Reforming the health care system to address structural racism

Smith, Tammy; Ogedegbe, Chinwe; Arredondo, Aaron; Romney, Marie-Laure; Hoffman, Jerome R.; Goldfrank, Lewis R.; Doobay, Kamini

doi:10.1111/acem.14303

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…A wider range of community and advocacy leaders should also be considered. 64 Second, a future task force should include a broader racial perspective. 65 , 66 The recent release of the Ketamine Investigatory Review Panel Report by the Colorado Department of Public Health & Environment can serve as an example of professional, racial, and ethnic diversity.…”

Section: Introductionmentioning

confidence: 99%

Revisiting “Excited Delirium”: Does the Diagnosis Reflect and Promote Racial Bias?

Walsh

Agboola

Coupet

et al. 2023

WestJEM

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Introduction: “Excited delirium” (ExD) is purported to represent a certain type of agitated state that can lead to unexpected death. The 2009 “White Paper Report on Excited Delirium Syndrome,” authored by the American College of Emergency Medicine (ACEP) Excited Delirium Task Force, continues to play a pivotal role in defining ExD. Since that report was produced, there has been an increasing appreciation that the label has been applied more often to Black people. Methods: Our aim was to analyze the language of the 2009 report, the role of potential stereotypes, and the mechanisms that may potentially encourage bias. Results: Our evaluation of the diagnostic criteria for ExD proposed in the 2009 report shows that it relies on persistent racial stereotypes: eg, unusual strength, decreased sensitivity to pain, and bizarre behavior. Research indicates that use of such stereotypes could encourage biased diagnosis and treatment. Conclusion: We suggest that the emergency medicine community avoid use of the concept ExD and that ACEP withdraw implicit or explicit support of the report.

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Section: Introductionmentioning

confidence: 99%

Revisiting “Excited Delirium”: Does the Diagnosis Reflect and Promote Racial Bias?

Walsh

Agboola

Coupet

et al. 2023

WestJEM

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Attitudes and Actions Related to Racism: the Anti-RaCism (ARC) Survey Study

et al. 2022

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BACKGROUND: Racism negatively impacts health and well-being. Members of the medical community must intervene to address racism. OBJECTIVE: To assess whether attitudes about the impact of racism on health or society are associated with intervening around racism. DESIGN: Cross-sectional survey of a large department of medicine in an urban academic setting. PARTICIPANTS: Interns, residents, fellows, and faculty. MAIN MEASURES: The primary outcome was the likelihood of intervening around an observed racist encounter or a racist policy. Predictor variables included age, gender identity, race/ethnicity, and attitudes about racism. KEY RESULTS: Although the majority of the 948 respondents endorsed the impact of racism on health and other societal effects, levels of endorsement were lower among older individuals, or those reporting male gender identity or selecting other race. Higher endorsement of the impact of racism on health was associated with increased odds of speaking up about a racist encounter or racist policy, with odds ratios from 1.18 to 1.30 across scenarios. Likelihood of speaking up about racism did not differ by racial or ethnic group, but older individuals were generally more likely to speak up and individuals between 20 and 29 years of age were more likely to speak with someone other than leadership or the source of a racist encounter. CONCLUSIONS: Awareness of the effects of racism on health is associated with increased likelihood of intervening when a racist encounter is observed or a racist policy is noted. Including information on the impact of racism on health and creating safe spaces to discuss racism may increase the likelihood of bystander intervention in antiracism strategies.

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Racism and Quality of Neonatal Intensive Care: Voices of Black Mothers

Witt¹,

Malcolm

Colvin³

et al. 2022

Pediatrics

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BACKGROUND AND OBJECTIVES: Black preterm infants are more likely to die than White preterm infants within the same NICU. Racism may lead to disparate quality of NICU care contributing to disparities in preterm infant health outcomes. The objective of our study was to understand Black mothers’ perspectives of the impact of racism on the quality of care for Black preterm infants in the NICU and what might be done to address it. METHODS: Using qualitative research methods, we conducted in-depth, semistructured interviews with 20 Black mothers of preterm infants in a single Level IV NICU 6 to 18 months after hospital discharge regarding experiences with disparate quality of NICU care. We developed themes iteratively and conducted interviews until thematic saturation was reached. RESULTS: The majority of mothers believed that racism impacted the quality of NICU care and described examples of racism in the NICU at structural, institutional, and interpersonal levels. Mothers also provided ideas for interventions that would decrease racism and improve quality of NICU care for Black families, including increased Black representation, increased peer support, and improved staff education and training. CONCLUSIONS: Black mothers of preterm infants experienced racism during NICU hospitalization that impacted the quality of care they received. Interventional studies directed toward mitigating these racial disparities may focus on addressing racism during the NICU period and should include input from Black stakeholders at all stages of design, implementation, and analysis.

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Reforming the health care system to address structural racism

Cited by 3 publications

References 10 publications

Revisiting “Excited Delirium”: Does the Diagnosis Reflect and Promote Racial Bias?

Revisiting “Excited Delirium”: Does the Diagnosis Reflect and Promote Racial Bias?

Attitudes and Actions Related to Racism: the Anti-RaCism (ARC) Survey Study

Racism and Quality of Neonatal Intensive Care: Voices of Black Mothers

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