The murder of George Floyd has shined a spotlight on racism, which affects every aspect of American life, including the health of children and adolescents. Photo by Gabe Pierce on Unsplash.
The murder of George Floyd has brought the issue of racism to the forefront once again. But racism does not affect just the justice system — it is the major determinant in the healthcare outcomes of children and adolescents.
Last August the American Academy of Pediatrics put out its first policy statement on how racism affects the development and health of adolescents and children. “Policy statements like these are welcome — and long overdue,” said Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health.
According to the AAP, racism has a profound impact on the health and status of children, adolescents, emerging adults and their families. The continued negative impact of racism on health and well-being through implicit and explicit biases, institutional structures and interpersonal relationships is clear.
Racism is a disease
“Those of us who have been doing this work are not surprised by findings like these,” Puffer said. The AAP states that racism, experienced directly or just witnessed, can lead to high levels of stress, depression and even inflammatory reactions. Race is also a factor in low birth weight, maternal mortality, heart disease and hypertension.
“If you saw these symptoms in a clinical setting you would diagnose racism as a chronic illness – one that is passed down from generation to generation,” Puffer said.
In addition to the direct physical effects of racism, there are the health effects of institutional racism and implicit bias built into every aspect of American life, including jobs, housing, policing, incarceration and our education and healthcare systems. All of these factors impact the health outcomes of Black and Brown students and families. Any one of these factors can kill.
COVID-19 is a textbook case. African Americans have the highest death rate for the disease in Los Angeles County: 13 deaths per 100,000 people versus 9.5 for Latinx, 7.5 for Asians and 5.5 for whites. The factors are myriad (poor healthcare, housing and greater co-factors like diabetes, asthma and heart disease), but underlying all these is racism.
“We need to advance on two fronts,” Puffer said. “We must address structural racism by investing in healthcare and preventative programs in our underserved communities.” Our communities — and the kids who live in them — are not getting the primary, oral and mental healthcare services they need and deserve.
Funding is needed, funding that is threatened by the budget cuts being actively considered in Sacramento and Washington. Community clinics, oral health providers and hospitals have been hit hard by COVID-19. “We must fight for government funding and reject false economies during this economic crisis,” Puffer said.
“We also need to look at racism and bias within our healthcare system itself,” she said. As many institutions have acknowledged, there is a long legacy of inequal treatment of Black, Brown and Indigenous peoples in the healthcare system. People of color, especially African Americans, are less likely to be heard, diagnosed and successfully treated than whites. “We need more Black and Brown healthcare providers. We must eliminate unconscious bias and serve patients in a cultural context. We’re making progress, but not enough.
“The healthcare providers I see working in our underserved communities are doing heroic work,” Puffer said. “They know their patients and they know their communities. But there are not enough of them and they do not have the resources they need,” Puffer said. “We must expand, not cut, healthcare in our communities.
“We must seize this moment and redirect our priorities to invest in the healthcare of our students and communities,” she added. “We can’t end racism overnight, but we can start dismantling healthcare disparities piece by piece, patient by patient. We must ensure the current revolution leads us to a long-term evolution of our healthcare system.”