We know that prevention is the best medicine. This is why we consider it our fundamental responsibility to address the systemic and individual racism that underlie so many of our nation's health inequities. Doing this requires more than a prescription pad. It requires us to fight back.
As a pediatrician in an urban area, I care for children from an enormous variety of socioeconomic, cultural and ethnic backgrounds. When I move from room to room on any given day, the health disparities in my patients are plain to see. Studies show that African American children suffer higher rates of illness and death
from chronic diseases than non-Hispanic white children. Once they become adults, they are 50% more likely to die prematurely
The root causes for these disparities lie in what the World Health Organization refers to as the social determinants of health
. These are the "conditions in which people are born, grow, live, work and age." They include things like the availability of clean water, nutritious food, safe neighborhoods and quality education. Policy experts believe these conditions have a greater impact on health outcomes than medical care itself. But we cannot address these social determinants of health without tackling the systemic racism
at their core.
The long history of housing, employment and lending
discrimination in this country, for example, makes it harder for families of racial and ethnic minorities to own homes or move from distressed areas. As a result, a number of my patients live in houses that are deteriorating, increasing their risk for lead poisoning
. Obesity and diabetes
are also more prevalent among African American than non-Hispanic white children, in part because under-resourced neighborhoods lack quality grocery stores and safe places to play. And gun violence is a constant threat -- something children in wealthier areas are more likely to learn about in video games, those growing up in poorer neighborhoods may learn about on their walk to school.
My patients who live in these circumstances attend vastly underfunded schools, and studies show this furthers their risk for adverse health outcomes
. Many go to schools with only part-time nurses. Many have to worry about mold and asbestos in classroom walls and cannot find healthy food at lunchtime. Bullying and physical violence are often the norm -- my patients have been cut, beaten and sexually abused in stairwells. Understandably, more families than I can count choose homeschooling rather than risk these threats to their children's health and safety -- a desperation move prompted by the failure of institutions their tax dollars pay for.
The widespread racial discrimination in our law enforcement and criminal justice systems also affects health outcomes in the children I care for. According to the Sentencing Project, African American adolescents are five times more likely
than their white peers to be detained or committed to correctional facilities. They are also more likely to be prosecuted and sentenced as adults,
and the trauma this inflicts cannot be overstated. Statistics from the Equal Justice Initiative
show there are currently 4,500 children housed in adult jails and prisons in this country. Compared to those in juvenile facilities, these children are nine times more likely to commit suicide.
None of this is to mention the health effects of day-to-day, personally directed, individual racism. The stress of experiencing racial discrimination on a regular basis can alter body fat distribution and lead to insulin resistance
in childhood. It can increase rates of anxiety, depression, ADHD
and adolescent substance abuse.
It is one of the adverse childhood experiences that can permanently alter a child's developing endocrine and neurologic systems, resulting in a range of adverse health consequences later in life.
Some argue that poverty itself creates environments that are detrimental to children's health. And it does. But when a child lives and breathes each day of his young life in a poverty that is combined with, and largely due to, hundreds of years of individual and systemic racism, the effects are magnified. The destruction to young life is immeasurable.
Eight minutes and 46 seconds is a very long time. Officials now say the officer had his knee on George Floyd's neck for one minute less
, an error that "made no difference" in the decision to charge him. And it does not lessen the horror.
There were too many of us to kneel outside our hospital. Instead, we walked in a steady stream of white coats and scrubs to a football stadium across the street. Once there, we stood 6 feet apart and listened to the words of Dr. Florencia Polite, chief of the division of general obstetrics and gynecology at Penn Medicine, over the loudspeaker. "Kneeling is our symbolic action," she said, "but understand, it is not THE action. When we kneel, I ask that we reflect on two to three actionable items that we will commit to doing to make this moment into a movement. What will you do when the media coverage dies down? What will you do next month, next fall, next year?"
Silence fell, the clock on the scoreboard began to count down, and I lowered my knee. For 8 minutes and 46 seconds I pictured George Floyd, face-down on the pavement. I pictured his neck. And I thought, what will we each do.
We cannot cure racism the way we cure other ills. What we can do is chip away at its effects on our patients' lives. We can start in our backyards, by creating inclusive work environments and addressing our own implicit bias in patient care. We can reach into homes with community asthma
and violence prevention programs.
We can partner with organizations that fight for equitable school funding,
justice for juvenile offenders
and reductions in gun violence.
We can tutor children in STEM careers. We can diversify our medical practices so children see themselves reflected in the nurses, doctors and others who care for them. We can rally, we can donate, we can support black-owned businesses. We can get out the vote.
I know we can't make the massive changes we need all at once or right away. But there were an awful lot of white coats rising up to our feet when the 8 minutes and 46 seconds were over. If every health care provider in this country took one step forward, that would be a lot of steps in the right direction.