Archives for October 2020

Carley Gomes, MD, FAAP

Carly Gomes, MD, FAAP, is a Neonatologist at Stony Brook Medical Center.  She serves as the Equity, Diversity and Inclusion Chair for New York Chapter 2

This year’s virtual American Academy of Pediatrics National Conference and Exhibition (NCE) featured perspectives of leading researchers and child health advocates on the adverse health and social/behavioral outcomes impacting non-white children and their families.  Systemic racism in the United States influences social determinants of health and contributes to inequities in health among minority children.  Although the clearest path towards improving the health outcomes of children of color would be to abolish racism, this is an overwhelming task to consider.  How do you begin to dismantle systemic racism when it is so ingrained in societal norms?  What can pediatricians do to elicit change and be advocates for minority children?

The AAP has taken the crucial first steps towards abolishing racism by formally identifying racism as an independent driver for health inequity in children and by apologizing for our organization’s own racist history.  Although many other medical groups have released statements addressing racial health disparities, the AAP is among the few to publicly acknowledge past discriminatory practices and the harm these institutional actions caused.

Through this process of recognition and reconciliation, the AAP has established itself as an anti-racist organization dedicated to promoting the health and well-being of all children.  As pediatricians and members of the AAP we can also do our part to establish ourselves as anti-racist health-care providers.

Below are 5 tips to get you started.

1. Increase your exposure to different types of people and experiences.  Surround yourself with diversity.  This can be as simple as trying foods from different countries or learning about holiday traditions in other cultures.  Take a critical look at your social media profiles and photos to see who your friends and acquaintances are.  Though it’s comforting to associate with individuals with similar backgrounds and interests, challenge yourself to interact with someone very different from yourself.
2. Self-reflect and identify your own biases.  Unconscious biases can increase during periods of stress or when you feel time-pressured.  Understanding your personal biases and being cognizant of times when these biases may become more pronounced is important in ensuring that they don’t significantly influence your thoughts and actions.
3. Educate yourself.  Consider adding Ibram X. Kendi’s book, “How to be an antiracist,” to your queue.   Kendi served as the virtual NCE’s closing plenary speaker this year.  Familiarize yourself with the AAP policy statement on the impact of racism on child and adolescent health and learn more about how all children are adversely affected by systemic racism.
4. Create a home and working environment that embraces inclusivity.  Set an expectation that racist commentary is unwelcome and encourage friends, family members, and colleagues to hold each other accountable for the use of racist or discriminatory dialogue.
5. Advocate for change.  Find an outlet where you can safely speak up against racial injustice.  Make your voice and opinions heard by exercising your right to vote.  Let us all do our part to elect anti-racist officials who are committed to decreasing health inequities in children.  This year, more than ever, we need to vote like children’s futures depend on it.

References:

• https://pediatrics.aappublications.org/content/144/2/e20191765?ijkey=1ca3c621e5861f5570fe82e52ae36206d8e173e0&keytype2=tf_ipsecsha
• https://pediatrics.aappublications.org/content/146/3/e2020019794
• https://www.aappublications.org/news/2020/08/27/gotv090120

Shetal Shah, MD, FAAP

(Dr. Shetal Shah, MD, FAAP is a neonatologist at Maria Fareri Children’s Hospital.  He is NYS AAP Chapter 2 President. This op-ed was published on Orlando Sentinel on September 16, 2020)

With only a few weeks until Election Day, voters are feverishly hearing from candidates running for offices from your local town board to president of the United States.  Though rallies, town halls and campaigning are mostly virtual this election season, candidates are articulating their visions and appealing to voters’ interests.  As an electorate, we are being demographically portioned into groups such as the “suburban” voter, the “millennial” voter or the “single-issue” voter.

However, one major constituency is not being highlighted in the current debate, which is why, as a pediatrician, I plan to vote like children’s futures depend on it in November.  Children are 20% of the population but 0% of the vote, and their problems don’t get addressed unless physicians, parents, teachers and those who care for kids make their issues are own.

Nothing is more fundamental to child health than health insurance and the ability to see a doctor when your child is ill.  For healthy children, insurance coverage allows kids to access preventive care like autism screening, vision/hearing/dental screening and life-saving immunizations.

But while the current COVID pandemic has highlighted disparities in children’s access to internet and quality virtual education, long-standing income-based gaps in children’s health insurance coverage have gone largely unnoticed.

Medicaid is the largest insurer of children, and along with Child Health Plus, covers about 39 million kids, including children in foster care and with special healthcare needs.  Deeper cuts to the millions of children covered by public insurance were only forestalled by the COVID-19 pandemic, but will be front-and-center next legislative session in every state as they grapple with budget deficits and coronavirus-related financial strain.

Nationally, we’ve seen an increase in the rate of uninsured children over the past few years. The COVID-19 pandemic, regulatory obstacles and reduced funding have led to over 425,000 children losing health coverage.  This reverses almost a decade-long trend of annual reductions in the number of uninsured kids. In 2016, only 4.7% of children were uninsured, the lowest rate ever recorded.

What did that mean?  It meant my patients with asthma could get inhalers and say away from the emergency room.  It meant more children with diabetes had access to insulin.  It meant more patients on my hospital’s oncology ward could receive chemotherapy.

I will be voting for kids because reduced Medicaid funding will harm my patients.  Patients like the extremely premature babies in my intensive care unit who — born the size of an iPhone — need special ventilators to breathe, medications to keep their hearts beating and customized intravenous fluids prescribed daily and adjusted hourly.  Half of all premature babies are covered by Medicaid and without a strong, well-funded program to support them, I fear they won’t get the physical, occupational and speech therapy they need to thrive.

Decades of data show children insured by Medicaid do better in school, graduate college and become healthier adults than if left uninsured and without access to a physician.  This makes Medicaid a good long-term investment as well. For every dollar invested in the program, the state receives a dollar in federal funds.

Protecting Medicaid locally and across the county is essential to the health of children.  That is why I plan to cast my vote with children’s needs in mind. The policies and laws and candidates we support today will impact our children.  Kids can’t vote, but I can vote like their futures depend on it.