Racial disparities v. disparities caused by racismBuilding off that, I am reminded that we must stop focusing on racial health disparities. What we need to start focusing on how racism leads to health disparities. This will drive us to look beyond these arbitrary categories and into that milieu of racism that our society has constructed to find solutions for our health, our patient’s health, and the health of our communities.
I practice at a community health center in Seattle, Washington. About 60-80% of our patients rely on the state for health insurance coverage. We serve a diverse population representing countless languages and perspectives. The trauma of experiencing racism is tied to just about every health concern I see. Research shows that exposure to discrimination is tied to higher rates of Attention Deficit Hyperactivity Disorder, anxiety and depression, for example, as well as decreased general health. American Indians and Alaska Natives also have the highest rates of suicide of any racial/ethnic group in the United States.Racism is indeed a profound social determinate of health. That’s why it’s important to view this issue as a public health crisis--a “socially transmitted disease,” as the policy authors say.
“We serve a diverse population representing countless languages and perspectives. The trauma of experiencing racism is tied to just about every health concern I see.”
The interconnection of racism & violence
Often, racism means increased exposure to violence, whether it's sexual assault or violence from law enforcement. There are many types of violence, and American Indian children are exposed to more of them children in general. One type of racism-based violence is historical trauma, increasingly called intergenerational trauma as the emerging field of epigenetics suggests that the effects of extreme stress and malnutrition may actually be passed down in our DNA. So if your great-great grandmother was on the Trail of Tears, for example, that experience may be affecting your own health and well-being.
We need more and better research to understand the impacts and tools for ending racism. But the AAP policy statement points to important ways pediatricians can start tackling the problem now. From a practice perspective, that means training to examine our own unconscious or implicit bias that can affect patient care. It means creating a culturally “safe” practice and addressing the negative impacts of racism on our patients, providing referrals to mental health therapy for racial trauma.
Toward more diverse providers
We should also be teaching our next generation of physicians these concepts and helping medical students, residents, and fellows learn in an environment free of racism. These very same trainees should reflect the diversity of our patients, a long unmet goal. Among the estimated 727,300 active physicians in the United States in 2016, for example, just 0.56% (4,099) were American Indians and Alaska Natives.
In my mind, our ultimate goal should be health equity, with each and every patient, family, and community able to achieve their ideal state of health through fair, just, and optimized care to meet their individual and collective needs. But we cannot achieve health equity without first addressing racism. So, if you are looking at disparate outcomes in your own institution, life, or practice, then look no further than racism for your marching orders.
* The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.
Shaquita Bell, MD, FAAP, is Chair of the American Academy of Pediatrics, Committee on Native American Child Health. Dr. Bell is also a Clinical Associate Professor at the University of Washington, Department of Pediatrics and Medical Director of the Seattle Children’s Hospital Center for Diversity and Health Equity. She practices pediatrics at Seattle Children’s Odessa Brown Children’s Clinic.