IN BRIEF

Racism in Our Hospitals and Communities: Everyone Matters

July 21, 2015

Let’s touch all families by erasing racism from children’s hospitals.

Here at Nationwide Children’s Hospital, we are engaged in an important new initiative: Everyone Matters.

The idea is simple — we each have effects that ripple far beyond us through our everyday actions and attitudes toward each other, our patients and our community. Those effects can be positive or negative. Unfortunately, racism is still an important experience that has long-lasting effects at many children’s hospitals.

James (Jimmie) W. Collins, MD, MPH, a friend and perinatal epidemiology expert from Northwestern University Feinberg School of Medicine, recently spoke at Nationwide Children’s Hospital’s Research Grand Rounds. His studies demonstrate a convincing connection between the racism black women experience and their birth outcomes. Specifically, African-American women who perceive exposure to racism during pregnancy have increased preterm delivery, infants born small for gestational age and higher infant mortality1-4. And last summer, researchers in Germany’s Central Institute for Mental Health published some of the first neuroimaging work providing evidence of structural and functional stress-related changes in the brain among African-American patients experiencing discrimination5. All of this work is consistent with similar studies on racism’s effects on asthma, mental health and cardiovascular disease6-8 among children and adults.

To change this, Jimmie challenged the audience to end racism through an honest, open and personal dialogue. It was his challenge to be personal that caught me off guard. In our city and our hospital, we don’t talk about racism publicly. But if we, as physicians responsible for the health of our patients and community, are not able to talk about it, who can?

I’ve decided to accept Jimmie’s challenge.

I’ll start with personal dialogue. I am father to two adopted African-American children, a boy and a girl. Their story is typical. When my son was in kindergarten, older boys told him repeatedly that his skin was the same color as “poop.” When he was 8, he was refused service at a restaurant because of his skin color. I don’t know how many other comments and events there have been. As for my daughter, I know that in spite of the best education and any resources I have, she is at roughly twice the risk of having a premature infant if she does get pregnant — due at least in part to any perceived racism she may experience.

Research suggests that a lifetime of racist comments and adverse experiences such as these take a toll. If we are committed to fighting infant mortality, or for that matter hypertension, asthma and other conditions with gross racial disparities in outcomes, what can we do? We can start by accepting Jimmie’s challenge — we can facilitate honest and open dialogue in our professional world to prove to society and the patients we treat that we know everyone does matter.

Our hospital is an open and inviting place for most people, but with 10,000 employees and thousands more patients and families, our institution is a microcosm of society. Not everyone has the best experience because of subtle and, if we are honest, occasionally overt, racism. And our hospital is no exception.

There are many simple examples of racism that are easy to envision, even in professional circumstances at hospitals in many communities:

  • An African-American female faculty member is assumed to be a secretary when attending meetings with a white faculty member.
  • African-American faculty are asked to be involved in every committee and recruiting event, a situation known as tokenism.
  • Supervisors may fear that disciplining an African-American employee could lead to charges of racism.

I am sure the list goes on for employees but also, sadly, for patient families. It is clear from the research literature that pediatric physicians have clear biases in how they treat children of a different race. However, we do not have a measure of most individual hospitals’ performance in this regard.

If even one child experiences racism from a health care provider or from members of their community, it is one too many. When children do experience racism — and when we do nothing to stop it — we are complicit in the perpetuation of bigotry and health disparities, such as the poor birth outcomes discussed in Jimmie’s research.

We each have a choice to make about whether or not to fight racism in our hospitals and in our communities. We can start by saying what might be unpopular things — correcting people when they make assumptions or telling people that their jokes are not appropriate. It’s uncomfortable, but necessary. Without your action, too many children and adults will continue to think that different is bad and that little “mistakes” or remarks are harmless. That will leave too many children with a life filled with or marred by prejudice.

I personally look forward to working with you on making our hospitals and communities welcoming and comfortable for all families and children. I am passing on the challenge for you to do the same — starting with an open, public dialogue.

 

Join the conversation. What instances of racism have you experienced or observed in your institution? What can health care professionals do to combat racism in children’s hospitals?

 

References: 

  1. Castrillio SM, Rankin KM, David RJ, Collins JW Jr. Small-for-Gestational Age and Preterm Birth Across Generations: A Population-Based Study of Illinois Births. Maternal and Child Health Journal. 2014 Apr 27 [Epub ahead of print].
  2. Collins JW Jr, David RJ, Simon DM, Prachand NG. Preterm birth among African American and white women with a lifelong residence in high-income Chicago neighborhoods: an exploratory study. Ethnicity & Disease. 2007, 17(1):113-7.
  3. Burris HH, Collins JW Jr, Wright RO. Racial/ethnic disparities in preterm birth: clues from environmental exposures. Current Opinion in Pediatrics. 2011 Apr, 23(2):227-32.
  4. Rankin KM, David RJ, Collins JW Jr. African American women’s exposure to interpersonal racial discrimination in public settings and preterm birth: the effect of coping behaviors. Ethnicity & Disease. 2011, 21(3):370-6.
  5. Akdeniz C, Tost H, Striet F, Haddad L, Wüst S, Schäfer A, Schneider M, Reitschel M, Kirsch P, Meyer-Lindberg A. Neuroimaging Evidence for a Role of Neural Social Stress Processing in Ethnic Minority-Associated Environmental Risk. JAMA Psychiatry. 2014, 71(6):672-680.
  6. Pieterse AL, Todd NR, Neville HA, Carter RT. Perceived racism and mental health among Black American adults: a meta-analytic review. Journal of Counseling Psychology. 2012 Jan, 59(1):1-9.
  7. Brown P, Mayer B, Zavestoski S, Luebke T, Mandelbaum J, McCormick S.The health politics of asthma: environmental justice and collaborative illness experience in the United States. Social Science & Medicine. 2003 Aug, 57(3):453-64.
  8. Markus H, Kapozsta Z, Ditrich R, Wolfe C, Ali N, Powell J, Mendell M, Cullinane M. Increased common carotid intima-media thickness in UK African Caribbeans and its relation to chronic inflammation and vascular candidate gene polymorphisms. Stroke. 2001 Nov, 32(11):2465-71.