Beyond Calling Racism a Public Health Threat in Medicine

we all carry an

invisible backpack now that backpack may

be

big or small maybe for the young

or for the old we can carry it on long

journeys

or just for the walk back home

but what’s important is what’s inside

our book bags

as many people don’t realize that the

items that are inside our book bags are

the same

across the board in that let’s just say

for the sake of this talk that the items

that are in our backpacks

are ones that impact our health so

what are these items and how do they

impact our health

well their education

our neighborhoods our income levels

our health care and basically

social impact now

i said that all of us have the same book

backs

right in that the items in our putback

impact our health and if we all have the

same

backpacks and they impact our health

then that should mean that our

health outcomes should be all the same

right well we know that’s not true

and in fact if we look at the early days

of the pandemic

we realized that black and hispanic

communities

were two times more likely to be

affected by the virus

than white communities when we’re

looking at new york city we also

realized that black mothers

were three to four times more likely to

experience

pregnancy related death outcomes and we

also realized that if we look at our

american

indians and alaska native families

that their life expectancy is five times

less than anybody else in the nation

so just looking at those facts alone we

know that

our health outcomes are not the same so

even though we have the same backpacks

and the same items in our backpacks our

health levels

they’re just not the same so

there must be another factor at play

so just because the items that we have

in our backpack which we’ll call our

social determinant of health

and our health outcomes that we’re

seeing help disparities

there must be something that’s taking

place that we’re not addressing here

so what if i tell you why don’t we

change the color of

our backpacks how does the color

of one’s backpack look when

we’re looking at social determinants of

health

well we notice that there’s a difference

we notice that

educational attainment is different we

notice that our neighborhoods no longer

look the same

we notice that there’s a disparity in

the income that we have

and we notice that our community and

social impact

vary and we also know lastly

lastly that the access to healthcare is

very different

so suddenly we’re seeing that the color

of one’s skin

varies differently and okay let’s take a

step back

someone might ask me okay faith well are

you saying that

race impacts the quality of your health

and the quality of your social terms of

health

well yes and no you know race

does have a factor in the quality of

your health but it’s not race alone

it’s how someone perceives your rights

it’s how someone adds

value or worth to your race that makes

them

want to either treat you well or

mistreat you well

something that we call racism

okay so you’re telling me that the act

of racism

is impacting my health and

yes it is and in fact in 2019

the american academy of pediatrics

actually came out with a statement

saying that

racism is a core determinant

of your health that we’re seeing that

among children

that racism is driving the health

disparities that we’re seeing

well if we know it’s affecting the

kiddos then it has to be affecting the

adults too

that health disparities are connected to

racism

in fact this is something that we know

is not new in medicine

we knew that health disparities have

always been there

and that they’re affecting different

populations

but one thing that we did know that was

different that dr

falci mentioned in white house press

conference

at the beginning of pandemic that

although health disparities

has always been the status quo medicine

that does not make them acceptable

this doesn’t make them okay and why are

we okay

with them being the status quo and i

agree with dr fauci

you know there have been decades

upon decades of research written

by people of color who are scholars

showing the clear connection between

racism and health disparities

so knowing that racism is a core

discernment of health

and knowing that it impacts and it

causes us to have the health disparities

that we’re seeing

we can’t just sit there i mean the

research has been there for decades

right

it’s nothing new so that means we must

acknowledge it

we must make statements out there to

make sure that people understand

that racism is a public health

issue and someone like me you know i’m

that type of person that’s not just

going to sit there

i’m one that’s going to be out there and

being the one that

wants to make the statement so my

friends

and i group of medical students across

the country

did just that and it worked

we were able to get an organization

that had barred black physicians

previously

and apologized for in 2008 from being

members of their organization

we got this organization that previously

only had

two policies out of thousands that

mention the word racism to now adopt

this policy

and at that point you know we’re feeling

like yes we took down racism and

medicine

we cured it we changed it but then we

suddenly realized

that nothing had changed the status quo

and medicine was still

the same we realized that you know

even though such a big organization that

impacts health care

made the statement the daily lives of

the people that are impacted by this

impacted by this did not change we

realized that

madison needed something more because

even though the ama had made the

statement

about 145 counties across

america had already made a statement

saying that racism was a public health

issue

and that’s when i realized that

