When talking about health disparities in D.C., the narrative is usually the same: African American residents in Wards 7 and 8 are either at risk or are greatly impacted by illnesses such as hypertension, diabetes, obesity and kidney disease. And their children, in many cases, follow suit. The lack of good, easily-accessible primary health care has long been an issue for D.C. residents east of the Anacostia River.
That tale is not only a national problem, but the basis of a new policy statement issued by the American Academy of Pediatrics (AAP). It focuses on the role of racism in child and adolescent development and health care. Researchers explored why disparities in health outcomes correlate to a patient’s race, and examine how early the pattern begins.
“If mothers are stressed around issues of racism, the data shows that it can affect the birth outcomes for their children and affect their pregnancy in general,” said Dr. Maria Trent of John Hopkins Medicine. “We see children who experience bullying or trauma related to racist acts, and that has a real impact.”
Despite the diversity of large cities, such as Washington, Trent said young people here are not immune to racist acts. Trent, who co-authored the policy, said when it comes to children’s health, it’s up to pediatricians and other child health professionals to counsel families of all races on the effects of exposure to racism as victims, bystanders, and perpetrators. Health care providers can implement systems in their practices to make patients know they are welcome, will be treated with respect and will receive high-quality care regardless of their background.
Addressing Racism, One Exam Room At A Time
First, Trent said, pediatricians should examine their own biases. It’s noted in the policy that providers should become advocates and work with community-based organizations to help remedy biases and inequities in health, justice and educational systems.
“We really want pediatricians to listen to children and their families, using a culturally competent, patient-centered and family-engaged approach to begin the process of healing and change,” Trent said.
Other recommendations for health care providers to reduce child exposure to racism include:
- creating a culturally-safe medical home, where the providers acknowledge and are sensitive to the racism that children and families experience
- training clinical and office staff in culturally-competent care
- assessing patients for stressors and social determinants of health often associated with racism (e.g. neighborhood safety, poverty, or academic access)
- advocating for increased support for mental health services in schools designed to help teachers better manage students with disruptive classroom behaviors and to reduce racial disparities in school expulsion
According to Trent, in order for children to thrive, they also need a healthy sense of their ethnic and cultural identity to be generally happy and hopeful for the future.
“Children need to be certain about who they are and proud of it. It seems like a small thing, but it shapes how they move through adolescence and into young adulthood,” said Trent.
Breaking Down Doctor-Patient Barriers
Cultural competence in health care refers to the ability of providers and organizations to effectively deliver services that meet the social, cultural and linguistic needs of patients. Across many areas of medicine, black patients as a group fare worse than their white counterparts. Researchers are still trying to understand what’s behind those health disparities. It’s not yet clear how much of those differences in care can be explained by bias, either from the healthcare system itself or the people who give care.
Some studies show that when the race or ethnicity of physicians and their patients are matched, the patient’s overall satisfaction and sense of trust are higher. But Trent is clear: There are providers who do not share a similar cultural background with their patient who, with proper medical training, are still able to provide the care needed.
“But the kid wants them to say, ‘I see you. I see your family. I see that there’s this big incident that occurred in your family, which was racially-charged. I am comfortable talking about that with you,’ ” said Trent.
The new policy also builds on existing AAP recommendations associated with other social determinants of health, such as poverty, housing insecurity, child health equity, immigration status, and early childhood adversity
Date: August 07, 2019