Pediatrician’s Role in Eliminating Racism in Care for Children and Adolescent Health

March 16, 2021 by
Michael Kho, DO

Michael Kho, DO

Michael Kho, DO,  is a PGY1 resident at Wyckoff Heights Medical Center

“We must dismantle racism at every level, from individual to institutional to systemic,” stated pastAAP President Sara “Sally” H. Goza, M.D., FAAP on June 1, 2020 one week after the killing of George Floyd.1  In August 2019, the American Academy of Pediatrics issued a policy statement entitled, The Impact of Racism on Child and Adolescent Health.  In this policy, the state of racism which children and parents may face from the school to the clinic was analyzed, and the AAP expressed urgency in combating racism as pediatricians.  The policy also provided guidance and advice for pediatricians to improve our own practices to counsel families, improve our as staff, and better our community to better ensure that all patients are treated with respect and free of bias.2

However, since the publication of the policy, the US has continued to face numerous challenges involving racism.  From the shooting of Ahmaud Arbery, the death of Breonna Taylor, the killing of George Floyd, and the increase of racially-driven attacks on the Asian community due to the COVID-19 pandemic, racism has continued to show how prevalent it remains in our society.  With increased visibility through social media and the internet, more and more incidences of racism have been sparking conversations and movements across the nation.  As this movement for activism and the fight for equality in the US continue, now is a good time to review the impact of racism on children and adolescent health and the AAP policy statement to reaffirm the need for improvement to better treat our patients, families, and communities.

Racism has been identified as a core determinant of health that has been found to be associated with poorer mental health, physical health, and general health.3  In children and adolescents, the impact of racism has been linked to complications from birth throughout development.  Studies have shown that racial disparities have resulted in low birth weights and increased infant mortality rates due to perceived racial discrimination and maternal stress.4  Throughout their school years, children may be exposed to incidences of racism through school teachers or fellow schoolmates both implicitly and explicitly.  These early incidents can lead to permanent impact in forming social connections as well as damage a child’s mental health.  Even children who were not directly exposed to explicit racism, but rather a bystander to racism and other forms of victimization have been shown to have psychological and physiological effects later in life as well.5  As these children face continued exposure to these stressors, they can produce increased stress hormones, such as cortisol, which can predispose these children to chronic disease.6  With all of the potential exposure to racism throughout childhood, and with the consequences that come with each event, it is our job as physicians to both address and ease these effects.

In AAP’s 2019 policy, a series of guidelines were provided for physicians to improve racial sensitivity within our clinical practices, professional education, as well as in our community.

For our own clinical practices, some strategies provided by the AAP are to:

  • Create a culturally safe medical home where providers acknowledge and are sensitive to racism that children and families experience.
  • Use strategies such as the Raising Resisters approach during anticipatory guidance to provide support for youth and families to recognize racism in all forms, differentiate racism from other forms of unfair treatment and/or routine developmental stressors, safely oppose negative messages and/or behaviors of others, and counter or replace those messages and experiences with something positive.
  • Train clinical and office staff in culturally competent care.
  • Assess patient for stressors and social determinants of health often associated with racism.
  • Assess patients reporting to have experienced racism for mental health conditions with validated screening tools and a trauma-informed approach.2

For Professional education and Workforce Development:

  • Advocate for pediatric training programs that are girded by competencies and sub-competencies related to effective patient and family communication across differences in pediatric populations.
  • Encourage policies to foster interactive learning communities to promote cultural humility and provide simulation opportunities.
  • Integrate active learning strategies such as simulation and language immersion.
  • Advocate for policies and programs that diversify the pediatric workforce and provide ongoing professional education for pediatricians in practice to reduce implicit biases.2

For Community engagement, advocacy, and public policy:

  • Engage community leaders to create safe playgrounds and healthy food markets to reduce disparities in obesity and undernutrition in neighborhoods affected by poverty.
  • Advocate for improvement in the quality of education in segregated urban, suburban, and rural communities.
  • Support local educational systems by connecting with and supporting school staff.
  • Advocate for federal and local policies that support implicit-bias training in schools and robust training of educators in culturally competent classroom management.
  • Advocate for increased access to support for mental health services in schools.
  • Advocate for curricula that are multicultural, multilingual, and reflective of the communities in which children in their practices attend school.
  • Advocate for policies and programs that diversify the teacher workforce to mitigate effects of current demographic mismatch of teachers and students.
  • Advocate for evidence-based programs that combat racism in the education setting.2

As physicians, it is our duty to create an environment to provide quality care to every patient regardless of race, sex, sexual orientation, religion, economic status, disability, or any other feature.  Despite our continued efforts, there remains room for improvement as explicit or implicit biases may remain while treating our patients.  As racism can impact a child and adolescent’s overall health both psychiatrically and physically, we must continue to review and improve ways to eliminate all forms of bias and racism in our practice and the community in which we serve.

References:

  1. Jenco, M. (2021, March 05). ‘Dismantle racism at EVERY level’: AAP President.  Retrieved March 10, 2021, from https://www.aappublications.org/news/2020/06/01/racism060120
  2. Trent M, Dooley DG, Dougé J; SECTION ON ADOLESCENT HEALTH; COUNCIL ON COMMUNITY PEDIATRICS; COMMITTEE ON ADOLESCENCE. The Impact of Racism on Child and Adolescent Health. Pediatrics. 2019 Aug;144(2):e20191765. doi: 10.1542/peds.2019-1765. PMID: 31358665
  3. Paradies Y, Ben J, Denson N, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10(9):e0138511pmid:26398658
  4. Beck, A. F., Edwards, E. M., Horbar, J. D., Howell, E. A., McCormick, M. C., &Pursley, D. M. (2020). The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatric research, 87(2), 227–234. https://doi.org/10.1038/s41390-019-0513-6
  5. Janson GR, Hazler RJ. Trauma reactions of bystanders and victims to repetitive abuse experiences. Violence Vict. 2004;19(2):239–255pmid:15384457
  6. Cohen S,Janicki-Deverts D, Doyle WJ, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. ProcNatlAcadSci USA. 2012;109(16):5995–5999pmid:22474371
Filed Under: Blog, Blog Archives