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.

Viral Violence and the Challenge for Public Safety

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As the screens we carry narrow our proximity to random and targeted acts of violence, many parents and families are rightfully questioning the impact viral violence has on shared perceptions of public safety and child health.

In pediatrics, we have long considered the link between media, violence and health.

We know kids who watch fake violence in movies or play violent characters in video games show signs of increased aggression. But what happens when the violence kids watch is real? Or when the cameraperson is only a teenager?

Today, youth can easily capture and consume real violence, in real-time, as a part of their daily routines – from snapping school violence, live streaming police violence, recording sexual violence, or sharing images of political violence. This is the new normal* and it’s more complex than the simple relationship between simulated exposures and aggression.

A child watching real violence from their cell phone now understands something tangible about the world; and a kid who records or shares violent imagery online can contribute to others understanding of the world. That elevation of the voices and experiences of youth can be extremely valuable. Indeed, in terms of activist’s movements like Black Lives Matter, the perspective of youth, magnified by social media, has become a national catalyst for police reform, criminal justice reform, and racial equity.

Yet, perpetual exposure to viral violence takes its toll – often manifest in feelings of victimization, grief, fear, intimidation, anger and sadness. And kids and teenagers may be most vulnerable to this kind of trauma because they are still developing the emotional and intellectual maturity to process troubling events. What is more, they rely on trusted adult figures to provide safe spaces in their life.

As we face these harrowing challenges, consider two thoughts:

1. While it’s okay to be protective, thoughtful and proactive regarding how youth experience and contribute to violent images online, we, as parents, caregivers, or providers, cannot simply turn a blind eye. While distressing, some images of violence advance our collective understanding, compassion, and empathy for the suffering that exists outside the walls of our private communities or our segregated social groups, and the privileges those spaces confer. In this way, confronting the visual of violence with a particular effort to center the interpretation of the events around the marginalized populations disproportionately affected, is the first step towards collective healing. And that healing begins with rigorous and vigilant public exploration of the ways systemic racism, sexism, Islamophobia, homophobia, xenophobia and intolerance threaten public safety.

2. As we live-stream our lives, we open windows to the neighborhoods we live in, the spaces where our kids learn and play, and the ways we perceive and are perceived in the world. When we don’t like what we see on the other side of that window, it can be easy to hide discomfort or insecurity with blame or shame or to create narratives that distort the humanity we witness. But each time one of us resists the opportunity to understand the burdens or experiences of another, we all move further from the co-existence necessary to bring peace.

*This is a piece I wrote with my friend and colleague, Dr. Wendy Sue Swanson, that was published in the July 2016 Pediatrics. It is available for free online for the first week of publication.

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.