Racism is a Public Health Crisis – PediaCast 464

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  • Dr Jordee Wells and Dr Fareeda Haamid visit the studio as we consider racism as a public health crisis. What exactly does this mean and who suffers the consequences? How did we arrive at this moment in history? And where do we go from here? Join us for answers to these questions and more!

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  • Racism is a Public Health Crisis

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Announcer 1: This is PediaCast.

[Music]

Announcer 1: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio. 

It's Episode 464 for June 24th, 2020. We're calling this one "Racism is a Public Health Crisis". I want to welcome all of you to the program. 

So this week, we are going to explore racism and describe how and why racism is a public health crisis. Now, you've probably heard this idea presented in the news, online, in your social media channels. But what exactly does that phrase mean? 

0:01:12

How is racism a public health crisis and what are the consequences of this fact? How did we get to this defining moment in American history and where do we go from here? How do we make a difference for Black and Brown lives today and for generations to come? 

All very important questions with answers that are sometimes clear and sometimes not so clear. In fact, the answers are often complicated. However, our resolve to answer them and to take action must be persistent and strong. Racism is a difficult topic for many families to talk about. And yet, one reason we are where we are today is a failure of White Americans to speak up, understand, stand alongside and take action.

0:02:00

It's time we change that. It's time that we talk about racism amongst ourselves and with our children. It's time we talk about what racism is, where it came from, when it happens, why it occurs and who is affected. And most importantly, what are we going to do about it? Because talking is not enough. Talking is a start. 

And I do have two terrific guests to help us begin the conversation, but and this is very important, our show today is a starting point. So please take what you hear and talk about it, with your spouse, your partner, your children, your extended family, neighbor, co-workers and with those who look different than you. 

It's important we have these conversations moving forward and we will continue to talk about racism on PediaCast because it's something that affects the lives of children and families each and every day. 

My guests this week are passionate about raising awareness, building understanding, and taking action as we consider racism. Dr. Jordee Wells is  
Pediatric Emergency Medicine physician at Nationwide Children's Hospital and Dr. Fareeda Haamid is a physician for teenagers and young adults also at Nationwide Children's.

0:03:10

Before we get to them, don't forget, you can find PediaCast in all sorts of places. We are available wherever you get your podcasts, the Apple and Google Podcast apps, iHeart Radio, Spotify, SoundCloud, Castbox, Himalaya and most other podcast apps for iOS and Android. 

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We also have a contact page over at pediacast.org, if you would like to suggest a topic for an upcoming episode or you have a question or a comment for the program. 

Also, I want to remind you the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider.

0:04:15

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at pediacast.org. 

Let's take a quick break. We'll get Dr. Wells and Dr. Haamid connected to the studio and then we will be back to talk about racism. That's coming up right after this.

[Music]

Dr. Mike Patrick: Dr. Jordee Wells is a Pediatric Emergency Medicine physician at Nationwide Children's Hospital and an assistant professor of pediatrics at the Ohio State University College of Medicine. Dr. Fareeda Haamid is an Adolescent Medicine physician at Nationwide Children's and also an assistant professor of pediatrics at Ohio State. 

0:05:18

They're here to talk about racism, including who it affects, what it is, when it happens, where we see it, why it persists and how we can all join in to make a difference. So let's give a warm PediaCast welcome to Dr. Jordee Wells and Dr. Fareeda Haamid. Thank you both so much for being here today. 

Dr. Jordee Wells: Thank you for having us here, Mike. I'm excited to be here. 

Dr. Fareeda Haamid: Thank you so much for the invitation. 

Dr. Mike Patrick: Yeah, thanks to both of you for taking time out of your busy schedules to be here with us today. So really important topic, and I just wanted to sort of lay our groundwork as we progress into the conversation. 

Jordee, what is that we mean when we talk about racism? What's the definition of that term?

Dr. Jordee Wells: Racism is oppressiveness and discrimination against a group of people based upon their race and ethnicity. There's usually a minority population that is targeted in this, and there's a power dynamic, where this group is viewed as inferior to the majority of the population based solely on race and ethnicity. And I think that's a key point, is it's just based on whatever characteristics are different. 

0:06:22

Dr. Mike Patrick: And it's complex and nuanced too, right? I mean, there's racism that you could look at and say, "Oh, that is racism," and you get the sense that that's what's happening. But there's also implicit and sort of subtle and conscious racism, individual racism, institutional and systemic racism. So it's more complex than just a simple Merriam-Webster definition, right? 

Dr. Jordee Wells: Absolutely. I think that the racism started such a long time ago. The construct, it was developed. It's not something that's intuitive, that happens. It's something that has been established. And it's perpetuated so long throughout our history that that's where we develop implicit biases and things that are unconscious that we aren't even aware of. 

0:07:15

I think there's also what we say macro aggression versus microaggressions when we talk about racism. There are those big things, racial slurs, large acts of targeted events against certain groups that we say absolutely not, that is not okay. We're able to recognize that. 

But there are smaller things that are not always a part of what we think about in our everyday life that can be hurtful and create an unfair advantage or disadvantage to different people.

Dr. Mike Patrick: And these things that you talk about, especially the subtle things that at the surface may not immediately be recognized by folks as being racism and yet it is, those aren't things we are born with, right? These are things that we're taught, that we learned. 

