Racism and social injustice as determinants of child health: the American Pediatric Society Issue of the Year

Abstract

We are now experiencing extraordinary challenges that are adversely impacting the health and well-being of our children and their families. These include multiple and very interrelated issues: coronavirus disease (COVID), Black Lives Matter, the struggling economy, immigration, environmental toxins, child abuse, gun violence, and others. Beyond responding to the complex acute stresses of clinical disease, the COVID pandemic has further unmasked chronic issues of racism, social injustice, disparities, and inequities that permeate our health care system. 1-7 For example, the disproportionate effects of COVID in Black, Latinx, and Native Americans is reflected by a greater susceptibility for disease, hospitalizations, and mortality with infection. 8,9 Such findings reflect many factors, including racial differences in jobs and exposures, nutrition, and other chronic health illnesses, such as diabetes, obesity, cardiovascular diseases, and chronic obstructive pulmonary disease. Well beyond the COVID pandemic, discrepancies in maternal, child, and adult health care, leading to death at earlier ages and worse morbidities, have been long recognized as reflecting major inequities in availability of health services, insurance coverage, social and economic factors, and other issues. 2,4,6 Thus addressing concerns underlying structural racism and sustained inequities in health care requires a greater awareness of the persistence of the US as an unequal society. 1-3

Racial and Ethnic Disparities in Outcomes Among Newborns with Congenital Diaphragmatic Hernia

“…Systemic racism, implicit bias, and societal constructs increase the likelihood that clinicians mislabel patients as unreliable or difficult, rather than addressing the source of their presumed inattention to care . These factors have been recognized on a national level, as racism and social injustice were named the Determinants of Child Health as the American Pediatric Society Issue of the Year in 2020 . It is clear that social determinants of health predispose Black patients to poor outcomes in CDH and discrimination might further propagate these negative results.…”

“… 19 These factors have been recognized on a national level, as racism and social injustice were named the Determinants of Child Health as the American Pediatric Society Issue of the Year in 2020. 58 It is clear that social determinants of health predispose Black patients to poor outcomes in CDH and discrimination might further propagate these negative results.…”

Impact of COVID-19 pandemic on access to online therapeutic education programs for children with sickle cell disease

“…Our findings show that patients and families may find interest in these tools, which could help in patients' daily lives. However, access to these interventions is likely unequal, with the risk of enhancing pre-existing social disparities [ Abman et al, 2020 ]. Increasing access to online training can help optimize healthcare equity and address disparities in access to care related to race and ethnicity and socioeconomic status.…”

Impact of COVID-19 pandemic on access to education programs for children with sickle cell disease and social deprivation: a qualitative study (Preprint)

“…Our findings show that patients and families may find interest in these tools which could facilitate patients' daily life. However, there is most likely unequal access to these interventions, with the risk of enhancing the pre-existing social disparities [24]. There is need for future research, in particular on the assessment of the safety and efficacy of these tools in SCD, and on the possibility to offer them equally to all patients and families.…”