Volume 68, Issue 3 | Page 16

PEDIATRICS RACISM: A CHILD HEALTH CRISIS AUTHORS Amber Pendleton, MD and V. Faye Jones, MD, PhD, MSPH As primary care pediatricians, our vision is for every child in every community to be safe, healthy and thrive. The bleak reality is that this may be possible for some children, but not all. Due to the long-standing oppression caused by structural racism, unjust health determinants continue to sink children of color, especially Black children, towards devastatingly worse health. Structural racism is “a system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity.” It is insidious and ingrained in every aspect of our social, economic and political systems, including the health care system in which we work. This year, the world has seen the COVID-19 pandemic disproportionately affect people of color. Then, horrific acts of racial violence on Black lives has caused widespread expression of grief, fear and anger. Although we are thankful for the loud voices and actions across the nation insisting this injustice end, we acknowledge our own anger and disgust that racism has continued to impede child and family well-being for centuries. Yet we have not done enough to dismantle it. Experts on child health at the American Academy of Pediatrics (AAP) issued a statement in 2019 alerting us that racism has a profound impact on the health status of our youth. It outlined a multitude of strategies for us to improve community engagement, education, research and clinical practice. It reminded us that we do in fact have a unique perspective, responsibility and power to prevent, diagnose and treat racism. One of our greatest privileges is growing with a child, sharing their triumphs and heartaches and becoming a trusted member of a family. For us, this privilege has shed light on the magnitude of health disparities that exist in communities of color even though race is nothing more than a social construct rooted in flawed history, not science. Over the years, we have witnessed the light in a child’s eyes slowly dim simply due to racial disparities. We have seen children of color swallow hard and clench their jaws to fight back tears when they have been bullied, mistrusted or marginalized. We have held little hands while they grieve after seeing their mother shot right in front of them. We have watched their heads hang low as we walk in the exam room, then slowly rise up to reveal facial bruises and broken glasses. We have sensed the humiliation and fear felt by teenagers pulled over by the police for simply “driving while Black.” We have cried with them. We have sat with them. We have loved them even more. And some of us have silently relived our own trauma. Now more than ever, there is no time for just sitting. We must act. Toxic stress rooted in racism causes flooding of hormones and inflammatory mediators that trigger changes in a child’s body leading to lifelong chronic diseases. These effects on their cellular biology, 14 LOUISVILLE MEDICINE