patients receiving less aggressive treatment, being deprioritized for organ transplants, or having their symptoms dismissed. The assumption that race is a biological rather than social category leads to differential—and often inferior—care.
Consider kidney function: the eGFR calculation includes a 'race adjustment' that makes Black patients appear to have better kidney function than they actually do. The result? Black patients are referred later for dialysis and transplant, leading to worse outcomes. The algorithm doesn't account for why Black patients might have different kidney function—the effects of discrimination, environmental racism, lack of access to care. It just adjusts the number.
The NFL's use of race-norming in concussion settlements brought this issue to national attention: the practice assumed Black players started with lower cognitive function, making it harder for them to demonstrate impairment and receive compensation. The assumption wasn't just wrong—it was racist. And it cost Black players millions of dollars in compensation they were owed.
Toward Equitable Healthcare
Removing race from medical algorithms isn't enough. We need to examine how racism—not race—affects health outcomes. We need to address social determinants of health, not use race as a proxy for them. We need to build healthcare systems that serve all patients equitably.
This means training healthcare providers to recognize their own biases. It means collecting better data on social determinants. It means building algorithms that account for systemic racism rather than encoding it. And it means listening to Black patients when they describe their symptoms—rather than assuming they're exaggerating.
Because the goal of medicine should be to provide the best possible care for every patient. And that's not possible when the tools we use assume some patients are worth less than others.