IMPACT RACISM HAS ON MENTAL HEALTH

The nation’s pediatricians call for action to reduce the impacts of racism and improve the health of all children.

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Racism has a profound impact on children’s health. With the goal of helping all children reach their full potential, the American Academy of Pediatrics (AAP) is publishing new recommendations on ways to lessen the impact of racism on children and teens.

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In the policy statement, “Racism and Its Impact on Child and Adolescent Health,” the AAP calls on pediatricians to create welcoming, culturally competent medical practices, to advocate for policies that advance social justice, and to engage leaders in their communities to reduce health disparities. The policy will be published in the August 2019 issue of Pediatrics and available online July 29.

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“While progress has been made toward racial equality, the impact of racism on communities of color is wide-reaching, systemic and complex,” said Maria Trent, MD, MPH, FAAP, FSAHM, lead author of the policy statement. “A combination of strategies will be needed to begin untangling the thread of racism throughout the fabric of our society, and to improve the health of all children.”

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Children can experience the effects of racism from other individuals, as well as through the places they live and learn, through limited access to resources and economic opportunity, and how their rights are enforced or exercised. A growing body of research has found that racism harms children’s mental and physical health.

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For example, children and teens who are the targets of racism are impacted the most, but bystanders are also harmed. Studies have found that young adults who were bystanders to racism as a child experience profound physiological and psychological effects when asked to recall the event -- comparable to the effects experienced by first responders after a major disaster. Research has also examined the impact of racism on specific health measures, such as pre-term birth, low birth weight and mental health.

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“As a pediatrician, I know that when children are stressed, it impacts their health and development,” said Jacqueline Dougé , MD, MPH, FAAP, co-author of the statement. " When children experience chronic stress, they are flooded with stress hormones such as cortisol that, after prolonged exposure, leads to inflammatory reactions. This can harm children’s health in the short term, but also creates long-term health problems like heart disease, diabetes, and depression.”

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The AAP believes pediatricians share a role in helping improve the conditions where children live, learn and play, by listening to families, creating culturally safe medical homes and advocating within their communities.

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“It’s important, as child health professionals, that we examine our own biases and work with families to gain their trust and confidence,” Dr. Dougé said. “We must be prepared to counsel families of all races on the effects of exposure to racism.  That includes talking with victims, bystanders and perpetrators about managing their circumstances and health.”

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Adds Danielle Dooley, MD, MPhil, FAAP and co-author of the statement, “In pediatric practice I care for children and families who are exposed to racism in the school system, the justice system, the public benefits system, the immigration system and other environments.  We must advance practices and policies that empower pediatricians to engage with families and communities on this critical challenge for child health.”

Upending deep-rooted racial disparities to improve children’s health will require a great investment, but the United States has developed ingenious solutions to significant societal problems in the past. For instance, the Food Stamp program, developed in the 1930s and revived in the 1960s, led to higher birth weights in babies whose mothers were at risk of nutritional deficiencies. When provided with food stamps three months prior to giving birth, the pregnant women gave birth with babies who had better odds of surviving, as a result. Similarly, expansion of child health insurance improved health care access for children, with significant gains for black and Hispanic children.

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“As a nation, we have made great strides in tackling other major challenges, and this one should be no different.   This is an area where we can – and must – make a difference,” said Dr. Trent.

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In the policy statement, AAP recommend that pediatricians:

• Create a culturally safe medical home, using evidence-based tools to improve their communications with families and training clinical and office staff in culturally competent care.

• Engage community leaders to create safe playgrounds and healthy food markets to reduce disparities in obesity and undernutrition in neighborhoods affected by poverty.

• Advocate for federal and local policies that support implicit bias training in schools and robust training of educators to improve disparities in academic outcomes and disproportionate rates of suspension and expulsion.

• Encourage community-level advocacy to develop policies that advance social justice.

• Collaborate with first responders and community police and share expertise on child and teen development and mental health, considering potential differences in culture, gender and background.

 

AAP has taken steps as an organization and advocate for children to address racism and be at the forefront of positive change. In August 2017, AAP formed a task force to address racism as a core social determinant of health for children and adolescents. The Task Force on Addressing Bias and Discrimination is charged with developing a plan to address common types of bias across a broad spectrum. The group will develop materials for pediatricians and parents, promote partnerships, and develop a policy agenda to build inclusive communities and health care systems. 

AAP also formed a provisional Section on Minority Health, Equity, and Inclusion that aims to advance health equity among children and promote greater inclusion and diversity in the pediatric workforce. In April 2018, the academy published a policy statement, “AAP Diversity and Inclusion Statement,” that committed to using policy, advocacy, and education to encourage inclusivity and cultural effectiveness for all.

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“This work is incredibly important for the AAP, for pediatricians, and for children, and it will remain a priority for our organization,” said AAP President Kyle Yasuda, MD, FAAP. “As a pediatrician, I know that when we help children grow up healthy and with equal access to opportunities, we improve all of society.”