What We Talk About When We Talk To Our Kids About Racism

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During the 2016 election, Americans opened a public discourse that sparked new and old fears, evoked unsettling and painful emotions, and surfaced certain real and perceived divides. When elections center solutions in the background to highlight problems in the foreground, it can be distracting and confusing, for adults and kids alike. Post-election, often those intensities fade. But this time, parents may find themselves confronting sustained and sometimes increasing worry, in the emotions and experiences of their children and their children’s classmates. These are the times when parents consider how they will explore complex and potentially charged topics with their children and teens.

As parents examine their values and their hopes for their children in this post-election climate, it may be helpful to consider how to approach a topic that is as oft-used as it is misunderstood – racism.

What are we talking about when we talk to our children about racism?

And how do parents start the conversation? 

When we talk to kids about racism, we are primarily talking about 3 things.

First, we are talking about history – things that happened in the past that are important to understand what is happening now and why it matters.

To illustrate the history of racism in America, some parents may find it helpful to review age-appropriate details. For example, teenagers may have knowledge of historical events like slavery and the civil rights movement. Starting with what they know, consider extending the conversation to other demonstrations of institutional racism like government-sanctioned red-lining practices that decreased the home values of people of color, particularly African Americans, and contributed to current racial wealth disparities in America. Or examine the implications of Japanese internment camps during WWII that used race and nationality to deny Japanese Americans their civil liberties. These events and the history they represent are the embers of old fires still kindling in our present and the more we understand them, the more we are equipped to recognize their reemergence.

Second, we are talking about feelings – the prejudiced assumptions and ideas about others based on race. When stated aloud, as a part of targeted comments or unintentionally as a part of repeated narratives, prejudiced feelings can result in trauma, stress, and anxiety for the people who become the butt of a hurtful joke or the demeaned character in a story. These types of one-on-one interactions highlight episodes of personally-mediated racism.

To help kids identify prejudice and its form of racism, parents may use children’s books to share helpful lessons. Some can be found here and here.

Third, and perhaps most importantly, we are talking about actions – everyday choices, big and small, to treat people differently because of their race. This is called discrimination and it is powerful because it not only hurts people’s feelings, it can also make them sick.

Simply put, racism – like many of the “isms” that have been heightened by this recent election – is about exclusion and harms. That exclusion can happen at the lunch table just as much as it can happen through laws. And the resultant harms can range from emotions like embarrassment, humiliation, and shame to physical violence, psychological stress, poverty, and disease.

As kids come home crying or with troubling stories of what they’ve seen or heard, resist the urge to dismiss their emotions with avoidance or denial. Instead consider these helpful tips:

DON’T tell kids it is unconditionally going to be okay, because for children and families who stand to lose their health insurance, residence, or civil freedoms, it may not be.

DO offer reassurance by discussing and modeling how to unconditionally support and care for classmates and friends who may be facing unique worries and stress at this time.

DON’T avoid conversations about racism, sexism, nationalism, xenophobia, Islamophobia, and intolerance.

DO put those conversations in an age-appropriate context that includes ways children and teens can stand up for peers when they witness their exclusion.

DON’T try to minimize a child’s fears by normalizing distressing language and behavior.

DO listen to their fears and talk about reasons for hope, including their ability to actively express empathy, support, and advocacy for peers whose fears may be different, more acute, imminent, or sustained.

These moments are opportunities to model engagement, tolerance, and compassion for children and teens trying to make sense of a world in which their values may be challenged, demeaned, or disregarded. Ultimately, what we are talking about when we talk to our kids about racism, is the type of person they can actively become.

 

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The Room to Wait

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The president-elect’s victory, and the tacit validation of his divisive and dangerous rhetoric and policy proposals, challenges those who call themselves liberals to be the values they espouse. Until 2 weeks ago, those values came at little cost. Aside from the news you read, the company you keep, and the places you buy produce, the daily politics of American life were, for many, comfortably cosmetic and consumer-oriented – simple public identities crafted by the items you purchase, relationships you explore, and content you share online. Then, Americans elected a xenophobic candidate who ran on an openly Islamophobic platform and has since designated overtly racist, nationalist, sexist, and homophobic advisors and federal appointees.

This. Is. The. Wake. Up. Call.

I fear we are missing it.

