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Looking Back, and Within, to Move Beyond Racial Inequities

Joseph L. Wright, MD, MPH, FAAP
July 29, 2019

*Editor's note: This is one in a series of "AAP Voices" blog posts highlighting how racism harms the health and well-being of children, teens, young adults and their familes. To learn more, see the newly released American Academy of Pediatrics' policy statement, "The Impact of Racism on Child and Adolescent Health."

With our mission to optimize the health, well-being and potential of every child, the American Academy of Pediatrics (AAP) has never been more well positioned to exercise broad leadership to reduce obstacles to this goal.

In 2009, the AAP Board of Directors approved a set of principles focused on the reduction of disparities and the promotion of equity in children’s health care.  Over the past five years, the academy’s strategic platform, the AAP Agenda for Children, has sequentially elucidated and emphasized cross-cutting issues such as early brain development, childhood poverty, and, most-recently, bias, discrimination and racism.

For the past two years, I have had the privilege of chairing the AAP Task Force on Addressing Bias and Discrimination (TFOABD) and working with more than a dozen talented, diverse, and dedicated colleagues to lay out a glide path for the Board of Directors to execute the academy’s strategic commitment to tackle racism through lens of child health equity.

In #AAPvoices, Dr. Joseph Wright takes a look back at @AmerAcadPeds’s history of addressing racism as it prepares to move forward in achieving health equity. #AAPvoices #RacismAndHealth

Addressing racism head-on
Through this assignment, my colleagues and I learned a great deal about ourselves and, importantly about the academy. For instance, the policy statement, The Impact of Racism on Child and Adolescent Health, is the first such statement to actually use the term racism in its title. This represents a significant advance from the broadly published commentary on the subject, "The Road to Tolerance and Understanding", co-authored in 2017 by leaders within the academy and several other pediatric organizations. Without calling out and identifying racism directly at institutional and organizational levels, we certainly won’t be able to deal with it appropriately in professional, interpersonal, and practice settings.  

In my report to the AAP Board of Directors on the TFOABD recommendations, I reminded the leadership how important it is to be mindful from where we’ve come in order to authentically understand where we need to go. This is highlighted in no greater detail than through the experience of the first two African-American members elected to the AAP in 1945.

With our mission to optimize the health, well-being and potential of every child, the American Academy of Pediatrics (AAP) has never been more well positioned to exercise broad leadership to reduce obstacles to this goal.

When membership required caution
Despite both being board-certified and established leaders in the pediatric academic community as faculty at the Howard University College of Medicine in Washington, DC, Roland Boyd Scott, MD, FAAP, and his mentor, Alonzo deGrate Smith, MD, FAAP, were both denied admittance upon their initial application in 1939. While the academy did not have overt by-law prohibitions against admitting physicians of color like many professional societies did, it was clear that the Board of Directors struggled in consideration of their applications.  

The following excerpt from the transcript of the minutes of the June 15, 1945 AAP Executive Board meeting characterizes the nature of the discussion:

"We talked with them for about a half hour and they conducted themselves as gentlemen. They said their only interest in wishing to join the Academy was for educational purposes. They said they would not attend any meetings held South of the Mason and Dixon line. They would attend meetings in other parts of the country, but under no circumstances enter into the social side for the reason that they did not want to get hurt themselves. I impressed upon them the importance should they be elected, of their being leaders and not pushers, and their acceptance into the Academy would be guidance for those who would come at a later time.
I think the problem is of much more concern to us than it needs to be. In the first place, we have a definite responsibility to these negro representatives and to the negro population of the country. The only trouble is the social implication. The burden lies much heavier upon Smith and Scott than upon us. As the President (of the Academy) says, we have the authority to say who will not be admitted. In the event that either of these men transgress the social lines, they completely stop the advancement of the negro."

The story of Drs. Scott and Smith helps us in understanding context, history, and legacy as we collectively embark on this complex journey. Only through this awareness and understanding can we truly facilitate optimal care for children and families, and ensure that all of us realize our greatest human potential.

* The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.

About the Author

Joseph L. Wright, MD, MPH, FAAP, is Chair of the AAP’s Task Force on Addressing Bias and Discrimination and is also Chair of the AAP Committee on Pediatric Emergency Medicine. He is President and Chief Executive Officer (interim) of Capital Region Health within the University of Maryland Medical System and has been recognized throughout his career for his advocacy and community engagement work.