Abstract and Introduction
Abstract
Pediatric patients of color experience personal, institutional, and systemic racism daily. Differences in appearance unfairly disadvantage families of color and deprive children of the right to equitable health care services. As pediatric health care professionals, we must seek ways to optimize clinical practice for all patients, ensuring that tomorrow’s children will receive equitable care from a thriving, racially sensitive pediatric workforce.
Introduction
After a year marked by a radical increase in awareness of social injustices and conversations about race, it should come as no surprise that pediatric patients of color experience personal, institutional, and systemic racism daily. Attracted to new stimuli in the environment, children as young as 3 years of age process information somewhat immaturely, actively constructing their own beliefs and assigning value to the color of their skin based on the social interpretation of how others look (Jones et al., 2008; Patterson & Bigler, 2006; Trent et al., 2019). When these same social interpretations of differences in appearance unfairly disadvantage families of color and deprive children of the right to equitable health care services, we must ask ourselves how we can optimize our clinical practice as pediatric professionals for all patients. How can tomorrow’s children receive equitable care from a thriving, racially sensitive pediatric workforce? Grounded in the 2019 American Academy of Pediatrics (AAP) policy recommendations for examining, acknowledging, embracing, and advocating for systemic change, these core principles are offered in an evidence-informed racial equity framework (Trent et al., 2019). It is well documented that by using self-reflective tools, whether as individuals or in groups, pediatric professionals of all disciplines and backgrounds can start to identify racial bias in clinical practice and mitigate discriminatory health care delivery and general health outcomes (Delano-Oriaran & Parks, 2015; Derman-Sparks & Edwards, 2019; Garcia Coll & Ferrer, 2021; Marchand et al., 2019; Tatum, 2010).
Today’s population of children in the United States is increasingly racially diverse. According to 2019 United States Census Bureau data, White children are being born at significantly lower rates than children of other races, and it is projected that by the year 2024, White children will no longer represent the majority (Bailey et al., 2017; Frey, 2018; Garcia Coll & Ferrer, 2021). See Figure 1 for the percentage distribution of children under age 18 years by race for 2000, 2021, and projected 2020.
Figure 1.
Percentage Distribution of Children Under Age 18 Years by Race in 2000, 2010, and Projected 2020*
*Data in this chart reflect the racial composition of children under 18 years of age living in the United States. Race categories are based on the 1997 standards outlined by the Office of Management and Budget (OMB) and are consistent with the latest U.S. Department of Health and Human Services (HHS) (2017) guidelines on data collection standards released in October 2011.
Source: Adapted from the Federal Interagency Forum on Child and Family Statistics (2017). This framework was created in good faith and should be used for educational purposes only.
This demographic shift is also accompanied by an opposite trend, that of an increase in the number of U.S. healthcare workers that classify themselves as White. Evidence-informed studies remind us that these demographic trends are, in large part, due to underrepresentation of Hispanics and Blacks in the health care workforce, which varies across the U.S. (Frey, 2018; Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, 2003; National Research Council Panel on Race, Ethnicity, and Health in Later Life, 2004; Trent et al., 2019). These trends are not novel, however. The gap in racial representation between the U.S. pediatric workforce and the children and families they support has been persistent and has widened over time (see Figure 2) (U.S. Census Bureau, 2019; U.S. Department of Health and Human Services HHS, 2017; Xue & Brewer, 2014).
Figure 2.
U.S. Health Occupations by Race in 2018*
*According to the U.S. Department of Health and Human Services (HHS) (2017), health occupations in the United States are categorized into Community and Social Services (e.g. counselors and social workers), Life, Physical and Social Sciences (e.g. psychologists and child life specialists), and Health Diagnosing and Treating Practitioners (e.g. physicians, nurse practitioners, and registered nurses). Race categories are based on the 1997 standards outlined by the Office of Management and Budget (OMB) and are consistent with the latest HHS (2017) guidelines on data collection standards released in October 2011: White, Black, Hispanic, Asian, American Indian/Alaska Native, Native Hawaiian and Other Pacific Islander and Multiple/Other Race).
Sources: U.S. Census Bureau’s (www.census.gov); Bureau of Labor Statistics, Health Care Occupations (www.bls.gov/ooh/health); US Health Resources and Services Administration (hrsa.gov); American Academy of Pediatrics (aap.org); American Psychological Association (www.apa.org); and Association of Child Life Professionals (www.childlife.org). This framework was created in good faith and should be used for educational purposes only.
Given the evidence that children experience structural racism through social settings, how can we identify our implicit and explicit racial biases as factors affecting health care delivery and population health outcomes? It is well documented that self-reflection is one of the most meaningful approaches we can take to evaluate our clinical practice and combat racism (Andrews, 2003; Derman-Sparks & Edwards, 2019; Love & Hayes-Greene, 2018; Marchand et al., 2019). Reflecting on our professional roles can promote educational and research agendas that inform this mission (Jones et al., 2008). Recent pediatric research shows that to do this, we must “take responsibility for the racist culture in which children are raised and affirm that racism is an issue that impacts children at each stage of development and can be fought from the earliest moments in childhood” (Matthew et al., 2021, p. 2).