The nation’s largest group of pediatricians warned this week that racism can have devastating long-term effects on children’s health.
A policy statement from the American Academy of Pediatrics is the first it has issued to its members on the dangers of racism. Doctors involved in the report said the current political and cultural atmosphere makes the work more urgent.
“If you look at what’s in the news today, in social media, on Twitter, there’s so much kids are exposed to,” said Jackie Douge, a pediatrician with the Howard County Health Department who co-wrote the statement. “As much as you want to keep it in the background, it’s not in the background. It’s having direct health effects on kids.”
Other pediatricians welcomed the report, which drew on 180 key studies and includes specific recommendations, and said the danger to their patients has become acute.
“There was a time not too long ago under another president when I think we as a society were talking about living in a post-racial age. That’s changed pretty dramatically,” said Nia J. Heard-Garris, a pediatrician at Northwestern University. “It’s a new age of racism.”
A study published last year in JAMA Pediatrics found an increase in teenagers’ stress and worry about discrimination between 2016 and 2017. The researchers surveyed 2,572 high school students in Los Angeles during the 2016 presidential campaign and again during the first several months of 2017, after Trump’s election. Teenagers who were more stressed were more likely to drink, smoke or experiment with drugs.
Scientists have documented health disparities among races in the United States for decades. African Americans are more likely than whites to die of diabetes and have a higher prevalence of hypertension and heart disease. Black children are four times as likely to be admitted to the hospital for asthma.
Environmental factors such as income levels, education, exposure to pollution and access to high-quality health care explain some of the differences. But researchers have become increasingly certain that racism and discrimination play a role, as well.
And researchers have increasingly identified dangers racism presents to the development of babies and children. Studies have found lower birth weights in babies born to African American mothers who experience discrimination. A recent analysis found an increased risk of premature birth among Latina women following Trump’s election, part of a pattern of poorer health outcomes among Latinos during his administration. Other recent studies have found an increased risk of depression, obesity and greater susceptibility to sickness among children who are exposed to racism. Researchers have linked racism experienced by children to worsened sleep, higher rates of doctor visits and lower self-esteem.
One of the main mechanisms responsible for those effects, researchers say, is the way prolonged stress wears away at people’s bodies. Experiences of discrimination can flood the body with stress hormones such as cortisol — a chemical that readies the body to fight or flee. Studies have show that even the anticipation of discrimination can trigger the stress response. Over time, stress hormones can lead to inflammatory reactions that make the body more susceptible to chronic diseases.
There are other ways discrimination can affect children’s health. The American Academy of Pediatrics report points out structural problems such as the disproportionate number of minority youths incarcerated by the juvenile justice system, disparities in access to health care, food insecurity and poverty.
One challenge researchers often encounter is how to measure exposure to racism and tease it apart from other health factors. Many studies rely on self-reported experiences or feelings of discrimination. They typically conclude that a correlation exists between racism and negative effects on health but cannot prove those health effects are caused by racism. But taken together, researchers say, the thousands of studies linking racism and health suggest there is a strong relationship.
A few studies have used real-life situations to measure racism’s effects more directly. One study linked the increase in harassment of Arab Americans after the Sept. 11, 2001, terrorist attacks to significantly higher rates of preterm birth and low birth weights among Arabic-named women in the six months following the terrorist attacks.
Another study was conducted after a 2008 immigration raid at a meat-processing plant in Iowa that involved hundreds of Latinos. Using birth certificate data from the nine months after the raid, researchers found a greater risk of premature birth and low birth weight for babies born to Latina mothers. The heightened risk existed for both immigrant mothers and those born in the United States, suggesting that the perception of discrimination was a factor, even for women not personally at risk of deportation.
In recent years, Heard-Garris has studied how vicarious racism — discrimination experienced by parents — can have health consequences for their children. In 2018, she published a systematic review of more than 1,300 studies on racism and children’s health. Some of the health impacts, she found, were more immediate and measurable, such as increased likelihood of substance abuse or obesity.
Other effects were more indirect and pernicious, she said. Even experienced vicariously, she found, racism can threaten a child’s sense of the world as just, fair and safe and instead foster feelings of helplessness and despair — which have long-term implications for mental and physical health.
The primary job of pediatricians is to protect children’s health, said Kyle Yasuda, president of the American Academy of Pediatrics. “It’s more than just medicine and genetic makeup. It means looking at all the determinants of health. And science has shown us racism plays a part in that equation.”
The new report issued by AAP to its 67,000 members includes an extensive list of recommendations. It advises pediatricians to take racism into account in their clinical practices — to be prepared to counsel families on their exposure to racism and to make their clinics as welcoming to all groups as possible. It also calls for pediatricians to examine their own biases and address them.
The report calls racism “a socially transmitted disease passed down through generations, leading to the inequities observed in our population today.” And, it says, “Pediatricians are uniquely positioned to both prevent and mitigate the consequences of racism as a key and trusted source of support for pediatric patients and their families.”
The AAP recommends diversifying the pediatrics field and training clinic staff and pediatric residents to be more “culturally competent” and better able to communicate sensitively and effectively with families from all backgrounds. And it calls for pediatricians to join community efforts — such as creating safe playgrounds or healthy food markets — to combat racism’s effects on segregated, impoverished areas. The report also recommends more funding and research to address the health effects of racism.
Researchers will keep monitoring the long-term impact of racism on kids’ health, Heard-Garris said. “I see them trying to shut it out and tune it out. I think they’re trying to figure out ways of coping that previous generations didn’t have to. And I don’t think we’ll know what the consequences are going to be for a while.”