And sometimes, that learning comes because people who are parenting us, so our moms and dads, grew up in a different time. And just the way that they, small comments, or the way that they present things, all these things kind of add to build to what you understand about racism even if it's not conscious. Am I overstating that?

0:08:26

Dr. Jordee Wells: No, I think you're really getting to the core of how these things develop over time and how the communities from which we live in, the people who we interact with, the separations that we don't necessarily think of the choices that we're making, we think that this is just how everyone is kind of navigating their own lives. But these little elements add up and they really make a difference in how our society is structured. 

Dr. Mike Patrick: Great point. And just as there can be subtle instances of racism, there can also be little steps that can make a big difference. And just one example of that, if you do look at the Merriam-Webster definition of racism, it is that a belief that race is the primary determinant of human traits and capacities. And that racial differences produce an inherent superiority of a particular race. 

0:09:21

And a couple of weeks ago, a recent college graduate by the name of Kennedy Mitchum, she sent an email to the editors at Merriam-Webster. And she said, it's not just disliking someone because of the color of their skin. There are systems in place in healthcare and the justice system that are automatically formed to put people of color at the bottom and keep them at the bottom of the barrel.

And in response to her email, Merriam-Webster came out with the statement that they are working on a revised definition. So that may have already been in the works, but it just shows you little steps that you take can make a big difference. 

Dr. Jordee Wells: Yes, absolutely.

0:10:00

Dr. Mike Patrick: As we go through our conversation, I'm going to kind of season the talk with some links, just ones that I have found helpful in recent days. Of course, reading and educating ourselves can't be the only thing that I do, but it is a start. And one of the links that I'm going to put in there is a recent article from The Washington Post called Understanding Racism and Inequality in America. And again, as we go through, I'm going to have some of these, and I'll put those in the show notes over at pediacast.org for Episode 464, so folks can find them.

Fareeda, what is it that we mean then by systemic racism? In what institutions does racism exist?

Dr. Fareeda Haamid: So thanks for the question, I think the term systemic racism, when you really drill down, we're talking about systems, right? So systems of education, systems of housing, systems of employment. 

0:11:03

And so, let's take for example, school district thing. And we know that a quite of deal of schools get their funding or money from property taxes. And if individuals in one neighborhood don't own property for a variety of reasons, some alluded to already, this leads to teachers not being paid well. There are too many students in the class. So there's concept of overcrowding, decreased access to things that happened outside of the classroom, so those extracurricular activities, those parks, sports clubs, trips to really cool places.

And so, if there are students who are not getting that, then the reverse is true, right? So there is a situation in which people are being better funded and better resourced, because I want to make the distinction that it's not just funding that leads to the advantage. So then, in those scenarios, teachers are paid well. The access to extracurricular activities is increased. 

0:12:11

And those leads to different set of opportunity. So one person in one neighborhood, another child in a different neighborhood. And in our head, they're growing up in this one place called America, but their paths become so vastly different. And so, that is the system of education where racism shows up there.

So then, if you carry that construct forward, well then, when it's time to get a job, I think there's a Harvard study that show that "White-sounding names" whatever that means to people, if that's on a resume, they're twice as likely to get more callbacks than those with "Black-sounding names". And so, if we grow up thinking that all things are fair, so you go to school, you go to college, you get a job, but if we're stuck on ”I can't get a callback because my name sounds a certain way,” then there's another structure, that labor market system, that is impacted as well. 

0:13:26

So I think that the other thing to really point out here is that the detriment is not only to the person who has been discriminated against. It's also the people not getting those rich opportunities that I will say that come from diversity. So just not having those conversations sometimes until college or in the workplace, where maybe the wrong thing is said because there was never that opportunity to cross paths. 

0:14:00

So those are the systems. Also, I've highlight one more that really hits home for a lot of people is housing, right? So that's another system that in this country, we know that there is an unfair practice called redlining. 

Redlining is so visual. In my head, I always envisioned that with the red marker like teachers used to collect their paper, governmental agencies use red lines or marked, or divided I should say, communities into areas that were better or worthy of investment and areas that weren't. And typically, those areas not worthy of investment that were redlined where pit places where Black people lived. 

And so, this is extremely detrimental to Black neighborhoods. So it robs them of access to investments, personal property or business investments. And so, I think we can't lose sight of the fact that those practices, even as far back as a few years ago, I believe in one of the Atlanta studies show that those practices are still rearing their ugly heads in terms of the impact of it. 

0:15:19

So those wealth gap that we haven't seem to narrow yet in this country. So systems of education, housing, employment, that's systemic racism. And when you see it that way, okay, two kids can grow up the same country and their paths be completely divergent, I think that gets to the core. 

Dr. Mike Patrick: And when we start layering system upon system upon system on particular groups of people, then that buries things even deeper. So you mentioned education and housing. We could make the same case for the criminal justice system, for example, and in terms of the percentage of arrests and the length of prison sentences, and that sort of thing.

0:16:04

And then, of course, this is a healthcare podcast. We could put healthcare on there. There are disparities in health and wellness, too, right? 

Dr. Fareeda Haamid: Sure.

Dr. Mike Patrick: That come out of racism, and we're going to talk about in much more detail. But the point here is that it's not just one thing, it's many things. And recent quote from the president of the NAACP, Derrick Johnson, he said this is not about one incident. It's about the systemic and pervasive nature of racism in this nation that must be addressed.