Despite eruptions of private emotions, public protests, and hashtags du jour, in the short 11 days since the election, some have returned to their daily lives, unscathed, and continue their daily work, unchanged. Perhaps seeking emotional refuge from their liberal outbursts, they hasten calls for stability rather than quicken the pace of resistance. They find room to wait while the marginalized among us live under the threat of violence, displacement, internment, and the insidious affront to their rights and their America that is hate speech and hate crimes that go unacknowledged and unatoned. This form of liberalism is privilege incarnate. It is the white tears that dry quickly, the fickle fetish of media sensationalism, the limited attention that only spans the interests and people that look and feel like “us” or “them,” and the normalization of public exclusion in the most powerful democracy in the world.

There is literally no time to waste. And every moment a “liberal” person, organization, or institution spends calling for caution in place of critique, pause instead of preparation, and waiting as opposed to imminent action are lost opportunities to defend the values and people liberals’ claim to hold dear.

This includes hospitals, and other public entities erected in service of community. “Carry on” attitudes that simply re-assert an existing mission without delineating concrete plans to defend or extend that mission should allied populations be endangered, are frankly not enough. And should employees fall victim to local or federal aggression, they offer no protection at all. If progress relies on accurate recognition of the problems, “carry on” stances silence the uncomfortable realities, conversations, and sacrifices required to look those problems in the face.

It is not alarmist to get prepared. And that preparation entails mobilizing the volume of resources necessary to support a diverse set of populations who now worry for their safety and security in this country. If the urgency of that need is somehow lost on you, don’t hide behind your liberal leanings and co-opt progress.

To Plan:

  • Place those most affected in positions to advise and lead how organizations respond to new needs or evolving threats facing the populations it serves.
  • Anticipate the needs of clients or patients with intersecting identities and consider forming coalitions with organizations best equipped to serve needs that may fall outside given expertise or capacity.
  • Vulnerable populations can be employed in positions that offer the least schedule flexibility. Consider adjusting those constraints as needs to care for family may rival needs to be present in the workplace.
  • Consider a buddy system or a phone tree between employees to increase the visibility of those worried about their ability to get to and from work safely.
  • Consider creating a safe space for affected employees to seek emotional or legal counsel should the need arise.
  • Consider supporting organizations that champion the needs of the marginalized with donations or service, and if possible, reflect their needs in joint legislative agendas.

The challenge liberals are facing is a kind of active democracy many have never known and it may be painstaking and overwhelming. It is also a burden people of color, the LGBTQ community, immigrants, and other marginalized groups have carried, often silently and alone, for years, centuries, as the spaces to publicly express, wear, and own their person-hood is narrowed.

Vigilance is too often inherited through wounds endured. For those who now find themselves unaffected or disaffected, it is time to ask, how many wounds must be sustained for you to move from the waiting room to hold space for action?

 

Community Benefit and Community Exploitation

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In the US, we live in a world of limited public resources and yet massive investment in healthcare services. Healthcare spending accounts for almost 1/5th of our country’s entire GDP. When compared to other peer nations, that huge expense significantly limits how much we can spend on social services. Now, there are 2 important programs that allow medical systems to pay for social services. One is old and one is new.

The old program is called Community Benefit. It requires non-profit hospitals, which make up almost 8 out of 10 hospitals in the country, justify their tax-exempt status by sharing the benefits of that status with the communities they serve. The new program is a Medicaid Waiver Demonstration or an opportunity for states to apply for money to meet the health needs of their population in innovative ways that include supporting community-based social services.

Sadly, both programs may result in hospitals keeping the money! And more than supremely selfish, it seems deeply problematic, inequitable, and yes, oppressive. I’ll explain.

Historically, only 15% of Community Benefit funds actually make it back to the community. Most are spent in-house, to reimburse charitable patient care. Additionally, some states are considering using their Medicaid Waivers to build social services inside hospitals, instead of supporting existing community-based programs.

Hospital systems will probably cite a myriad of reasons to build their own suite of social services rather than rely on the community. Some of those reasons may even sound credible. For example, some healthcare systems will likely point to a lack of community capacity to handle the volume of need this funding will generate. Because if we know anything, it is that if you pay hospitals to do something, they are going to get really good at it, and here that means potentially identifying more individuals who need a service than there are services to provide them.

But it has to be recognized that “lack of community capacity” doesn’t happen in a vacuum. It occurs as a direct result of the resource scarcity engineered by systems siphoning funds away from neighborhoods and public spaces back into conglomerate enterprises, like hospitals and large medical systems.

