brain architecture and genetic code increase their risk for a wide
range of illnesses, including seven of the top 10 causes of death in
the US. The good news is that racism is completely preventable, and
the effects of toxic stress on the body and brain can be mitigated.
When we signed up to become physicians, we knew that writing
prescriptions and referral orders were just small components of the
role we envisioned. We agreed to something bigger, the promise of
improving young lives, especially for those who need it the most.
But how?
For long-lasting, meaningful solutions, we must call on political
leaders and health care organizations to make vast changes. For
the latter, resources such as “Achieving Health Equity: A Guide for
Health Care Organizations” published by the Institute for Healthcare
Improvement (IHI) can provide an organized framework to increase
diversity and inclusion and eliminate bias and discrimination. In
addition, individual physicians need education on how to reach
these same goals as health care leaders and clinicians.
First, we must acknowledge our own role in enabling structural
racism to continue. How often have we examined our policies, procedures,
educational training, research and organizational structure
through a lens of equity? How often have we sensed inequities, but
remained silent? If we do not speak up, we perpetuate this health
crisis. In addition, we need to dedicate ourselves to fully understanding
the impact of racism and gain knowledge of effective methods
to eliminate health disparities. We should identify our own blind
spots through understanding implicit bias and commit to lifelong
self-evaluation and cultural humility.
What can we do for the child and family sitting in front of us? We
can intentionally remind ourselves that humans have no hierarchy
of value. We can check our judgement at the door by identifying
moments when we can constructively reframe our thoughts with a
trauma-informed lens. For example, ask, “What happened to you?”
not, “What’s wrong with you?”
We can implement universal screenings for toxic stress, mental
wellness and social care needs. We must not only screen the child,
but also the parent or caregiver since their stability and well-being
is a major health outcome indicator for the child. We can ask them
about their strengths, their village and their hopes and dreams.
Now what? After you collect this history, how do you turn it into
an effective treatment plan that truly mitigates the effects of racism
and health disparities? We believe you can’t do it alone and the key
lies in building partnerships with the community.
expectations for ourselves? For example, sometimes a safe, positive
afterschool program may be the best prevention and/or treatment
strategy for a child. We should ask ourselves how much time do we
invest in learning the after-school program options for our patients?
We believe it is important to take the same rigorous approach to
prescribing non-pharmacologic strategies for improving health,
such as connecting to community resources.
When our clinical team dedicates itself to this goal, amazing
things happen. Since making the commitment to prescribing community
in our clinic, we have slowly grown a multi-disciplinary
team. On-site social workers, nurse care coordinators and integrated
mental health providers work collaboratively to address the
comprehensive needs of the families we serve. Embedded resources
such as a Dare to Care Food Bank and medical-legal partnership,
Doctors and Lawyers for Kids, work to alleviate the daily stressors
of food insecurity and unmet legal needs. Through creating connections
to invaluable community resources, we now “prescribe”
parenting villages such as Play Cousins Collective, refer for racial
trauma therapy at the Collective Care Center and connect families
to trauma-focused interventions at Seven Counties.
We understand that our work toward health equity is just beginning,
and we have much to learn and many more steps ahead.
Keeping momentum will be critical to achieve real change to build
an anti-racist health care system. Let us remember that our greatest
strengths lie in our collective voice and shared goal of giving children
the promise of a healthy tomorrow.
References
PEDIATRICS
Aspen Institute. 11 Terms You Should Know to Better Understand Structural
Racism. 2016. Found at: https://www.aspeninstitute.org/blog-posts/structural-racism-definition/.
Trent M, Dooley DG, Dougé J, AAP Section on Adolescent Health, AAP Council
on Community Pediatrics, AAP Committee on Adolescence. The Impact of
Racism on Child and Adolescent Health. Pediatrics. 2019;144(2): e20191765.
Shonkoff JP, Garner AS, Siegel BS, et al. The Lifelong Effects of Early Childhood
Adversity and Toxic Stress. PEDIATRICS. 2012;129(1): e232-e246. doi:10.1542/
peds.2011-2663.
Franke H. Toxic Stress: Effects, Prevention and Treatment. Children.
2014;1(3):390-402. doi:10.3390/children1030390.
Wyatt R, Laderman M, Botwinick L, Mate K, Whittington J. Achieving Health
Equity: A Guide for Health Care Organizations. IHI White Paper. Cambridge,
Massachusetts: Institute for Healthcare Improvement; 2016.
Dr. Amber Pendleton is an Associate Professor of Pediatrics at University of Louisville
and is a pediatrician at Norton Children’s Hospital (non-member).
Dr. V. Faye Jones is a Professor of Pediatrics and Senior Associate Vice President
for Diversity and Equity at the University of Louisville (non-member).
When a medicine has been proven to improve health outcomes,
we expect medical providers to be knowledgeable about when
and how to prescribe it, adjust it and weigh the risks and benefits.
What if the best treatment isn’t a medicine, do we have the same
AUGUST 2020 15