And another one of those links I was talking about, there was a recent article in USA Today called What is Systemic Racism? Here's What It Means and How You Can Help Dismantle It. So that's another good read, I'd encourage people to check that one out. Again, all these links will be in the show notes over at pediacast.org.

So Jordee, what then are the consequences of all of individual and institutional racism that we see? 

0:17:01

Dr. Jordee Wells: Yes, I think it's important to distinguish the two, like you said, Mike, because the individual racism, those are personal traumas. Those are added stressors. 

Those are added barriers on our regular basis that a person is experiencing, whether that is being subject to racial slurs, whether that's being racial profiled in a store, whether that's changing the look of your name on an application as Fareeda was mentioning in order to try to improve your chances of gaining employment in a place. 

Those things are additive in an individual's life. And it happens across the life span because there is no Black person in America that is immune to racism. From birth to the entire lifespan of their life because it's all based on the color of the skin, at that point. 

So that's an important thing to recognize. And I think from an institutional racism standpoint, we're talking about the distribution of resources, power, wealth, opportunity. And it leads to unequal access to employment, housing, wealth, the criminal justice, and education systems as we talk about. 

0:18:15

All of those things are compounding, and it started all the way back to 1619 when the first slaves arrived and it has built the system. Policies have built the institutional racism, the structure of our country. That is something that's been additive. And so, I think sometimes, when we think about outcries of need for change, it's someone thinks it's sparked by one incident or one episode that someone's had. 

But no, people have been dealing with this for years and years and years in the Black community and there'd been many instances in our history where there's been a need for a change and a need for that. But the impacts are at the individual level and that are also impacted at the institutional level as well. 

0:19:08

Dr. Mike Patrick: And as Fareeda has said, it really then comes down to what your life experience is based on all of these systems of life. So you're being at a disadvantaged of those when you experience this. So you're more likely to experience poverty and not get as good of an education and that can start to impact  physical health, mental health, not having opportunities, not having the same access to health care, not getting the preventative type of healthcare services that other people get because of the systems that are in place.

So I did want to focus a little bit more on that, Jordee. How does racism affect physical health and wellness? 

Dr. Jordee Wells: Racism has a profound effect on physical health and wellness. I think one of the most critical points that the American Academy of Pediatrics made in their statement about the impact of racism on the health of children and adolescents was the fact that racism affects health and not race. 

0:20:04

Race on its own is a not  a factor in distinguishing kind of the fabric of our DNA, what makes us human. Those things are the same across the board. But when we're born into this world, the circumstances that we're born into really shape our health outcomes. 

A lot of the times, there has been a large emphasis in the medical community that the disparities we see in diabetes, high blood pressure, obesity, they're all related to race. When in fact, that is not the case. It's related to racism. 

It's related to the fact that if you're Black in America, you're more likely to live in area where there's food deserts or your nutrition is poor, or you don't have access to healthy foods. Or  you don't have access to larger green spaces where you can engage in physical activity. Really, it's the racism that is more impactful, not your race.

0:21:03

And I think it's an important conversation and change in a conversation to include those impacts of both individual and systemic racism on health care. And you mentioned, Mike, about kind of racism within the medical community. There are hesitancies in the Black community to seek out care because of past discrimination, because of past instances of medical racism. 

I think the Tuskegee Experiment is probably one of the most widely cited really traumatic events of medical racism that we have, but there are many more. Some as great as that and some that are smaller that really make it so that Black people may present poor conditions later in order to seek care because of that hesitancy. Their complaints may not be taken as seriously when they come and talk about that.

So there's a lot of elements of our physical health and wellness that are uniquely and specifically the result of racism as opposed to race itself. 

0:22:11

Dr. Mike Patrick: And not only the experience of individual people who have experience racism in the medical environment but also family stories. You may be hear about an uncle who had a particular thing happened to him. And as you mentioned, the historical stuff that White people may not have even heard about those things and yet these are stories that get told in families from generation to generation. And so, then there may be distrust in the medical system that we don't even realized is there because we've not heard those stories.

Dr. Jordee Wells: Absolutely. I think it's really important to understand that layered history in order to understand where we are now and how we got there. Because if you want to try to regain some of that trust back and be able to engage with the community so that they know that you're there for them and you want the best for them. 

0:23:04

That's a journey, and that requires education from providers, from families, from families, from staff to be able to be sensitive to those needs as well and to really bring it to the forefront because it's important. 

Dr. Mike Patrick: And health disparities really begin right at the moment of birth. And so, we see in Black and Brown people more deaths during childbirth. We see more premature babies, more instances of sudden infant death syndrome. And then, as children are growing up, we see more asthma, again diabetes, hypertension, heart disease. And even with the recent COVID-19 pandemic, the Black community has been hit harder because of these disparities in health, right? 

Dr. Jordee Wells: Absolutely. And I think that one message, especially through COVID-19 that has been clear is that the health disparities in COVID-19 have always been there. This has helped to uncover to some degree more and let that be something that is brought to the attention of people who may not have known that they were going on.

0:24:09

And so, it's not  that COVID-19 has done something drastic, these things have been going on. And when we're stressed as a country during a pandemic, those are going to be even worse during those times. 

