The aff’s expansion of state power over life allows for unaccounted racism in the name of the “social good” throughout society

To widen this issue as to how racism is perpetuated in medical education, we look to the philosopher Michel Foucault, who asserts that power is everywhere [7]. In his work, he coined the term biopower—literally to have power over others’ bodies—to describe how institutions exert power over the human body in the name of the social good [8, p. 140]. In his work, Foucault examined the numerous ways the human body is manipulated and used in the context of a particular social system. For example, Foucault analyzed how discourse reinforces norms around sexuality, sanity versus insanity, and how the framing of these issues allows individuals to be manipulated and controlled by outside forces. In creating categories of what is “normal” for/in the human body, bodies become docile and are used to exclude individuals who do not fit socially acceptable understandings or categories.

From a Foucauldian perspective, power is not just an interaction occurring at a macro-level whereby governments or institutions exert influence on society. Rather, power is also enforced on the micro-level by individuals between doctors and patient, teachers and students, etc. It is maintained through these dispersed, decentralized networks, which Foucault calls the dispositif [9]. In this conceptualization, power is dissipated throughout institutions by individual actors (i.e., teachers, administrators, and students) who contribute to the creation and maintenance of institutional norms and practices. For example, when medical educators only show photos of white skin when discussing dermatological issues, according to Foucault these preferential acts normalize the presentation of the disease in white skin, which in turn disadvantages patients with a different skin color. In this way, preferences for what is normal are perpetuated throughout the profession in ways that frequently go unaccounted for.

In contrast to other conceptualizations of power, which begin at the macro-levels of society and trickle down into the micro-levels, biopower begins at the micro-level, exerting itself in everyday life. Foucault’s conceptions are important to consider because systemic racism operates at the macro-level, in which public policies, institutional practices, cultural representations, and other norms work in various and reinforcing ways to perpetuate racial inequity [10]. Focusing on systemic racism is important because it identifies dimensions of our history and culture that have allowed privileges associated with “whiteness” to endure and adapt over time, while continuing to disadvantage groups associated with “color.” At the same time, these structures are comprised of an amalgamation of individuals who work to keep the institution in operation. They are products of a society that is imbued with whiteness and therefore bring their lenses, tools, and decision-makings capability to the medical education enterprise. In this way, not only are institutions contributing to the problem, but so are the people within them. Thus, racism is being boundlessly perpetuated from both the “top-down” in public policies, institutional practices, cultural representations, and other norms and the “bottom-up” in the individuals working within these systems. For this reason, Foucault’s work urges us to not only focus on systemic racism at the macro-level, but to also address it at the micro-level, by considering the ways biopower—power over others’ bodies, including the ways bodies are represented, talked about, counted, rendered highly visible/invisible—is perpetuated in formal and informal ways to maintain white supremacy.