Anyone still there?

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Blog Fam –

You were the first platform that welcomed my critical analysis on the intersections of racism, health, and justice. You helped me hone my voice and you watched me grow. I’m so grateful for this little blog in my tiny corner of the internet and all it has taught me. And I wanted to let you know I’m still here. But lately, I’ve been fortunate to be invited to share my voice on bigger platforms and sometimes even in front of a live audience(!) So I just wanted to pop up and say, thank you for rocking with me and in case you’re still following (thanks Ma and Pops for always following!) here’s a rundown of some of the things I’ve been up to.

1. In June 2018, I wrote a commentary for The Lancet on a landmark study exploring the mental health impact of police violence. If you haven’t read this study, read it! It provides rare causal evidence that police killing unarmed Black Americans caused poor self-reported mental health in Black Americans who live in the same state. This effect did not require Black Americans to witness the event, live in the same neighborhood, or be a close relative to victim(s). Black people merely had to live in the same state as victims to experience the mental health impairment. The researchers estimated the magnitude of the mental health impairment was so high, it was comparable to the mental health burden of having diabetes. Meaning, Black Americans are so affected by policing killing unarmed Black Americans in their state, they have almost as many poor mental health days as individuals who actually have diabetes! I wrote a twitter thread that summarizes the paper’s major takeaways, in case you are short on time. Anyways, here’s a link to my commentary entitled, Police Violence and Built Harm of Structural Racism (and it is still free to view!)

2. In June 2019, I wrote an essay for The Lancet entitled, The Case for Desegregation, (which is free to view!) that essentially offered that the US health care system doesn’t have a problem with diversity, it has a problem with segregation. I also wrote a twitter thread on the topic for those who like short summaries.

3. In July 2019, the American Academy of Pediatrics (AAP) released it’s first policy statement on racism’s impact on child and adolescent health! To mark the historic occasion, I was honored to be among those asked to write a blog on the topic. I chose to write on what it means that a policy statement like this was published in 2019 and where pediatricians and child health advocates have to sprint next (spoiler: to address the child health impacts of police violence). Here’s a link to my piece on the AAP’s Voices Blog The Weight of the Little. And my twitter thread on it.

4. Last month (October 2019), I was invited to be the keynote speaker for the Data-Across Sectors for Health (DASH) All-In Conference. DASH is apart of the growing data infrastructure in health care that is also focused on equity and public health. So it was a real honor and dream to be invited. But it was also a real challenge. It’s one thing to talk about racism and health in my tiny corner of the internet. But it’s quite another to get up in front of a room of people, look them in the eye, and say let’s talk about white supremacy and how it hurts people (which is one of the many points I made in the talk). So here’s a link to the video of the presentation and slides. And no, it doesn’t have a twitter thread 🙂

Okay, those are some of my recent highlights. Thanks again for rocking with me on here and more soon!

Rhea

 

 

The Most Important Questions We Won’t Answer For You

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My fellow pediatrician and friend Nia Heard-Garris and I wrote a piece on medium about how White Supremacy and anti-Blackness show up in medicine and how to start the conversation.

Check it out here and let me know what you think!

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.

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.*