Dr. Mike Patrick: Yeah, absolutely. So as we think about physical health, and we kind of transition into how racism affects mental health, the two really do intersect. Because we know that when you are exposed to stressful environments... So you're living in poverty. You fear for your life. Maybe you have a single mom at home who's struggling and so you're being raised by siblings who may not be responsible folks. 

So this layer upon layer of stress in your life. And we know that toxic stress causes an increase in cortisol levels. So there are hormones that are involved here. And as those systems in your body are firing, that can also affect long-term health with things like diabetes, hypertension, heart disease. It can shorten lifespans as we're exposed to toxic stress. 

0:25:15

And for those who are interested in learning more about that whole process, we did a CME podcast. So this is one of the podcasts that we do for medical providers. It's a Continuing Medical Education podcast. But I think moms and dads will be interested in this as well. We try to make the science understandable even in those episodes, and it was on toxic stress and resiliency. It was PediaCast CME Episode 26, and I'll put a link to that in the show notes for this episode, 464, over at pediacast.org.

Fareeda, let's talk a little about mental health and racism. How does racism affect our mental health? 

Dr. Fareeda Haamid: Well, sure, I think as Jordee and you have beautifully illustrated this stress response is the key thing in mental health. So we know we can't detach some line from our bodies, and so if you see the stressor, I always think of if you're a kid, you're taking a test. Or if you're an athlete and if you have this big game, maybe it's against your rival, with all this buildup about it, certainly, a certain degree of stress is necessary at times. 

0:26:26

But if that thing, that discrimination is assumed from the mind as a stressor, and then it's constant, and Jordee said they are constantly exposed to this stress. And so, what we know is that it's okay to have that sometimes, to be soup up or amp up to play the big game if necessary, you need a degree of nerves. But all the time, it becomes an issue. 

And so, the mind does different things, so there's sadness, there's a depression that comes with that. There's feeling anxious. 

0:27:07

So if you were always going into the big game, how much time the night before you would spend ruminating and thinking about, oh, my goodness, what am I going to do? Is it going to be up to me to take the last shot or score the last goal? So just think of that over and over and over, and we understand why it affects our mental health so greatly.

And I think that is most devastating is that this is a time in childhood, in adolescents included in that, that we're expecting children to be developing and sort of getting all these milestones in that identity formation. So, "I know who I am. And I'm confident to go in a situation and conquer it or at least be able to identify adults to help me do that." 

0:28:01

And so, when the stressors or eroding or kind of just chipping away at that confidence, that's where we see this blossoming of mental health issues related to racism. So am I confident enough to think that I can go on to a school when maybe I'm the only black student and deal with the everyday things that happen in class? That don't necessarily get kind of a check mark as the worst things that ever happened, but it's added to things, as Jordee said earlier. 

And then, also that these accomplishments that we expect children to kind of have can't really be realized if they're stressed out or if they're really sad or if they're thinking about processing kind of the events of the country now, where it's nonstop. We also have nonstop access to things that are pretty scary, whereas before in our country, we could "turn it off".  

0:29:06

And now, it's constant. And so, I think those are the things that the sadness, the nervous feelings we're seeing. Not a thing that we should assume that kids can just get over and not a thing that we should assume that adults shouldn't help them with. 

And I think we have to have adults help them deal with the immediate effects, "Okay, you're stressed in this very moment," and then adults to help them figure out how to make the world a better place. 

It sound cliche, but I think seeing that there are solutions is also therapeutic for children, to see that okay, "This really big bad thing is happening, but there are people I trust who are working hard to make it better. So I think I can relax. I think I can sleep tonight. I think I can not be sad tomorrow morning." And that's that mental health impact of racism.

0:30:06

Dr. Mike Patrick: Yeah, absolutely. And that really then is what builds resiliency despite the toxic stress environments, is that when kids do have someone, an adult in their life who they can trust and who they feel loved by. And that is the way that you can really make a difference in a kid's life. You may not be their parent, but you may be the person who they're able to trust and that can be so important. 

This is all made worst by lack of access to healthcare by these kids then who are experiencing anxiety and depression and increased risk for self-harm and suicide. So if you have that climate and then, you also, these kids can't get the help they need, that makes things even worse, right, Fareeda? 

Dr. Fareeda Haamid: I would agree. Also, I want to point out here that this may be going on in communities where it is not popular to seek health for mental health issues. So I see that we are, in our country, becoming more and more aware that mental health is not a taboo or something we should shy away from.

0:31:10

And I think that is an amazing effort by athletes and really people that children can kind of really identify with. I think if it's done by them, it's so impactful. And I'm always very, very happy to see that. 

However, we know that in this system of not being able to access things or where you just don't feel like that is the thing you can do, then you're not getting professional help. And I think parents do the best they can do and just saying, okay, never mind. Don't worry, but there's a point where don't worry really is not helpful because while we not worry, the world is literally burning. 

And so, having professional people to go, well, let's unpack that. What does that mean? How does that affect you today? How can we get you through the first four periods of your class without a panic attack? Or something like that. 

0:32:16

I think that access to mental and making it more popular to be honest. I saw on Calm app Lebron James has a portion on there. And I think just the visual of him, he's on this very pensive or contemplative look on his face. But it just shows kids that, okay, even this guy needs to take a minute to turn it off. And so I think it's important, I say that. 

