The Doris Duke Charitable Foundation has awarded the AAP a two-year, $2 million grant to launch a project to support the elimination of race-based medicine.
Several other medical organizations also received grants for this purpose.
The AAP project, “Establishing a Race-Conscious Approach to Clinical Guidance in Pediatric Care,” will create a process for identifying and correcting race-normed clinical algorithms and test a revised algorithm in an emergency department setting. Funding from the foundation, whose mission is to improve the quality of people’s lives through grants supporting the performing arts, environmental conservation, medical research and child well-being, extends from March 1, 2023, to Feb. 28, 2025.
Results of the project will be used to guide the development of clinical recommendations from the AAP and other medical organizations seeking to eliminate race-based medicine and improve health outcomes for children. The effort will address individual-level factors at the patient-physician level as well as system and policy-level factors.
Leading the project is Joseph L. Wright, M.D., M.P.H., FAAP, who will become AAP chief health equity officer and senior vice president of equity initiatives on Sept. 11.
A former member of the AAP Board of Directors (2020-’22), Dr. Wright is immediate past chair of the Committee on Equity. He is an emergency medicine specialist, currently serving as senior vice president and chief health equity officer for the University of Maryland Medical System, where he is a professor of pediatrics and of health policy and management.
Recognition of AAP efforts
The AAP has been taking steps to correct the inappropriate use of race in clinical decision-making, medical education and research such as in Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation (2022). Dr. Wright was lead author of the policy statements Eliminating Race-Based Medicine (2022) and Truth, Reconciliation, and Transformation: Continuing on the Path to Equity (2020).
“The fact that the Doris Duke Foundation and others have been following our work and are interested in supporting this effort going forward is very exciting,” Dr. Wright said. “I think it’s also a testament to the work that has been ongoing for several years now.”
These efforts have been collaborative, he said. “We recognize that eliminating race-based medicine and focusing on health equity and anti-racism can’t be done in isolation.”
Multipronged approach
The AAP grant will be used to:
- conduct a rapid revision of two race-corrected or race-normed clinical algorithms in AAP policies and guidelines and develop accompanying guidance, and
- partner with Children’s National Hospital in Washington, D.C., to test the feasibility and effectiveness of implementing an alternative algorithm in a high-volume acute care clinical setting.
Background, rationale
Focusing attention on child health is critical to eliminating racial and ethnic health and health care disparities that can last a lifetime, the AAP noted in its grant proposal.
Inappropriate diagnoses or inadequate medical treatment in childhood compound over years and contribute to adult diseases and conditions like diabetes, depression and other chronic illnesses. Race or ethnicity has been used inappropriately as a surrogate for social variables. Individuals or systems have conflated socially defined race with genetic ancestry, overgeneralized or made claims based on limited data and promoted racial stereotypes.
The vocabulary used to describe these efforts also matters, Dr. Wright emphasized. Terms are easily confused.
“Two of the most conflated terms that I find in doing this work are inequity and disparity. What we have identified are disparities — the outcomes. … What we are going to do is unwind the inequities that lead to those disparities. We’ve defined disparities; what we haven’t done, as authentically and rigorously, is to determine the inequities — structural or otherwise — that have led to disparities.”
The project will follow the science, he said.
“From a big-picture perspective, we have to apply equitable care for all children … and this is more than a moral imperative. This is acting on the evidentiary information we have available and will discover.”
He is encouraged about the potential. “What’s so exciting about this funding is that it will allow us to dig deeper and really fix these inequities,” Dr. Wright said.
As part of this project, the National Academies of Sciences, Engineering, and Medicine will convene a multidisciplinary committee to assess the use of the social constructs of race and ethnicity in biomedical research and provide recommendations to guide the scientific community.
The Doris Duke Foundation is pledging $10 million in grants for its Racial Equity in Clinical Equations initiative, calling it “the largest investment to date to provide data that can effect progress on this issue.”
The other grantees are the American Heart Association, American Society of Hematology, Coalition to End Racism in Clinical Algorithms (initiative of the New York City Department of Health and Mental Hygiene’s Office of the Chief Medical Officer) and the National Academy of Sciences.
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