How you can prevent, mitigate impact of racism on child health

As pediatricians, we know that many health disparities are rooted in fundamental social and structural inequalities. As AAP president, I have witnessed these inequities on a national scale.

The impact on communities of color is wide-reaching, systemic and complex. I have learned that indigenous people have among the worst health status and greatest underrepresentation in the health care workforce. I have spoken with migrant children who are experiencing debilitating effects of toxic stress. And I have met with pediatricians in urban communities, where black teenage boys live in fear not only of gang and gun violence but of being targets of the law enforcement and criminal justice systems meant to protect them.

Discrimination both causes and magnifies poverty and illness, which is why pediatricians need to be at the forefront of addressing racism as a core social determinant of health for children and adolescents. A child’s right to attain the highest standard of health can be exercised only when health facilities, educational institutions and basic human services are accessible to all and provided in a nondiscriminatory manner — especially to the most vulnerable or marginalized sections of the population.

The AAP has released a new policy statement that addresses the impact of bias and racism on child and adolescent health (see article at http://bit.ly/2Y0PQWO). Though it is our first formal policy statement devoted to racism, it builds on our previous statements regarding other social determinants of health such as poverty, food insecurity, housing insecurity, child health equity, immigration status and early childhood adversity.

It comes at a time when the population of children in our country is not only more diverse than ever, it is more mixed. The U.S. Census Bureau predicts that by 2060, the number of multiracial Americans will be three times larger than it is now.

As a trusted source of support for families, pediatricians are uniquely positioned to prevent and mitigate the impact of racism by influencing our practices, our communities and the systems with which our children interact.

In our practices, we must make sure all patients and families know they are welcome, will be treated with respect and will receive high-quality care regardless of background.

In our communities, we can work with government and community-based organizations and advocate for initiatives that:

• redress biases and inequities in the health, justice and educational systems;
• reduce exposure to adverse events that alter the health and perceived self-value of youths, and
• optimize vocational and educational attainment for all students.

We also must create a more diverse and culturally effective pediatric workforce that can meet the health needs of diverse racial and ethnic backgrounds by:

• promoting policies and programs that increase the numbers of racial and ethnic minority pediatricians, pediatric providers and medical students, and
• providing ongoing education for practicing pediatricians on how to reduce implicit biases and improve safety and quality in the health care delivery system.

Our organization has a history of helping solve significant societal problems that affect children and their health. This new policy serves as a vital bridge to take us from acknowledging disturbing realities to generating effective solutions and interventions.

As a Japanese-Americanboy growing up in Hawaii, I was fortunate to have been a beneficiary of the “aloha spirit” — a culture of love, compassion and taking care of one another. Living on an island, we understood how small and fragile our world was and how much we depended on one another. It was an identity based not on race, but on being and feeling “local.”

It is in this spirit I invite you to join me in our efforts to end discrimination, remove barriers to opportunity and optimize the potential of all children.