Dr. Mike Patrick: Yeah, absolutely. We've really, as we're outlining the impact that racism has on physical and mental health, that really leads us into this idea that racism is a public health crisis. I think we've been making the case for that. Sort of sum up for us, Fareeda, how exactly is racism a public health crisis?

0:33:07

Dr. Fareeda Haamid: Right. I do, I feel like we've been marching there and laying it out in the last several minutes. I think that as we talk about public health, I'll break that down into the health of the public, right? So it's not this term that we think about, oh, what is this big thing called public health? It's the health of the public, the health of the people.

And so, it's the systemic thing, these problems where people don't get access or people are discriminated against, severely impacts the health of the public. And so, how is that manifested? Well, decreased life expectancy, literally living less than people of different skin colors. 

And lead poisoning we saw Flint, Michigan, being impacted by lead poisoning. We've seen access to cool water in certain communities with Indigenous People, Native Americans. We've seen children dying or babies dying sooner than other babies of different color, that infant mortality piece. 

0:34:19

So I think all of these things, and then you drop COVID-19 as a pandemic in the middle of that. And it really just brings to the forefront the health of the public or health of people. There's a crisis here that we kind of have to respond to. 

And I hope that kind of answers the question that I feel like it's all of those things that the health of the public, it suffers from not kind of acknowledging what's going on, not having the access, and then needing health professionals in all arrays of health to really understand what's going on, and the public to not kind of roll their eyes and go, "Oh, this is somebody else's problem."

0:35:09

Because it actually is everybody's problem. So if more people are accessing the healthcare system to get the really in-stage services. So Jordee is an emergency medicine doctor and we all know that it cost way more money to treat somebody in a severe asthmatic kind of episode than it does to just give them access to controller medicine that they take every day. 

Well, okay, then how do we get that controller medicine to them? Do we have enough money, do we have the healthcare? Can they go to the pharmacy and get it? So I think we have to look before the crisis happens.

I always cringed that we've gotten into a crisis, but there are steps there. I always have a relative who says if you're starting your car and head for, let's say, Miami, you just don't end up in Miami, right? There are signs along the way. There are goal posts. Okay, now, this is the last stop before you get to this place.

0:36:15

So we don't end up here just overnight as Jordee said. These things are additive. So I think we ought to start paying attention to before we end up in Miami. It's a long road from Columbus to Miami but we have to be paying attention to the goal posts and the signs along the way. 

Dr. Mike Patrick: Yeah, absolutely. And I love the way that you paint this as this is an issue for the public, for everyone. We are all Americans and we all kind of pride ourselves on the fact that America is the land of opportunity. 

But when you have, based on the color of people's skin, there being more poverty, more chronic illness that's not genetic, shorter life expectancies, increased arrest and incarcerations, increased risk of being killed by police officers, fewer educational opportunities, fewer job opportunities that's perpetuated from generation to generation, how can we be proud to be Americans when we're not dealing with the health of all of us, all of the public?

0:37:17

And so, I really feel like we are at a defining moment in American history right now. And that's a good thing in terms of making a difference for generations to come. I hope that in the future, future generations can look back at us and say they stepped up and made the difference. As we think about this as a defining point in American history, Jordee, help us understand how exactly we got here.

Dr. Jordee Wells: I think that's a complex question in and of itself. I think that there's a really long answer to how we got here. But I think what I want to focus on is right now, in this particular moment why I think it was right for this to happen. I think Will Smith has been quoted a lot saying that racism isn't getting worse, it's getting filmed.

0:38:04

We live in a world right now where our ability to connect with each other through social media by using our instrument of our phone that we take everywhere to capture. A lot of these moments of racism that we haven't been able to catch on our own real time as quickly as we have in this era of the digital age, I feel like. 

And there's also, this has been going on for a while. I think about Ferguson, that was six years ago. So these elements have been documented but what about this moment in our history is different? And I have to give some credit to the current pandemic. The pandemic has caused a lot of us to be home more. We don't have the distractions of our everyday routines. There's less travel, vacations, things that normally occupy our time. We are more idle right now. 

And I think that as we seek media to understand what's going on with our health, for this current pandemic, we also have been bombarded in the media of consistent and repetitive really violent of racism. We've seen deadly acts happen.

0:39:20

And when we sit with that as individuals in our personal lives and our homes, and we think about it, and we reflect on it. I think it has made people really come out and say, this is not right. There needs to be change. There needs to be change from a policy standpoint because this can no longer go on. 

And think that idle attention to that has been really important in this point. And I think there's a large movement as well from our youth and our young leaders that are rising up and protesting. 

If you look at the makeup of our protests, this is not just a collection of Black people. This is the entire melting pot of our country coming together and standing up and saying this is not right and we're all here to make a difference and we can all have an impact on that. And I think that's really important. 

0:40:07

Dr. Mike Patrick: So where do we go from here? What are the next steps for awareness and understanding and action? 

Dr. Fareeda Haamid: Well, I think it starts, I like to think that a lot of things start with intent, right? So what is our intent? And I think as Jordee said, we are seeing this a melting pot. So if we actually believe this concept of America being a melting pot, then we have to start talking about it. Do we really want to see change? And I think we're answering that question in real time over the last several weeks. 

