How Does Racism Affect Health? California Doctors Speak Out

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It’s not uncommon for Dr. Ilan Shapiro to confront ailments in his child and teen patients that defy a straightforward medical explanation.

At his practice at AltaMed Health Services in Los Angeles, the pediatrician has treated children with insomnia, teens whose hair is falling out and kids who have stopped trying in school, despite being academically capable. Often, these children are struggling with depression, anxiety and stress. But there’s also a deeper, less tangible cause, Shapiro said.

Racism, whether overt bullying at school, or the less obvious day-to-day toll of social exclusion and economic disadvantage, underpins many of these children’s health issues, Shapiro has found. Experiencing racism can undermine a child’s physical and mental wellbeing from an early age, and increase the risk of lifelong health problems, research shows.

“It’s a cumulative effect,” Shapiro said. “Some kids are fine and resilient, but others respond physically to what’s happening … Over the long term you start seeing the kids that have issues with the way they’re managing anger, depression. All those little things start adding up.”

Medical providers in California and nationwide are increasingly recognizing that racism and discrimination affect children’s health, and they’re seeking to tackle the problem. Last month, the American Academy of Pediatrics issued its first policy statement on how racism affects the health and development of children and teens. The academy called racism a “socially transmitted disease” with historical origins that continue to affect the circumstances children grow up in, how they’re treated and the opportunities they have today.

African American, Latino and Native American children, for example, are more likely than white children to live in low-income households, lack access to quality education and be involved in the juvenile justice system. On top of this, racism and unconscious bias can lead people such as health care providers, teachers or law officers to treat minority children differently than white children. In turn, children may internalize biased attitudes, leading to negative, self-limiting beliefs about themselves and others, the academy said.

Dr. Tiffani Johnson, a pediatric emergency physician at UC Davis Health and member of an American Academy of Pediatrics committee on health equity, said the organization has been aware of race-related inequalities affecting children’s health for years, but is now moving more aggressively to address the problem.

“Racism is an issue that is difficult to take on, it’s an issue that makes a lot of people feel uncomfortable,” she said. However, “If we want to achieve our mission of health for all children, we need to tackle racism head on. There’s just such a growing body of evidence showing that, yes, children and families experience racism, and these experiences have a negative impact on their health outcomes.”

Current anti-immigrant policies and political rhetoric have made the need to address the health impacts of racism on children particularly acute, said Mayra Alvarez, president of The Children’s Partnership, a California-based health advocacy group. She’s heard from schools, clinics and community organizations about increased incidences of race-related bullying. Alvarez said some immigrant families live in fear of taking their children to the park, local events or even the doctor.

“That takes a mental toll on children and their wellbeing,” she said.”We know that racism, the environment of fear, of a lack of safety, has translated into increased anxiety in our kids, increased levels of depression.”

Alvarez said California is making progress in addressing health inequities related to racism. She applauded a bill now before the governor that would require all doctors, surgeons and nurses to receive training on how to reduce bias in patient treatment. Gov. Gavin Newsom has appointed a surgeon general, Dr. Nadine Burke Harris, who is an expert on early childhood trauma, including the impact of racism. And the state plans to pay for routine trauma screenings for children and adults enrolled in Medi-Cal starting next year.

But more can be done, Alvarez and Johnson said. At the clinic level, doctors must make sure their practices are welcoming to people of different cultures and ethnicities, Johnson said. Educators and law enforcement officers, as well as health care providers, should receive anti-bias training, she added. More broadly, the state needs laws that tackle structural racism by supporting fair housing and reducing criminalization of youth, for example, Johnson said.

Alvarez agreed that tackling racism requires a multi-pronged approach. Given the political environment, providers especially must make sure they’re aware of how immigration policies are affecting people’s health, she said. And communities need to do more to connect vulnerable families with legal aid and health services that can help reduce their anxiety, she added.

For Shapiro, helping children and their parents cope with racism can start with naming the problem. Talking about racism helps children better understand the issue and how it affects them. Then they can come up with strategies to deal with it, he said.

“It makes everybody happier, because at least you’re acknowledging that there’s something there,” Shapiro said. “It’s important to understand that (racism) is not going to go away, and we need to be prepared to talk about it with our kids, with our families … We can help them improve their resiliency.”

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