Racism Revisited

Five years after the publication of this post on racism, the topic is as relevant as ever. In the wake of racial disparities in the COVID-19 pandemic, continuing incidents of police brutality costing the lives of unarmed Black people, and a seemingly ever-present racial discord on social media, we as a nation and as a community are having to come to terms with what race and racism mean to us. As a health care system, we must come to terms with what race and racism mean for health. That is not easy and it’s not comfortable, but that doesn’t make it any less real.

The Columbus City Council and the Franklin County Board of Commissioners have pushed this conversation into the forefront by declaring racism a “public health crisis.”  Franklin County’s declaration stated that “racism and segregation in Ohio and Franklin County have exacerbated a health divide,” offering concrete examples of lower life expectancy, higher levels of infant mortality and greater long-term complications from diabetes. The City of Columbus stated, as part of their declaration, that the city is “committed to honestly and directly addressing minority health inequities, including a systematic, data-driven focus on poverty, economic mobility, and other factors that impact the social determinants of health.” These statements signal a newfound willingness to call out the “elephant in the room”.

Public recognition of racism as a public health crisis by governmental agencies is certainly a step forward, but it leads me to two questions: What does it reflect? What does it require?

The relationship between health and race does not reflect an immutable biological construct. Instead, it reflects a society that allots health opportunity differently based on race as a social classification. In the real world, that looks like a child with asthma frequenting the emergency department because of moldy carpets in the “Black” part of town, an expectant mother skipping prenatal visits because the best job available to her doesn’t offer medical leave, or a college student experiencing the physical symptoms of extreme anxiety after being threatened by racist classmates. Public health is the product of the exposures experienced by a population. Racism is a toxic exposure.

If the recognition of racism as a public health crisis reflects the impact that “living while Black” has on health in African American populations, it also requires us to do something. The declarations and demonstrations that have swept the nation (and the world) in the spring of 2020 have been important first steps. Those activities have raised awareness, generated difficult conversations, challenged leaders, and engaged young and old alike. They have also brought to the surface simmering hostilities that can’t be addressed until they are faced.

But what’s next?

“What’s next” requires something different from each of us. Each of us must examine our personal biases and think about how they impact others. Each of us must look at the institutions in which we work or engage and actively push those organizations to, not just be non-racist, but to be anti-racist. Each of us must find ways to donate our time, talent and treasure to improving the lives of children, particularly children of color.

My personal commitment to addressing racism as a public health crisis is grounded in my lived experiences: as a Medicaid-enrolled youth struggling with chronic illness in a culturally insensitive health care system,  as a family member of young black men whose safety is constantly at risk from the people charged with keeping them safe, and as an African American health researcher, obligated to pointing out why race matters when I’m often  “the only one in the room.”

My commitment is also grounded in my recognition of structural racism – in our education system, in our criminal justice system and in economic systems. Structural racism goes beyond interpersonal experiences to affect health at the population level.

As I watch the demonstrations in the streets and the pain in the news, I feel like the spring of 2020 is a turning point for our nation. What direction we turn is still unknown, but I can choose my direction.  I choose to believe that I can be a part of change for the better. I choose to believe that I can encourage the organizations that I am a part of, including Nationwide Children’s Hospital, to be part of a change for the better not in the moment, but in a sustained fashion. I choose to believe that I can encourage those around me to do the same through active dialogue. I choose to believe that belief matters, but it is not enough. I must act.

As director, I am excited to work with other faculty in the Center for Innovation in Pediatric Practice and with leadership in the Abigail Wexner Research Institute to more formally include research on health equity and minority health in our institution’s research priorities.  This means conducting research on how racism and other social factors drive health disparities in children, measuring and monitoring disparities in care within our institution, implementing and testing interventions designed to close the gaps, ensuring that all research in our institution reflects the diversity of the populations that we serve, and providing a training ground for the next generation of diverse health researchers who will continue this important work.

Research is my voice for change. Hopefully, recent events help you to find yours.