Yes, I think people want to see change. So then what happens next? So I think we can all agree that let's say we all need to eat, right? We all need to nourish ourselves. So let's start by inviting diverse backgrounds of people to this table to eat, right? 

0:41:05

And so, then what happens when that occurs? Well, once at the table, we can hear about your likes, my likes, your dislike, my dislikes, my past experiences with maybe bad meals. In the same way, it would be frowned upon for us to turn our nose up at what's been presented at the table, the meal at the table. We have to hear those expressions of heart and pain from others with minimal judgement. 

So now, we're all at the table, we've all outlined our like and dislikes, you like this food, I like that food. Then, what else can we do? We can continue to share and talk and continue to kind of break bread and eat meals together.

And then, let's admit when we make mistakes. Really, I mean, if we are all at the table, the food comes out and it's burnt, we can't go, "I didn't see that." So if we're seeing, we're all the table, we can all acknowledge something went wrong, then we can all work to say, and this is a really simplistic metaphor, however you want to call it. But if you brought out a burnt meal, you literally start thinking about troubleshooting, like "Oh, we left it in too long." 

0:42:25

So I think if we were not all at the table, we're robbing each other of the opportunity to troubleshoot, which is an innate human thing. There's something wrong, we can fix it, right?

So I think those are the things, the intent, inviting everyone to the table when we get there. Let's respect each other's opinions and hear. Then let's continue talking, let's continue eating together. Let's acknowledge when food is crap, and let's figure out how to fix that. 

And I think most people appreciate being at the table. Most people appreciate seeing themselves in pictures or seeing themselves in textbooks or seeing themselves represented in a variety of settings. So I think that's the thing, that basic content and just moving toward really basic things that we can do, that aren't so scary. 

0:43:23

Dr. Mike Patrick: I love that, I love that metaphor. That's really great. And when you look at all the people at the table, there's going to be some who can understand why the food came out burnt and others who may have had not any idea of why that happens. So having different people's perspectives and then talking about it and sharing and learning from one another really makes that experience at the table much more worthwhile and productive. And at the end of the day, helpfully, we'll get a good meal. 

Dr. Fareeda Haamid: Yes, indeed. And I think the worst thing we could do was all sit there and act like the food isn't burnt. Like, woah. 

[Laughter]

Dr. Fareeda Haamid: That's not the answer. Yeah, thank you, guys, for indulging me with that analogy. 

0:44:07

Dr. Mike Patrick: No, I love it. I think that is fantastic. So other thing is, right now, especially as we are at home and maybe we can't actually physically be at the tables of folks that we would like to be there with them because we have to be distant. And as you are at home and you're trying to learn more about this, so you're aware that there is a problem with racism in America, but I want to understand more. I do have some other resources for you that will be in the show notes over at pediacast.org for this episode, 464.

One of them is a site from the University of Wisconsin, Madison, just Racism and it has a list of anti-racism websites. And so, it's a curated list of some really good informative places that you can check out. 

NPR also put out Books, Films and Podcasts About Racism, and The New York Magazine offered up 7 Anti-Racist Books Recommended by Educators and Activists. I'm currently reading one from this list called White Fragility Why is it So Hard for White People to Talk About Racism, and that is a very good and eye-opening read. 

0:45:16

But, of course, we have to go beyond just reading things and informing ourselves. It starts there, but then those engaging conversations is the next step. And just really getting to know folks and getting to have a feeling for what life is like in their shoes is I think the next step.

And in terms of healthcare workers, Fareeda, and the hospitals and academic institutions, as the healthcare community, what can we do to then go beyond just arming ourselves with information and engaging each other? What can we do next? What is next for us in terms of making a difference? 

Dr. Fareeda Haamid: Well, I think, and I'll definitely ask Jordee to pitch in here because I think we're actually living in what's next. So this conversation is what's next. 

0:46:09

I think institutions, or I should say people understanding that... Institution sounds like this big bad wolf, right? But institutions and systems are made of people. So on the very basic level, people can do different things. And so as healthcare workers, we are people who can make sure that our spaces are diverse. Make sure that our waiting rooms, if we're dentists or pediatricians, that they're books that include everybody.

Make sure that our children see themselves, any spaces that they go to, make sure when they get there, we believe them. So when they say, this happened to me at school today, I think it was because of this. We don't start discounting their stories. 

0:47:02

I think that's kind of what health providers can do. I think hospitals, as sort of this larger kind of larger entities can be very deliberate about what it means to recruit and attract people from a variety of backgrounds in a way that is authentic and not checking boxes and sort of meeting quotas. 

And I feel this is a time in our country where the change demand will become louder and louder. But I think we need to examine our intent and make sure we are including people because it is the right thing to do. Because we know we all suffer when we don't as oppose to including people because well, that's beneath your response to people being upset. 

So that's what I think. In academic institutions, I know Jordee can help me with this. What we can do, I just feel like it's still part of that conversation. Really , just because we're academic institution, that means we like to study. We like numbers. And we know the numbers support the facts of everything laid out in the past several minutes.

0:48:18

So then, not turning a blind eye to those numbers, those very numbers that kind of drive our existence, all three on the spot geek out about numbers and percentages. And so, let's actually use that really, that seal or fervor for book smarts to impact change. 

