Editor’s Note: Dr. Earl Chism (he/him/his) is a first-year resident physician in pediatrics at the University of California, San Francisco. He is a member of the Pediatric Leaders Advancing Health Equity (PLUS) Program, and his interests include medical education and improving health outcomes by increasing representation in healthcare. – Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
As physicians, many of us have become accustomed to ever-changing guidelines and constantly updating literature. Part of staying up to date is adapting to new ways of thinking and incorporating new terms into our everyday vocabulary. One term has existed in several circles and has more recently been making rounds in the healthcare sphere: antiracism.
Antiracism as a practice can be implemented into clinical spaces in many ways, yet many of us in pediatrics seem to be asking, “How do I create effective, antiracist policies in my health system?”
Drs. Aditi Vasan, George Dalembert, and Arvin Garg, from the Children’s Hospital of Philadelphia and the UMass Memorial Children’s Center, tackle this very question in their article entitled, “An Antiracist Approach to Social Care Integration,” which is being early released as an Equity, Diversity, Inclusion, and Justice feature in Pediatrics this week (10.1542/peds.2023-062109). Opening with a description of antiracism based on the work of Dr. Ibram X. Kendi, their article expands upon the different domains of racism and describes actions that health systems can take to combat these different, overlapping forms of racism.
Structural racism is described as racism at the societal level and operates to systematically disadvantage and minoritize individuals. By taking action, such as investing in and supporting communities, partnering with local organizations, and ensuring equitable access to programming, health systems can work against this form of racism.
The authors describe institutional racism as racism that exists at the level of a system of authority. To combat this, systems should re-allocate power and allow for engagement of marginalized peoples as well as community members and community-based organizations.
The authors also mention interpersonal racism—based on a person’s implicit and explicit biases—and how trainings in structural competency and intentional documentation practices can limit its effect on our delivery of care.
Lastly, internalized racism, coming from one’s own acceptance of another’s interpretation of themself, also exists in our clinical spaces. We need to be intentional, thoughtful, and reflective about how we are asking our patients about their needs. In this way, we can provide space for people to share their needs without perceiving these needs as deficits.
I would encourage you to read this entire article, which provides several examples of how we as pediatricians can use our health systems to minimize the effect of the many faces of racism on our patients and their caregivers. We have the power, using an antiracist framework, to create effective policies to serve our communities. Many in our field have identified racism as a root cause of the disparities we see; many of us are identifying that addressing systems, engaging communities, and giving back to said communities are best practices in combatting these disparities. If racism is the root cause, then antiracist practices are the antidote. Drs. Vasan, Dalembert, and Garg, in their article, have both dissected the problem and provided a restorative framework for social care integration.
