Pediatric Grand Rounds - Racism (Not Race) as the Ultimate Social Determinant of Health

Doctor's Jessica Fowler and Anireddy Reddy who are both in Pediatric Critical Care in Philadelphia and they both seem to be in sync and harmony when it comes to their ideas and beliefs on care for children and the social determinants of health that create such perilous health outcomes for the minority groups and youths that pertain to them. Doctor Fowler began the presentation by giving a brief history of Racism in medicine; she defined racism as a system of structuring opportunities and assigning value based on the social interpretation of how one looks. The interpretation unfairly disadvantages some individuals and communities while unfairly advantaging other individuals and communities; the system of racism saps the strength of the whole society through the waste of human resources. Dr. Fowler then went on to define the different aspects of racism and used a chart to show that institutionalized racism is the house that we grew up in and we exist inside of the institution that was built upon the back of slavery; we didn't choose this house but we are a part of it nonetheless. Personally mediated racism is the impact on how we interact with one another because of the house of racism in which we grew up in. Internalized racism is the thought processes and biases that become part of us because of the house that we grew up in. I felt like the defining of these terms really helped solidify some of the differences in racism and can really help people who don't believe they are racist to recognize that although they may not be racist intentionally, they may have many tendencies and social behaviors that lead to racist behavior and unintentional microaggressions.

Dr. Fowler and Dr. Reddy then described the systemic racism in healthcare, talking about segregated hospitals, the use of minority bodies as tools for experiments such as with the Tuskegee Syphilis Studies, Henrietta Lacks and HeLa cells, and Mississippi "appendectomies." I am still appalled at our history of using black individuals and communities for experimentation as though they were not human or subhuman. Dr. Reddy referenced the care continuum that we have discussed so many times in class and specifically with regards to Sepsis in children. She discussed how early recognition is important and noted the disparity between white children, who are more likely to be treated for sepsis than white children although minority children are more likely to have Sepsis to begin with. She then pointed out that black children have a higher mortality rate than white children and all of this because of failures in the care continuum.