Dr. Mike Patrick: For the pediatricians in the audience, a couple of things that you can do to start taking those steps of making a difference. It is the middle of summer and this is the time when we reup our membership in the American Academy of Pediatrics. And there are a couple of organizations within the AAP that you can join to really start working to make a difference.

0:49:04

One of those is the Section on Minority Healthy, Equity and Inclusion. And that's a section of the AAP that anyone who is a fellow of the American Academy of Pediatrics can join and can start working to make a difference within the field of pediatric healthcare. It's not expensive, it's $30 a year to join. And so, when you re-up your membership, I'd encourage folks to join that section. 

And then, also the Council on Communications and Media because if you'd like to learn how to best have a voice of communicating these things and making a difference in that way, that one just $25 to join. And so, I think both the Section on Minority Healthy, Equity and Inclusion and the Council on Communications and Media within the American Academy of Pediatrics are great opportunities to work for change. 

And of course, there are other opportunities, individual state levels and local chapters and just getting involved. And it's even less if you're a medical student or resident or fellow joining those things are even less costly.

0:50:05

Jordee, speaking specifically about Nationwide Children's Hospital and the Ohio State University. What sorts of things are we doing to respond to racism? 

Dr. Jordee Wells: Nationwide Children's Hospital, especially with what's happened in the last several weeks has really been intentional in its actions against racism. And I think that started with our executive leadership, with our CEO, Tim Robinson, setting out a statement that of our stance as a hospital against racism, which I think is vitally important, not only for the people who work there, but for anyone who's going to engage with Nationwide Children's Hospital. 

We, also, I feel like there has been accretion of safe spaces for dialogue, whether that is the town halls or discussions that really include everyone at our institution, our faculty, our staff, so that we can talk about that. There are going to be hospital-wide initiatives to have unconscious bias training. That really gets into everyone who interacts in our institutions needs to be aware of what their biases are and start to think about those, and think about how they may be affecting how they interact with their colleagues, how they interact with patients and others that are here at the hospital. 

0:51:25

And I think finally, our institution has wonderfully been intentional about starting an action plan with the Diversity and Equity Inclusion Committee in order to really have a long-term plan to address these issues. Because right now, we're in a moment, but we don't want to lose momentum of really the great progress that we've had in doing so. And we really want to make this a part of who we are.

But for me, Mike, I think one of the biggest messages that Nationwide Children has had on this has been what is actually on our hospital walls? What is on the fabric of the building? Starting in the coronavirus pandemic, our Child Life colleagues had put up really on the walls of our hospital, "We got sunshine on a cloudy day." 

0:52:18

And that really was helpful with morale during that time. I remember looking at it going in and out of the hospital being really engaged and really invigorated by just those really wonderful words. And now, those words are equity, justice, peace, safety. 

All of these things support children. So that lets us know that anybody coming into our hospital, whether you work here, whether your child is treated on a regular basis and get therapies, whether it's the first time you're coming into our institution, whether you're visiting, or even just driving by, we are making a really big stance about our institution and how we feel. So I think that that is really powerful and it resonates every time. 

0:53:03

Dr. Mike Patrick: Yeah, I completely agree with you and I have the same experience walking into the hospital and seeing those messages, just really, really encouraging. And I'll put a link in the show notes to the Diversity and Inclusion Program at Nationwide Children's Hospital. There's a section of our website that has more information for those who are interested in learning more. 

Fareeda, what about governments and communities? What can those big sort of organizations do and institutions do to make a difference? 

Dr. Fareeda Haamid: I think we can start by listening and making sure that people actually hear what the concerns are. I think the other thing we're saying intentional, a decent amount here. And I think it's because we don't want to do it after the fact. So having these planning committees that actually think about this before we get to crisis level concerns.

0:54:03

I think communities can remain engaged, support each other. So I think we do have to care about our neighbors to actually be impactful. I think one of my pet peeves is the word tolerance. I find that so disturbing, "Oh, you can tolerate me." I really don't need you to do that. I need you to actually care that I have a job and can get healthcare when I need it.

So communities where we're making an assumption that people actually care about each other and we want the neighbors to do well and we want the neighboring towns to do better, then that makes it easiest for us to say, "Well, why is it that the school district is poorly resourced? What can we do differently? Why is it that some children can go on these field trips across the country and others can't? 

0:55:02

And so, I think also, it's always thinking that government and communities at the basic level are made up of people. And so, the people have to be involved. And another thing I like is just figuring out whatever you're into. So if you're a runner, what is your running community doing? It's so easy to galvanize people. 

I think that perhaps shared experiences that we have, later, if you want to go a step further, I should say, and have those conversations with people who you think might disagree with you, that can be scary. But I think at a minimum, we can start with people who have shared experiences. And so, let's do this particular thing. 

And I think that the more successes we have with that, then we branch out and we start talking to people who become less scary because in the end, we're just having a conversation. So I think that's what communities can do. Think that they're part of the larger picture but then do those really small things that become bigger things. 

0:56:12

Dr. Mike Patrick: And as we think about communities and governments, they are led by people and those people are often voted in. And so, one way of making a difference in your community and in your government is by registering the vote and then learning about the views of the people who would like to be in charge of your government or your community. And do they have awareness and understanding of the problem of racism? And do they have a plan for making a difference? And so, as parents who want to see our kids grow up in communities that care, it's going to be really important to vote. 

