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Break the Sound of Silence

January 7, 2022

This month’s Feature article by Dr. Tiffani Johnson (10.1542/peds.2021-052115) is a powerful testimony to the insidious and pervasive nature of racism in our society. Dr. Johnson speaks eloquently and passionately about how silence, denial, and ignorance exacerbate the racist nature of our world. We (especially the privileged) allow racism to continue if we do not speak up, look for, and recognize it. While overt racism is easy to see and address, it is the more subtle racism that goes unchecked.

For example, child abuse is more prevalent among Black and indigenous people of color (BIPOC).1 By prevalent, I mean that BIPOC children are more likely to be reported to state child protection agencies. Does that mean that these children are more likely to be abused? Are we “seeing” abuse more in these children, or are they in societal-based situations (like environmental violence or poverty) which increases their risk for abuse? And what can we do about that?

The hardest and most confusing thing for me is determining how to respond. It seems that there is no one right way, which if you think about it, makes sense. Everyone has experienced racism and discrimination in a different way and for them, the response may need to be different, but this should not stop us from trying, and trying, and trying again.

What Can We Do?

  • Please educate yourself. Do not run from the media or gloss over the op-eds or books on racism. Lean in. Ask questions. There are powerful lessons to be learned. Please stand up and speak out. You will make mistakes, (believe me, I have) but a mistake from which you can learn is much better than keeping quiet and perpetuating the lie.
  • Advocate for your patients and families. The structural roots of racism need to be cut off. Poverty, insufficient housing, health disparities, violence, etc. are all more pervasive for BIPOC children and families. We, as physicians, can advocate with legislatures, city planners, and health departments to stop these structural issues.1 For example, there are significant decreases in abuse and neglect in states that expand Medicaid, a policy that uniquely affects low-income families.2
  • Ask questions and keep asking. Is this person/patient/family suffering from discrimination? How does the world look from their perspective? Am I making a diagnosis or rushing to judgment based on bias and racism?

I have started (fitfully) my journey. I have faltered and I recognize it is easier to ignore the truth than to face it head on. But that is not the right thing to do. Dr. Johnson’s statement is another stark reminder to keep pushing.

I want to thank Dr. Johnson for having the courage to speak out and share her story.


  1. Luken A, Nair R, Fix RL. On Racial Disparities in Child Abuse Reports: Exploratory Mapping the 2018 NCANDS. Child Maltreat. Aug 2021;26(3):267-281. doi:10.1177/10775595211001926
  2. McGinty EE, Nair R, Assini-Meytin LC, Stuart EA, Letourneau EJ. Impact of Medicaid Expansion on Reported Incidents of Child Neglect and Physical Abuse. Am J Prev Med. Jan 2022;62(1):e11-e20. doi:10.1016/j.amepre.2021.06.010
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