Moving towards anti-racist praxis in medicine

Crear-Perry, Joia; Maybank, Aletha; Keeys, Mia; Mitchell, Nia S.; Godbolt, Dawn

doi:10.1016/s0140-6736(20)31543-9

Cited by 59 publications

(69 citation statements)

References 10 publications

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“…This observation parallels historical trends: In the 1960s and 1970s, shifting criteria that linked schizophrenia with hostility or aggression, characteristics that overlap with stereotypes of Black peopleparticularly Black men-as inherently violent, contributed to racial differences in diagnosis [26]. Finally, understanding the effects of structural racism-or the totality of ways in which societies foster racial discrimination through mutually reinforcing systems [27]-can direct attention toward institutional policy reforms to enhance equity [28][29][30]. These include reforms of preventative services, involuntary treatment, and security presence in psychiatric units.…”

Section: Discussionmentioning

confidence: 61%

Racial and Ethnic Differences in Psychiatry Resident Prescribing: a Quality Improvement Education Intervention to Address Health Equity

et al. 2021

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Objective Quality improvement (QI) tools can identify and address health disparities. This paper describes the use of resident prescriber profiles in a novel QI curriculum to identify racial and ethnic differences in antidepressant and antipsychotic prescribing. Methods The authors extracted medication orders written by 111 psychiatry residents over an 18-month period from an electronic medical record and reformatted these into 6133 unique patient encounters. Binomial logistic models adjusted for covariates assessed racial and ethnic differences in antipsychotic or antidepressant prescribing in both emergency and inpatient psychiatric encounters. A multinomial model adjusted for covariates then assessed racial and ethnic differences in primary diagnosis. Models also examined interactions between gender and race/ethnicity. Results Black (adjusted OR 0.66; 95% CI, 0.50-0.87; p < 0.01) and Latinx (adjusted OR, 0.65; 95% CI, 0.49-0.86; p < 0.01) patients had lower odds of receiving antidepressants relative to White patients despite diagnosis. Black and Latinx patients were no more likely to receive antipsychotics than White patients when adjusted for diagnosis. Black (adjusted OR 3.85; 95% CI, 2.9-5.2) and Latinx (adjusted OR 1.60; 95% CI, 1.1-2.3) patients were more likely to receive a psychosis than a depression diagnosis when compared to White patients. Gender interactions with race/ethnicity did not significantly change results. Conclusions Our findings suggest that racial/ethnic differences in antidepressant prescription likely result from alternatively higher diagnosis of psychotic disorders and prescription of antipsychotics in Black and Latinx patients. Prescriber profiles can serve as a powerful tool to promote resident QI learning around the effects of structural racism on clinical care.

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Section: Discussionmentioning

confidence: 61%

Racial and Ethnic Differences in Psychiatry Resident Prescribing: a Quality Improvement Education Intervention to Address Health Equity

et al. 2021

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“…Continued collaboration between the public health and the housing and community development sectors creates the potential for leveraging housing interventions to support maternal and infant health and reduce disparities in maternal health outcomes. To be an effective anti-racist intervention, housing and maternal health interventions must be developed through a racial-equity lens and be centered around supporting the agency and voice of BIPOC mothers [ 82 ].…”

Section: Discussionmentioning

confidence: 99%

More Than Shelter: Housing for Urban Maternal and Infant Health

Reece

2021

IJERPH

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Housing quality, stability, and affordability have a direct relationship to socioemotional and physical health. Both city planning and public health have long recognized the role of housing in health, but the complexity of this relationship in regard to infant and maternal health is less understood. Focusing on literature specifically relevant to U.S. metropolitan areas, I conduct a multidisciplinary literature review to understand the influence of housing factors and interventions that impact infant and maternal health. The paper seeks to achieve three primary goals. First, to identify the primary “pathways” by which housing influences infant and maternal health. Second, the review focuses on the role and influence of historical housing discrimination on maternal health outcomes. Third, the review identifies emergent practice-based housing interventions in planning and public health practice to support infant and maternal health. The literature suggests that the impact of housing on infant health is complex, multifaceted, and intergenerational. Historical housing discrimination also directly impacts contemporary infant and maternal health outcomes. Policy interventions to support infant health through housing are just emerging but demonstrate promising outcomes. Structural barriers to housing affordability in the United States will require new resources to foster greater collaboration between the housing and the health sectors.

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“…18,19 The impact of COVID-19 on systemic racism has shown what many activists and experts have been saying for years: racism is a public health crisis. 2,20 However, unlike COVID-19, systemic racism has been perpetuating inequities in healthcare for generations. Therefore, all healthcare workers, including physician-scientists, need to be actively learning and implementing anti-racist and traumainformed practices in the pursuit of health equity for all of our patients.…”

Section: Educational Goalsmentioning

confidence: 99%