Jordee, what about parents and families? So this really is where the rubber hits the road for our listeners. The families, you're seeing what's happening in the world. You may or may not have personal experience with racism yourself or you're not aware. Or as you start to search, then you start to become more aware of racism in your life. 

How do families then talk about that and what can families do to make a difference?

0:57:13

Dr. Jordee Wells: Mike, I agree. I think this is really the core question, it's the core issue here because I think that that question can seem very daunting for a lot of people. Where do I start, and when you start thinking about how do I teach this to my children, when do I do it? At what age can I even think about starting this conversation? When is too early or too late? 

And some families I think are concerned about burdening their children with everything else that's going on in the world. Like maybe they shouldn't have to deal with that or have these conversations. But I will say this, the science is very clear about this issue. The earlier, the better in having parents and families engaged in these conversations.

As early as age five, children can show racial bias and start to treat individuals different in their own little circles. And so, I think it's important for parents and families to be open. Children are naturally curious and their little views of the world are sometimes the reason I think we all became pediatricians, is that they really can make you think about things because of their innocence and their purity in that.

0:58:26

But if they bring up something, don't fear that you can't talk about it or you can't recognize what they're going through. I think that children by the age of kindergarten really do understand the concept of fairness. And so, I think that that can be a tool that can be used in order to say it's not fair for someone to be judged because of this or that. 

You can talk about these issues in a way that is really tailored to the developmental level of the child. And that does not have to wait until they're really in adolescence of beyond that. And older children, I think it's great to inquire what they know and what they think about things that are going on. It's important to discuss especially if there's something in the media and to try to answer questions that may happen.

0:59:15

And it's okay. If you don't have all the answers, we can always seek and learn together as a family and I think that that's really important. I think one of the key things that parents and families can do make a difference though is to celebrate diversity. If your child is pointing something out that's different from them from someone else, acknowledge that and say that it's true. And say, "Isn't that great that we're unique and different?" Be accepting of that diversity. 

And also, lead by example, and show that. And think about the areas of your life to which you interact with others, and think about ways you can include diverse perspectives and ideals into that. Because I think that those are the first steps that really make a huge difference, especially in a child's development. 

Dr. Mike Patrick: Absolutely. And we're going to put lots of links in the show notes for resources to really talk about racism with your family and with your kids. The 700 Children's Blog here at Nationwide Children's Hospital had an article on how to talk to your kids about racism. Another, Caring for Children after Exposure to Race-Related Violence in the Media. 

1:00:22

The American Academy of Pediatrics has some great articles, Talking to Children About Racial Bias, Talking to Children about Racism: The Time is Now, a message from the American Academy of Pediatrics president, Dismantle Racism at Every Level.

And then, Harvard University had a great article on How Racism Harms Children. The New York Times had one, Talking to Kids About Racism, and Insider had a list of 16 Anti-Racism Books for Young Children. And I'm going to put links to all of these resources again in the show notes for this episode, 464, over at pediacast.org, along with all the other resources that I've been mentioning as we've gone along. 

1:01:01

So Dr. Jordee Wells and Dr. Fareeda Haamid, both with Nationwide Children's Hospital, we really, this has just been so enlightening and encouraging. And really, I would say that it has been, I don't know, it's something that need to talk about. And my deepest wish is that this conversation will continue and that the things that we've talked about then, the parents who are listening will talk with your families and talk with your kids and your neighbors and your co-workers. 

And just really, the more conversations that we had with one another and amongst folks who are different from one another, the more we can begin to understand and then take on actions that will make a difference. 

I really appreciate both of you taking time out of your days for being here today. Thanks so much. 

Dr. Jordee Wells: Thank you, Mike. Thank you for using this platform to have this conversation. It's super important and I'm really that I was able to be a part of it. 

Dr. Fareeda Haamid: I agree. I am super super excited that we were able to talk about this in a way that it seems like it's manageable for people and not so scary. So thank you so much. We appreciate the opportunity. 

1:02:13

[Music]

Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. 

Also, thanks to our guests this week, Dr. Jordee Wells with Pediatric Emergency Medicine at Nationwide Children's Hospital and Dr. Fareeda Haamid with Adolescent Medicine at Nationwide Children's.

1:03:01

Don't forget, you can find PediaCast wherever podcasts are found. We are in the Apple and Google Podcast apps, iHeart Radio, Spotify, SoundCloud, Castbox, Himalaya, and most other podcast apps for iOS and Android. 

Our landing site is pediacast.org. You'll find our entire collection of past programs there, also show notes, all those links that we talked about in today's episode are there, our Terms of Use Agreement, and that handy contact page if you would like to suggest a topic for a future program. Also, reviews are helpful wherever you get your podcast. We always appreciate when you share your thoughts about the show.

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Don't forget, we also have a program for healthcare providers called PediaCast CME. That stands for Continuing Medical Education. It's similar to this program, we do turn up the science a couple of notches and we offer free Continuing Medical Education Credit  for those who listen. Shows and details are available at the landing site for that program, pediacastcme.org. You can also listen wherever podcasts are found. Simply search for PediaCast CME. 

1:04:09

Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.

[Music]

Announcer 1: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.
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