Dr. Goza praises AAP, pediatricians for meeting challenges during trying year

Editor’s note: For more coverage of the 2020 AAP Virtual National Conference & Exhibition, visit http://bit.ly/AAPNationalConference2020.

In summarizing a year filled with unprecedented challenges, AAP President Sara “Sally” H. Goza, M.D., FAAP, reminded pediatricians that the Academy is marking its 90th anniversary.

“When the year began, I knew we’d be marking history, but I never dreamed the extent to which we’d be making history,” Dr. Goza said during the President’s Address Saturday at the Virtual National Conference.

During her plenary speech, she took stock of the myriad events and issues that impacted pediatrics in 2020. The coronavirus pandemic was the key challenge that created new issues and amplified existing disparities. She credited pediatricians, pediatric medical subspecialists, pediatric surgeons and surgical specialists, retired pediatricians and trainees, “who rose to the occasion by changing how we care for patients in innovative, even heroic ways.”

While the sentiment of the moment is “we’re all in this together … we’re not,” said Dr. Goza. “… the coronavirus has found, exploited and widened every inequity. In the middle of the greatest health crisis in generations, millions of Americans find themselves impoverished and disconnected from medical care, joining the tens of millions who have always lived that way.”

Hispanic, Black and Native Americans have higher infection rates and face more severe health and economic consequences. Three out of four COVID-19-associated cases of  multisystem inflammatory syndrome in children have been among Hispanic and Black children, she reported. The AAP, she stated, is taking action to tackle these inequities through efforts to increase access to care, reverse declining vaccination rates and address mental health and behavioral issues.

“We can’t let policymakers, or the voting public, forget children or lose sight of how Medicaid, CHIP and other federal safety net programs improve health and life trajectories,” Dr. Goza said, while underscoring the importance of voting.

In spite of the pandemic, the AAP continues to make headway pursuing other critical pediatric initiatives, including gun safety and the epidemic of e-cigarette use among youths.

The AAP also is responding to a growing mental health crisis. According to Dr. Goza, 63% of young adults ages 18 to 24 say they’ve experienced pandemic-related anxiety and depression, and one in four has considered suicide. “I worry about what this is doing to fragile children and teens, as well as for the emotional functioning of families … which is why the AAP is advocating to expand, rather than cut, behavioral health services during these times of social distancing, uncertainty and unrest.”

Children and adolescents are not alone in this struggle, she pointed out. “Just as our patients are under stress, we’re stressed, too, with fears of becoming infected or infecting our families, helping our children with remote learning and coping with our own financial and emotional challenges.”

In response, the Academy developed resources and continues to hold discussion groups to support resilience, she added. Additionally, the AAP continues to work with the National Academy of Sciences, the Women’s Wellness through Equity and Leadership project and the Accreditation Council for Graduate Medical Education to change the culture of medicine to one that values providers’ well-being.

“We were called to this profession because we care about others,” Dr. Goza said. “Yet sometimes, the weight of the white coat becomes unbearably heavy. When our patients hurt, we hurt. If you’re battling exhaustion and compassion fatigue, you’re not alone.

"I’ve been there. It’s OK not to be OK.”

She acknowledged the financial hardships to pediatricians caused by the pandemic and accompanying recession. The Academy responded with the Call Your Pediatrician campaign to bring children back to their medical homes and continued pressure on Congress and the Department of Health and Human Services to ensure adequate financial relief and payment parity between Medicaid and Medicare.

As the country moves closer to having a COVID-19 vaccine, the Academy is working to improve the delivery of vaccines and confidence in vaccines. To that end, the AAP has issued recommendations to federal, state and local governments on how to strengthen the immunization delivery system as well as the Vaccines for Children program, she reported.

The Academy’s work also continues on ending the “socially transmittable disease of racism,” she said. “Racism is a public health issue that undermines the safe, supportive environments all children need to thrive. Every day in my practice, I see evidence of disparities built upon centuries of systemic and institutionalized oppression and dehumanization.”

A year ago, the AAP published the groundbreaking policy The Impact of Racism on Child and Adolescent Health. A year later, it published the policy statement Truth, Reconciliation, and Transformation: Continuing on the Path to Equity, which confronts the Academy’s history of engaging in discriminatory practices and apologizes to those who were wronged by the Academy.

More recently, a referendum passed by an overwhelming vote of the membership to add broad-based anti-discrimination language to the AAP bylaws.

“And we will continue to confront bigotry and racism through child health policy and programs as well as community engagement and broader social change …,” said Dr. Goza. She added that next year the AAP will publish a policy on “adverse policing exposures” that will:

• address how adverse encounters with law enforcement harm children, families and communities, and
• explore the criminalization of certain racial groups and the punitive treatment of developmentally appropriate behaviors in Black youths.

Strengthening these actions is a new Equity Agenda that addresses five domains: internal processes, education, leadership, clinical practice, and policy and advocacy.

In closing, Dr. Goza said: “We have before us an unprecedented opportunity … to remake the world and our health system into one where every child can grow up to be healthy and have a bright future. And to move us toward a society where we can truly say ‘we’re all in this together.’”