AAP issues first policy on racism’s impact on child health and how to address it
MariaTrent, M.D., M.P.H., FSAHM, FAAP
The AAP has consistently taken a stand on issues that make some children and adolescents
more vulnerable than others. Policy statements and other reports have addressed many
of the social determinants of health from poverty to trauma as potentially adverse
childhood experiences that shape longitudinal health outcomes as youths move into
In a new policy statement, the Academy has taken the next step to incorporate and
specifically address racism’s impact on child and adolescent health, consistent with
the vision outlined in the AAP Blueprint for Children.
Racism is defined here as a “system of structuring opportunity and assigning value
based on the social interpretation of how one looks (which is what we call ‘race’)
that unfairly disadvantages some individuals and communities, unfairly advantages
other individuals and communities, and saps the strength of the whole society through
the waste of human resources,” as described by Camara Phyllis Jones, M.D., Ph.D.,
The policy provides a historical perspective on the factors that have led to the persistence
of racism and how institutional (structural), personally mediated (interpersonal)
and internalized (self-directed) racism undermines individual and population health
Scope of problem
Pediatricians strive to care for children and adolescents such that they all have
an opportunity to reach their full potential. Although we have progressed toward greater
racial equity, racism continues to undermine the health of children, adolescents and
families. Children and adolescents experience racism through the places they live
and learn, by what they have economically and how their rights are protected.
The stress generated by experiences of racism may start through maternal exposures
while in utero and continue after birth with the potential to create toxic stress.
This transforms how the brain and body respond to stress, resulting in short- and
long-term health impacts on achievement and mental and physical health. We see the
manifestations of this stress as preterm births and low birthweights in newborns to
subsequent development of heart disease, diabetes and depression as children become
While the notion of addressing racism may seem overwhelming given that it is a construct
that has been sewn through the fabric of American society, the policy offers practical
strategies. These are grounded in the principles the Academy already is leveraging
to address child health in the office, within community practices, health care organizations,
community agencies and pediatric training environments, and through effective advocacy
and innovative research that incorporates a focus on health disparities.
The backbone of pediatric care delivery occurs in individual practices, school health
systems, public health systems, community-based health centers and hospitals nationwide.
Pediatricians can implement approaches within their practice settings to ensure that
patients and families feel welcomed, are treated respectfully, and that patient- and
family-centered culturally and linguistically appropriate care is at the heart of
the services provided.
This may include signs with statements of inclusivity and the availability of multilingual
staff or interpreter services at the organizational level. Pediatricians can show
images in the office that reflect the diversity of the communities they serve and
ensure that AAP-supported early literacy programs reflect a diverse range of images
During individual visits, providers might ask about recent events in the community
that may have had an impact on the patient and family, determine the need for counseling
or alternative forms of support such as affinity groups at school, and provide anticipatory
guidance on effective communication and strategies to keep children and adolescents
safe. Pediatricians can collaborate with local schools, school health systems and
justice systems to ensure that all patients meet their developmental and vocational
Ultimately, the policy asks that pediatricians reflect on their own biases and integrate
structural and individual-level strategies that optimize professional practice. By
engaging patients and families in clinical care settings and through effective anticipatory
guidance, pediatricians can help parents raise children and adolescents who can do
identify racism when they see (bystander) or experience it (target);
differentiate racism from other forms of unfair treatment;
oppose the negative messages or behaviors by others; and
replace it with something positive or constructive to prevent the observed longitudinal
health and developmental consequences associated with internalizing those experiences.
Dr. Trent is a lead author of the policy statement and chair of the AAP Section on
Adolescent Health Executive Committee.