statements alone

will not help us build and maintain

same build stability

in order to create in order to foster a

community

that will combat racism instead we have

to find

ways in which we can

build a mindset of sustainability

in order to do that we have to look at

how we are viewing the healthcare system

so last year my grandfather came down

with covet pneumonia

and though my grandfather was really

knowledgeable about the health care

system

he worked as a social worker a hospital

administrator and as a chaplain

he still became successful to the

disease

and still was not able to obtain the

quality health care

he needed to the system he was invisible

and as someone who was in health care

you know i

advocated for my grandfather i was there

i talked with his medical

team i made it clear the minute he was

admitted

to the hospital that he needed icu level

care

however i was denied three times

by his medical team they felt that my 84

year old grandfather

would be able to do well on a regular

hospital floor

even though his oxygen levels were

fairly above 90

on 40 liters of oxygen per minute

they felt that he would do fine it

wasn’t until one night

when his oxygen levels went down to 70

that they realized he probably does need

icu care

but at that point it was too late and

within five days he passed away from

copen

now this story is similar and more so

than seen in black and round communities

that though we do have the medical

knowledge we do have the access to

health care

and we do have family advocates or we

self-advocate

that we were still dying from coping

and no one seemed to care

so at this point we’re wondering

what do we do how do we build a mindset

of sustainability and we have to look at

health care again

as a medical resident i

am still an optimist and believe that we

can change

how we’re seeing medicine i believe that

we can build a mindset of sustainability

and there are some ways i think we can

do this as

as i travel from coast to coast looking

at programs

and trying to figure out as a new doctor

where i should go

i realized there’s certain language that

people use to describe their patient

population

i realize certain programs who use words

like

non-compliant difficult low income

not really engaged with the health care

system

with programs that didn’t really have

good health outcomes

in a in community with their patient

population

but when i went to programs that looked

at their patient population

their black and brown patient population

and described them with words of

diverse um goal oriented

resilient you know very engaged with the

system

their healthcare outcomes were a lot

better

and that’s when i realized the language

that we use to talk about our patients

matter and someone can say to me okay

fake

you know language yeah i mean that’s

easy anybody can

act like they care they can use those

words that doesn’t mean that they mean

it

but i said okay well i didn’t just stop

there

when i was at these institutions i also

asked

how do you value the people that work at

your institution already

that are part of the black indigenous or

people of color community

how did they feel working at your

institution did they feel when there was

acts of racial

racism or discrimination supported

did you only put out fancy statements or

create committees on diversity inclusion

retroactively after something happened

did you promote them to positions that

were high within your

institutions but not provide the

resources they need

in order to be able to handle their job

and if you ask them to be on those

diversity inclusion panels

did you make sure that they were

absolutely compensated

what i was asking for is basically how

did you value the black and brown people

that you work with

in an everyday life because it’s okay to

put out fancy statements and say that

racism is an issue

discrimination is bad and stuff but if

you are not

caring and being compassionate for the

black and brown people you see

every day in real life that statement

means nothing

now someone will say okay faith you know

you know your language makes sense i’ll

change my language you know treat the

black and brown people i see

in everyday life well i mean that’s fine

but you lied to me in terms of will this

take time will this take money

like yes maybe in that aspect it will

but

going back in history i realize it

really doesn’t

because i’ve seen this actually happen

so way back in the day there was a black

physician who wanted to create a

hospital

within a community a lot of people were

just

not really poor but he realized that the

soul community

is one that would value the hospital so

he went to the black ministers by

physicians

the black businessmen and asked for

their support but it wasn’t until he

included the black club of the area

who looked for the supplies the money

here and there

that he realized the community will

build this hospital

and within five months this hospital

providence hospital was able to be open

for this community

and we realized that this hospital two

years later

that the black physician that wanted to

build it dr daniel hell williams

was able to perform the first successful

open heart surgery

in this hospital when you value

a community and when you put them at the

forefront

of your work the quality of your health

care changes

we realize that when you center

community and you talk about it

positively

using good language health changes

it’s not statements about racism that

will change how medicine is

it’s how we use the language about our

patient population

how you treat your bipod colleagues

and how we value the community that we

serve that will move

medicine that will allow us to combat

racism

thank you