Tribute & Truth: Experiencing the National Museum of African American History

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2 weeks ago, my family and I visited the National Museum of African American History.

It is said the museum was a century in the making.

When you walk in the doors, you know exactly what that means.

We happened to enter behind a black family of four. Two parents, who appeared in their mid-late 30s, and two young boys, both of whom could not have been more than 5. It was raining that day and they were all bundled up – hats, vests, scarfs, boots. Despite the aggressive gear, as soon as we got inside, off those boys ran, like they were in their own playground. While a lot of kids run everywhere they go, to see these little black boys, brothers, running free and unencumbered in this building, their building, on the National Mall, erected to honor their ancestors, standing in honor of them, was the perfect prelude to what lay before us.

The whole day, we saw babies and watched children, crawling, running, sitting, climbing. Like the little one, maybe 3, who walked up, alone, and sat next to me on a bench. Together, in silence, we watched a short video about the contributions of African American athletes. Shortly afterwards, his father and brother arrived, obviously happy to have found him. But there he was, drawn to the images, sitting still and watching intently, as people who look like him did great things. I can’t imagine what the moment felt like to him. Perhaps it was simply another age-appropriate act of independence and environmental curiosity. But sitting next to him, the moment felt full and hopeful.

But it wasn’t just the young who captured the moment, it was also the elderly. Those who entered the museum with canes and walkers, who moved with the support of their family or church or neighbors. Those draped in t-shirts commemorating their visit, who traveled across states just to be there.

I think of one woman in particular.

She walked slowly, with her weight heavily upon a cane, her white hair curled, her lips peach with pigment. A women who seemed like her daughter walked at her side, supporting her, and a young woman, maybe age 20 or so, walked in front of them guiding them towards an exhibit on Greenwood in Tulsa, OK. The walls were flanked with images of a town that looked ravaged by a natural disaster. The air in the small exhibit felt thin and heavy. You stood, surrounded, by a town decimated in ash. Only the actor was not an unruly Mother Nature, but rather the destructive, unpredictable, and irrepressible swell of White Supremacy that leveled, literally burned, an entire neighborhood, notably one of the wealthiest black neighborhoods in the country at that time, to the ground. As I stood, solemnly confronting the wall-sized photos and recovered personal items, next to what appeared to be a family of women, I watched as the elder asked the youngest to read the inscriptions to her. I don’t know if it was the photos, the women, or the collective recognition of what black people have endured, suffered, and lost in this country they have called home – but I cried openly there. Left my tears, my heart, my gratitude, to those women, to that place, to the grit that rose from those ashes to trouble and inspire me.

My experience of the newest Smithosonian museum was captured in small moments and big. Moments when I stood shoulder to shoulder with history and watched as the future crawled along the floor, with a certain mix of joy and pride I can only remember having felt so vividly the morning after Barack Hussein Obama became President of the United States. There was a palpable shift in the world as this black girl turned black woman saw and was seen. Standing with my family only added to the consequence of the moment.

As science, history, literature, the arts, and public consciousness inch towards full acknowledgement, engagement, inclusion, and elevation of our presence, our personhood, our importance, and our centrality in the American experiment, this building will stand in tribute and truth. The gift is our ability to return to it, in reverence and expectation, to share that truth with our future generations.

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Towards Equity-Centered Care

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A “Health in All Policies” framework has been touted in the past few years as a strategy to illuminate the intersections between public health and other areas of civic life. It’s one way to incorporate health metrics into existing and proposed public policy – from education to transportation. But the question is, will it work?

It seems fairly obvious that health-centric framing may obstruct interdisciplinary collaboration. But at a more fundamental level, will replacing multivariate, silo’d interests with the singularity of health effectively capture the complexity necessary to create shared agendas across public sectors?

The short answer is no. Here’s why and how we got here.

The former structure of medical education and training was rooted in the idea that the greatest knowledge in medicine was best revealed through individual patient inquiry and the greatest challenges in the field were best understood and addressed through individual clinician excellence. So clinicians were evaluated based on their individual aptitude, patients were assessed based on their isolated symptoms, and each sector of the health and human service network operated in silos, training and treating pieces of the problem, without ever quite appreciating the inter-connected whole.

This paradigm of education and practice placed clinicians at the center of care and patients and allied partners at the periphery. Allied learners were taught separately and systems communicated poorly, both of which resulted in fragmentation – in how problems were evaluated and in how care was delivered.

A more recent iteration of this care ecosystem, like the “Health in All Policies” approach, now places patients and health at the center of delivery models and public policy strategies to treat disease and advance wellness. These patient-driven, health-specific metrics ensure that systems are oriented to serve and public policies are structured to mitigate health impacts.

However increased focus on individual patient outcomes may obscure population-level drivers of health disparities and unilateral dependence on health as the primary outcome, may ostracize allied disciplines, institutions, and learners whose work or study contributes to advanced understanding of human behavior and the complex relationships between structural environments and the pathophysiology of disease.

The bottom line is: the intricate problems that threaten child and community health will not be solved by the individual capacity of excellent clinicians or public servants, but rather by the ability of leaders to organize interdisciplinary teams that learn, work, communicate ideas, translate interventions, and are evaluated across shared infrastructures, in the service of shared outcomes.

If identifying health as the primary outcome of interest or individual patients as the primary drivers of systemic priorities, alienate important partners and dilute the input of minority populations, it is time for a new centering principle. In my mind, that principle should be equity.

Placing equity at the center of the care ecosystem ensures each sector of the health and human service network and each provider and recipient of care has a role and contributes to the shared societal realization of public safety, economic security, and wellness.

