forms. This increased attention to racism and its effects on health
disparities made me consider this patient encounter, and countless
others with children of color, in a different light. As a white female
physician, I undeniably have the privilege of not experiencing racial
prejudice in my daily life. In a profession that is still largely made of
up white physicians, our own privilege can blind us to the realities
of our patients’ lives. How much more impact could we have on
our patients by explicitly naming the root of their health inequities
and doggedly pursuing focused solutions?
As an internal medicine-pediatrics trainee, I see a direct path
from childhood inequities to these health struggles in adulthood.
My adult patients of color are too often suffering from higher rates
of heart disease, diabetes and hypertension. It paints a stark picture
of the consequences that racism has on our smallest patients, as
they grow up and become adults. Throughout the course of a day I
can switch from this girl in clinic to another patient 15 years older
who is struggling to afford insulin and maintain a diabetic diet due
to the same race-dependent factors. Twenty years more and I will
likely be seeing that same patient struggling with chronic kidney
disease and dialysis. The trajectory of racism’s impact on health
is clear in my everyday patient interactions. It is no surprise that
a child born in predominantly Black West Louisville has an adult
life expectancy up to 12 years less than one born in East Louisville.
This is a striking difference, with inescapable roots in Louisville’s
racial history.
Research on adverse childhood experiences (ACEs) has found
strong ties between childhood trauma and numerous poor health
consequences later in life. An adult that experienced multiple ACEs
as a child can expect to have a higher risk for cancer, depression and
hypertension than peers with a smaller burden of ACEs. A recent
study examining community ACEs such as racism and violence, that
often disproportionally affect minorities, found not only a higher
burden of community level ACEs in non-white children, but that
racism in particular had the strongest negative effect. Without intervention
and recognition, these factors will continue to contribute to
poor health outcomes for our patients. This further emphasizes the
special role pediatricians are called to have as anti-racist advocates
for our patients. All physicians have a duty to acknowledge and advocate
for health equity – but those of us treating children have the
ability to not only treat, but also to prevent consequences of racism.
My young patient with obesity has already suffered consequences
of racism that threaten to cut short her potential and life expectancy.
We owe it to her and every other child to find solutions. Targeted
anticipatory guidance on the role of racism can prepare families of
all races on the effects of racism. Simply acknowledging racism’s
effect can also foster trust in communities of color that historically
have been denied access and equity in health care settings, improving
the patient-physician relationship and likely compliance.
Improved screening for stressors and social determinants of health
can connect families to community resources, such as options for
fresh produce and affordable housing. Advocacy for polices that
directly target social factors rooted in racism can disrupt systems
of oppression and decrease disparities in our communities. I urge
readers to continue to question the equity and transparency of the
systems we work in. Applying evidence-based strategies, such as
those outlined in the recent American Academy of Pediatrics policy
statement on racism, can be powerful tools towards improving the
lives of the children we serve.
As pediatricians, we take care of the most precious and vulnerable
patients. We take pride in our fierce advocacy for those who
cannot speak for themselves. Countless times through my medical
training, I have seen posters proclaiming, “The Kids Sent Us” or
“Protect Our Kids.” From the opioid epidemic to gun violence
to combating vaccine hesitancy, we have never shied away from
addressing difficult issues on our patients’ behalf. We tackle these
issues head-on because we understand that not only do children
suffer adverse effects in the short-term, but that those same effects
will continue to affect their physical and mental health throughout
their lifetimes. Intentional focus on racially driven health disparities
is urgently needed to provide a better future for today and tomorrow’s
children. It is time we proudly embrace our role as anti-racist
pediatricians.
References
PEDIATRICS
Trent et al. The Impact of Racism on Child and Adolescent Health. Pediatrics,
August 2019 https://pediatrics.aappublications.org/content/144/2/
e20191765?cct=2326
Goyal et al. Racial and Ethnic Differences in Emergency Department Pain Management
of Children With Fractures, Pediatrics May 2020, 145 (5) e20193370;
DOI: 10.1542/peds.2019-3370 https://pediatrics.aappublications.org/content/144/2/e20191765?cct=2326
Raman et al. Racial Differences in Sepsis Recognition in the Emergency Department.
Pediatrics. October 2019.
https://pediatrics.aappublications.org/content/144/4/e20190348?cct=2326
Louisville Metro Health Equity Report. 2017. https://louisvilleky.gov/sites/
default/files/health_and_wellness/che/health_equity_report/health_equity_report.pdf
Thurston et al. Community-level Adverse Experiences and Emotional Regulation
in Children and Adolescents. Journal of pediatric nursing, 2018, 42, 25–33.
https://doi-org.echo.louisville.edu/10.1016/j.pedn.2018.06.008
Heard-Garris, Cale, Camaj, Hamati, Dominguez. Transmitting Trauma: A
systematic review of vicarious racism and child health. Society of Sci Med. 2018.
Jean L Raphael, Suzete O Oyeku. Implicit Bias in Pediatrics: An Emerging Focus
in Health Equity Research. Pediatrics, May 2020. https://pediatrics.aappublications.org/content/145/5/e20200512?cct=2326
Dr. Carpenter is a third-year resident in internal medicine-pediatrics at the University
of Louisville.
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