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The Weight of the Little


Rhea W. Boyd, MD, MPH, FAAP
July 29, 2019


*Editors’ note: This is one of a series of “AAP Voices” blog posts highlighting how racism impacts the health and well-being of children, adolescents, young adults and their families. To learn more, see the newly released American Academy of Pediatrics' policy statement, "The Impact of Racism on Child and Adolescent Health."

In 2014, Tamir Rice, a 12-year-old boy, was killed by police, in Cleveland, Ohio. It was 4 months after the contested shooting of Michael Brown, an 18-year-old adolescent, killed by police in Ferguson, Missouri.

At the time, in 2014, there was too little national epidemiological data to clarify whether Tamir and Michael’s deaths signified anomaly or dangerous trend. There were no clinical guidelines to place their deaths in a pediatric context and few policy statements to direct public health advocates to prevent future harms. At the time, there were the voices of families, neighbors, friends, and allies who organized, protested, and publicly decried police killing Black women, children, adolescents and men. And for the AAP, there was silence.

Two years passed. And in 2016, following the deaths of Alton Sterling, Philando Castile, and five police officers in Dallas, the AAP released a statement in which then President Dr. Benard Dreyer urged pediatricians “to confront the twin epidemics of violence and intolerance in the lives of children, adolescents, young adults, and their families.”

New @AmerAcadPed policy on racism’s impact on child & adolescent health is a place to start addressing the ways intolerance informs and shapes young people’s exposures to violence beyond current conversations, @RheaBoydMD writes in #AAPvoices #RacismAndHealth

Racism shapes & informs children’s exposure to violence
These “twin epidemics” reveal a past history and present reality of racism in the United States that is deeply contingent upon exacting and maintaining forms of structural and physical violence in the lives of Blacker peoples. These forms of violence don’t exist in parallel with racism, they are its manifestation and their use reifies dominant racial hierarchies.

While the AAP has been a long-time advocate of addressing the impacts of violence on the lives of children and families, we, as an organization, have yet to contend with the ways racism informs and shapes children and adolescent’s exposures to violence.

Now in 2019, with the release of the AAP’s newest policy statement, “The Impact of Racism on Child Adolescent Health",  we have a place to start. That place, as the authors note, is with the recognition that “little has been done in pediatrics to address the influence of racism on child health outcomes and/or to prepare pediatricians to effectively identify, manage, and prevent the physical, emotional, and developmental harms resulting from racism.”

Here, the word little describes not only the limited breadth of our actions in the AAP to address racism, but also the devastatingly narrow scope of our advocacy. This is not to deny the powerful role the AAP has played in successfully advocating for children and families since its founding in 1930. It is to say that some children and their families have received too little attention.

If our advocacy around gun violence excludes children, adolescents, parents, and neighbors who are the victims of police shootings, we fail to account for the disproportionate toll this form of violence takes on Black, Latinx, and Indigenous communities in the United States and to contribute to public health efforts to address it.”


An anti-racist approach to advocacy
For example, if how we talk about gun violence solely frames it around mass or school shootings and home gun safety, we fail to acknowledge and address the Black boys aged 15-19 whose leading cause of death is homicide, the vast majority of which occurs from disproportionate exposure to guns.

If our advocacy around gun violence excludes children, adolescents, parents, and neighbors who are the victims of police shootings, we fail to account for the disproportionate toll this form of violence takes on Black, Latinx, and Indigenous communities in the United States and to contribute to public health efforts to address it.

If we isolate our analysis of the atrocities occurring to children and families at our nation’s Southern border from our analysis of the disproportionate detention, detainment, and separation of Black, Latinx, and Indigenous families within the criminal justice system, we ignore the larger political forces that criminalize, dehumanize, mistreat, and harm children and families in the United States.

And if we address child poverty without confronting the ways economic mobility is shaped by neighborhood level exposures to racism, we are ill-prepared as advocates to equip generations of children with a brighter future.

Whether from little data, little policy, little training, or little interest, as members of the academy, our lack of engagement around racism should weigh on our conscience, on our advocacy, on our science, and on our clinical practice. It should propel us, as an organization, to consider the ways in which we have under-evaluated and under-served certain children and families.

This new policy statement is an important beginning. But it cannot be the end. While we may start with forms of racism we are familiar with, we must prepare to address forms of racism that challenge us, make us uncomfortable, and most importantly, push us to learn and evolve as an organization, “to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults.”


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

About the Author


Rhea W Boyd, MD, MPH, FAAP, is an Executive Committee member of the American Academy of Pediatrics (AAP) national Council on Communications and Media and serves on the board of AAP’s California Chapter 1. A pediatrician and child and community health advocate who lives and works in the San Francisco Bay Area, she writes and teaches on the intersections of health and justice, and travels to lead work to address the impacts of racism and poverty on children, families, and communities. She works clinically at the Palo Alto Medical Foundation and serves as the Chief Medical Officer of San Diego 211 and the Director of Equity and Justice for, The Children's Trust, a campaign to expand behavioral health access to every child in California.