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