By Erica Wright
The Birmingham Times
The nation’s pediatricians are calling on members to help address the impact of racism on child and adolescent health.
A recent American Academy of Pediatrics (AAP) policy statement encourages pediatricians to advocate for policies that advance social justice. That’s a good idea, said several Birmingham-area doctors.
“We can ask families how they’ve experienced racism and then ask the children if they know what racism is [or] if they themselves have been a victim of racism or witnessed racism,” said Courtney Burrell, MD, a pediatrician with the Alabama Regional Medical Services (ARMS) in Birmingham.
After speaking with patients, doctors can “offer support, whether it be counseling or … medication because they’ve developed depression or anxiety, so that [patients] can flourish and become healthy citizens,” Burrell added.
Tina Simpson, MD, an assistant professor at the University of Alabama at Birmingham (UAB) in the Department of Pediatrics who practices in the Adolescent Health Center at Children’s of Alabama, said pediatricians must be cognizant of the impacts of racism.
“For instance, if a child sees the killing of unarmed black men day in and day out, that causes an amount of chronic stress for black males themselves, as well as their families, in terms of trying to raise young black males,” she said. “That stressor may affect other things in terms of depression, anxiety, potentially acting out, self-esteem issues, and concerns around safety.”
Exposure to Racism
The AAP policy statement entitled, “Racism and Its Impact on Child and Adolescent Health”—the first time the group has explicitly focused on the issue of racism—draws from hundreds of studies to alert doctors about the impact of racism on children.
“While progress has been made toward racial equality, the impact of racism on communities of color is wide-reaching, systemic, and complex,” said Maria Trent, MD, lead author of the policy statement, in a recent press release. “A combination of strategies will be needed to begin untangling the thread of racism throughout the fabric of our society, and to improve the health of all children.
She also noted, “Racism affects children before they’re even born … and continues to affect them across their lifespan. It affects them in the places they live, the institutions they interact with, including schools and law enforcement.”
Burrell agreed that racism can affect children and families in a number of ways.
“If children witness an event [involving] racism against people that look like them or maybe don’t look like them, they may be fearful of … becoming victims and experiencing violence or backlash from others because they don’t look the same, [have] the same accent, or whatever the case may be. That can cause stress.”
She added that the effects of racism on children can lead to other health problems, including weight gain, high blood pressure, anxiety, alcohol and drug abuse, and depression.
Racial Disparities
Racial disparities are prevalent and can factor into a lot of the issues faced by children, said Jaime McKinney, MD, an assistant professor in the UAB Department of Pediatrics and a pediatric physician at Children’s of Alabama.
“Access to resources and opportunities is huge amongst our children, [including] what ZIP code they happen to be zoned for,” she said. “We have a lot of patients who witness violence in their communities on a daily basis just because of where they live. We have kids who have no access to healthy foods in the areas in which they live [because there are few] grocery stores. … All of that is racially based.”
Social determinants, such as housing, income, and even environmental circumstances, all can play a part in the health of children, said McKinney: “Say, you live in [in a community] where there is a higher level of pollution, whether it’s the land or the air, and you have asthma. … Say, there are no grocery stores in that area … and a lot of the kids go to the gas station for their foods.”
Or, it can be as simple as having a park in the neighborhood where children can play or exercise; this can affect health, too.
“Whether it’s the food they eat, the amount of exercise they get, the quality of their education system, even the ability to see a doctor, all [of this] affects every aspect of their care,” McKinney said. “We see kids with toxic stress, environmental stress … that is pretty much based on their race, what they can afford, and where they live.”
Implicit Bias
The AAP report also indicated that doctors need to check their own implicit biases.
“I’ve caught myself feeling a little biased toward certain patients because I’m like, ‘I know this family’ or ‘This type of family is going to come in with 100 complaints.’ With a different family, [however], I might just be more open,” Burrell said. “I have to really catch myself, so I don’t let that show in my attitude toward the family and to make sure I deliver proper care.”
Simpson said all people, not just doctors, have biases.
“I think one of the first things in addressing our biases is to be aware of what they are and where they are, so we can slow down and fix it through being more thoughtful in our approach,” she said, adding that it is important “to be mindful of all of our encounters, to really try to listen to patients and understand where they’re coming from and where they are, so we can understand the perspective … and improve our encounters with patients and their families.”
McKinney believes medical professionals are doing a better job of addressing racial bias. For instance, the medical school at UAB is doing a good job in the admissions process and interacting with students, she said.
“They actually require us to conduct bias training and seminars about bias and prejudgment,” said McKinney. “I think the university is doing a great job at recognizing that we all have biases and [helping us] better address that and act accordingly.”
Solutions
McKinney has made it her personal mission “to address educational inequities based on fundamental racism.”
She believes that fighting racism begins with education, and as an assistant professor at UAB she encourages her residents to tell parents the importance of reading to their babies. She also served on Birmingham Mayor Randall Woodfin’s birth to pre-K task force.
“[We] had a book fair, where people donated books to families with lead characters of color,” McKinney said. “I’ve [also] been working with the medical school to increase representation of [diverse] students in the medical school and beyond.”
Simpson agreed that a more diverse and inclusive workforce can help potentially eliminate racial bias.
“With a more diverse workforce, you’re more likely to not perpetuate policies that reinforce elements of racism,” she said. “[It’s important to] slow down and thoughtfully [consider] the history of why things may be happening because racism is so ingrained in our culture. … You have to be mindful about the whys.”
