Structural racism is everywhere. Because it is so embedded into every facet of our society and there are so many things to repair, it can be difficult to know how to start.
My eyes were thus drawn to an article by Drs. Puja Umaretiya, Robert Vinci, and Kira Bona from Harvard University and Boston University, entitled “A Structural Racism Framework to Guide Health Equity Interventions in Pediatric Oncology,” which Pediatrics is early releasing this week (10.1542/peds.2021-054634).
This article is for everyone, not just pediatric oncologists.
The authors use pediatric oncology as an example, both of how structural racism can lead to outcomes that are less than optimal and of how one can think about how clinical protocols and pathways can be changed by intentionally focusing on structural racism. But this framework can be used in all of our practices.
The authors describe three specific ways in which systemic racism results in poorer outcomes:
- Access to care: For instance, Black and Brown families are more likely to have public insurance, and they may not be able to get subspecialty appointments quickly. Their choice of hospital or specialist is limited by where they live, if they have a car, or if they can afford to take a day off from work.
- Interaction with the healthcare system: The quality of the health care encounter is different for families with lower educational levels, limited English proficiency, or low literacy. They may not fully understand what is being said, or they may feel embarrassed to acknowledge that they cannot read the prescription instructions. We often make assumptions that these families know what we are saying, and we are not careful in assuring that they do actually understand.
- Toxic stress: The authors cite the research that finds that adverse childhood experiences lead to physiologic changes that can adversely impact future health.
The authors also make recommendations for how we can decrease systemic racism in our healthcare system. These include recommendations for screening for social determinants of health, increasing clinical trials access for families with fewer resources, and focusing research on the physiologic impact of toxic stress.
I hope that you will read this article and brainstorm strategies that you may be able to use in your own practice. Examine the various workflows in your practice with a systemic racism lens. How can you start to decrease systemic racism in these workflows, potentially through quality improvement projects or similar efforts?