Shared values, like equity, are important foundations for building integrated public systems. And integrated public systems are important to create parity in resource dissemination and improve productivity through partnership with allied disciplines and institutions. Although the process of integration may generate new financial costs, it will hopefully save money on the back end by aligning incentives and improving efficiency.

In the end, equity will be the framework for the future of care and policy that aims to improve health. So as we move towards the future, let equity be our guide.

* In appreciation for their wisdom: I want to acknowledge Dr Rajiv Bhatia who’s novel work on The Civic Engine, and Dr. Damon Francis whose generously shared expertise, informed the ideas presented in this piece.*

Police and Pediatrics

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As many of you know, I took a 6-month hiatus from my blog last year to write and edit a piece on policing and pediatrics. I am excited to finally share my work entitled Police, Equity, and Child Health, that was published in Pediatrics this month! AND because this is a topic of public interest and concern, I’m also excited to announce the journal has agreed to allow free access to the piece online for the entire month of February! Check out the pdf version here and feel free to share your comments below. I can’t wait to hear what you all think!

For me, this issue is personal and writing and defending this piece for the past 6 months has been incredibly emotional. But it has also been one of the most rewarding experiences of my early career and I only hope to continue to push myself and my field to consider and engage issues that uniquely and disproportionately affect the health and well-being of children and people of color. To use a line from Black Lives Matters co-founder, Alicia Garza, at its best, this piece is a love letter, and I hope those who read it feel my deep love for my people and my people feel loved and cared for by me, and by proxy, by my profession.

I also want to publicly acknowledge and thank my mother, Avis Boyd, who reviewed every word, every line, and every intention of this piece. She is the backbone that kept this piece afloat when biting critique wore at my resolve. For this and everything, she is everything.

Last year, when Walter Scott died, I pleaded in exasperation, for my colleagues and my field to consider his death and the death of other young black folks an affront to our professional commitment to promote health. But it wasn’t enough. And although these words were powerful for me to write, they will not be enough either.

So I’ve also drafted a resolution to the American Academy of Pediatrics’ Annual Leadership Forum taking place this March, where the academy sets the agenda for child health for the coming year. The resolution is #71 The Impact of Adverse Police Exposures on Child Health and it urges the academy to both advocate for community and school policing policies that place children’s health first and to research and fully articulate the disproportionate impact children of color face from adverse police exposures.

If you are a pediatrician or a student member of the American Academy of Pediatrics, click here, to comment on and support this resolution, bringing the issue of policing and pediatrics across the country and helping the academy take an important step to better serve children and families of color.

If you live in the San Francisco Bay Area and are interested in joining a local coalition seeking to understand and address how police practices and policies can protect, promote, or harm health in our community, leave a comment and I’ll add you to our email list.

Happy Black Futures Month!

Black on Black Crime: Let’s Talk About It

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After publishing a few pieces on police violence, public health and safety, I received a number of comments asserting the “real” problem is black on black crime. I get this a lot.

So let’s talk about it.

According to the numbers, the most recent of which come from the FBI’s 2014 crime report, the critics are right. Black victims of homicide were overwhelmingly killed by black offenders. This occurred in almost 90% or 9 out of 10 homicides and includes both male and female victims and offenders.

BUT…

This is also true of white on white crime.

In fact, most victims of homicide are killed by someone of the same race or ethnicity. For white people, more than 8 out of 10 homicide victims die at the hands of another white person. And though Latinos have the highest rates of inter-ethnic homicide, 7 out of 10 victims still succumb to a fellow Latino.

So while it is true that black on black crime accounts for most black homicides in America, racial congruence between homicide victim and offender is hardly unique to African-Americans.

What is unique is the rate at which African-Americans are killed by police.

Let’s review the evidence.

Most data on police-related deaths come from the FBI and Bureau of Justice Statistics. The FBI counts deaths they term “justifiable homicides” or incidents in which the victim was a felon shot in the line of duty. The Bureau of Justice Statistics data is more robust, in that it includes deaths resulting from any use of force while a civilian is in law enforcement custody.

However, these agencies have been criticized for generating unreliable and out-dated data. For example, the exact number of “justifiable homicides” are difficult to pinpoint in any given year, because the tally relies on precinct reporting that is largely voluntary and often incomplete. And the Bureau of Justice Statistics’ most recent metrics are from 2009, and have since been replaced by the Death in Custody Reporting Program, whose latest data is from 2012.

This lack of accurate data clouds the public’s ability to understand the racial context surrounding recently publicized police-related injuries and deaths, and may be leading some to short-sighted conclusions.

The good news is, people are working on it.

Powered largely by news reports, social media announcements, and civilian tips, crowd-sourced databases and other open access portals are keeping public records on incidents of police violence and most importantly, providing real-time, interactive access to the critical numbers necessary to appreciate the size and scope of the problem.

But one database in particular, Mapping Police Violence, is leading the way in illustrating how this issue uniquely affects African-Americans.

Here are 3 moving charts from their work which chronicles police violence from

January 2013 to Dec 29, 2015.

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These findings are alarming. But what is more disconcerting are assertions that the deaths of some Americans are not “real” problems because those same people face additional threats to health and safety in their communities.

It is certainly easier to indict “cultural” pathologies instead of confronting systems that serve us – systems we pay for and participate in – to demand for our neighbors what we demand for ourselves. But the legacy of racism that results in poor, communities of color suffering heightened risk of violence, displacement, and resource scarcity, continues to structure vital access to justice and safety.

Thus, perhaps the “real” problem is our collective inability to feel empathy on behalf of communities facing complex and compounding traumas, traumas we contribute to through our general apathy for a people and their color.