Similarly, concerns regarding scale when large systems must interface with a diverse network of community-based social service providers, highlight the dysfunction of the system, not of the smaller players, as may be assumed. The onus for adaptability must always lie with the more resourced-partner, which in this case is the hospital. That means when certain referrals are difficult or meet a dead-end, hospitals will need to provide resources to help community-based organizations figure it out. Note that here the hospital is providing the money, staff, or training, but not driving the actual process by which communities determine how they want to be served.

This is the transformation. This is the re-design.

Payment reform does not simply challenge the conceptual ways we pay for care, it challenges the very notion of relationship between providers, care systems, and the patients, communities, and neighborhoods they serve. That relationship has been historically strained by competing financial priorities, exploitation of people and communities of color, and the commodification of disease to the extent that it bankrupts people and devalues holistic notions of wellness.

The solution then, is not to further strain this already charged relationship by usurping the role of community members and community-based organizations in serving their own needs. But, to admit the ways in which our instinctual preference to reinforce our walls, tears theirs down. To acknowledge the ways our desire to have more power in the shaping people’s lives, even if for the better, may minimize an individual’s power to shape their own life. And to confront the ways medicine historically and currently contributes to gross wealth and racial inequity in this country, through exorbitant costs of care and limited workforce diversity.

At their best, programs like Community Benefit and Medicaid Waivers are a foremost way to redistribute wealth in the United States through the healthcare system. That is a powerful imperative in these times of great inequity and those of us who understand that, must hold our field accountable for proceeding with humility and most of all integrity, when distributing these vital funds.

My Anger

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Although I write a blog that centers people of color in exploring the connections between the medical system and race  – an activity that has always been fundamentally personal – I rarely discuss how it personally affects me.

The occasions in which I have, were driven by my need to make sense of Trayvon and Walter, Tamir and Freddie and to reconcile their lives with how I move in my life, as a black physician. But there is no sense to be made of state-sanctioned murder and each time I left the task weary with emotion.

I used those emotions to power 6 months of writing and editing my first submission to Pediatrics, the most important academic journal in my field, on police violence; both begging and demanding this type of violence be considered a devastating threat to public health and safety for children of color. The first comment my co-authors (also black women) and I were asked to address was what the editors called our “anger” and the last was to “say something nice about the police.”

Here I was, asking to be seen; asking for black children and families to be seen; but having to respond to why I don’t see police and why what a white man perceives as my emotion, is a problem to be addressed, in writing. My emotion. That they named anger.

To be labeled angry and asked to publicly disavow said emotion for professional legitimacy was nothing new, for me, my co-authors, or centuries of black women accosted by the limited public characterizations of our person-hood. But when they named my emotions anger, did they also name my tears? Did they name the deep humiliation I processed to explain, to a pediatric medical journal, why the deaths of black parents and children should be a priority?

Did they furiously, nauseatingly, mind-numbingly, cry over the public executions of their people? Did they choke and swallow those emotions back everyday just to function as a productive adult in the world? Did they wake to bury the devastation that allows them to hold academic conversations about the threats, challenges, and disparities that may amount to the extinction of their people?

In medicine, if we talk about racism at all, we talk about how it is unfair – but no ones fault really. Short of bias training that validates a generalized lack of explicit accountability – we primarily do nothing. It is as if medicine thinks the solution to centuries of systematic racism and racial inequality that continues to poison black bodies, young and old alike – through public divestment, disease and varying degrees of despondency – is self-reflection.

But it is killing us.

Racism. Is. Killing. Black. People.

Sometimes I feel the poison in me. Squeezing my chest in anxiety, fear, or fury as I navigate the complex terrain of my public female black-ness, trying to wear my emotional and intellectual complexity in a way that at best, allows me to be seen but at least, prevents me from being dismissed altogether. The daily work of avoiding the silencing that accompanies being mistaken as simply an “angry black female” while also finding safe spaces to be a black female who can hold anger and the emotional complexity inherent to full humanity – is an extra job, that I do, at my regular job and on vacation.

Sometimes I see the poison in my family, as they do the work of making space for their whole self in a world that can easily, effortlessly limit them to an assumed identity. I watch them negotiating other people’s comfort in an exhausting performance of excellence and I understand the raw pain blackness chafes on their humanity.

Racism excludes black people from public goods and private sympathies. It is the root cause of health disparities, the education gap, the wealth gap, the gender wage gap for black women, and the unconscionable incidence of institutional violence against black bodies.

And in so much that medicine ignores that root cause, it is and will remain complicit in the maintenance of institutional racism, both inside our walls and out.

So just in case you have wondered or are wondering, yes, I am angry.

I feel intense and unapologetic anger. But know, my anger isn’t the poison, racism is.