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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Walter Scott and a Pediatrician’s Conscience

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The recent killing of Walter Scott was another brutal reminder of the home African-Americans wake to daily. Their America, is one where your father might not come home at night, because his brake light went out and that cost him his life. It’s a place where petty crimes are penalized by life sentences, doled out on the streets by the very men and women charged with their protection. But too often, they don’t find protection. And black men and boys are left lying there, without aid or comfort, in a pool of their own blood, for all to see the boundaries of permissible police conduct.

For there is no crime too small for which black fathers and sons may face imminent death. For some, death may merely be a traffic ticket away. And for others, no crime is even necessary. Simply disobeying social expectations, or committing crimes against the social order, can threaten an African-American’s life, if one encounters the wrong officer or wrong neighbor, wearing the wrong hoodie or playing with the wrong toy. For them, their public presence can be a justifiable cause for homicide and their assailant may not even face trial.

So as the death toll rises, the leading cause of death for black males aged 10-24 fails to shock anyone – it’s homicide. But you might be surprised to know that doctors are doing little to nothing about it.

In the wake of Sandy Hook, the response from physicians, and pediatricians in particular, was astounding. But as boys who could be my sons and men who could be my father, lie in the street, week after week, the medical profession is silent and I’m frankly appalled.

These deaths should weigh on every physician’s professional conscience. They rip into the very fabric of our degree and challenge the meaning of practices essential to modern medicine – harm reduction and disease prevention. If we, as a field, fail to even acknowledge the lives lost, let alone devise systematic interventions, at a certain point, we fail to honor the oath of our practice and to serve the core of our professional obligations.

Targeted police violence against African-Americans is a public health problem and it uniquely affects children. Yet to this date, there has been no public statement on behalf of the American Academy of Pediatrics, or any other professional medical association to my knowledge, recognizing the tragic deaths of African-American men and boys across this nation. So while my lone voice is hardly sufficient, I offer these words as a part of my professional responsibility to care for the lives of all my patients, big and small.

  • The toll police killings take on black families, including those not directly involved in the events of violence, matters and the chronic stress it generates may adversely affect family dynamics, community safety, and the mental and physical health of African-Americans of all ages.
  • Adolescents, both male and female, commonly participate in risk-taking behaviors as a part of their development as youth. Those same behaviors can have significant and lasting costs for African-Americans, as they may suffer higher rates of arrest, incarceration, and death.
  • Efforts should be taken on behalf of physicians caring for black families to discuss the toll police killings have on health. If there is concern for impending danger, appropriate referrals to local authorities and community organizations should be sought on behalf of the physician, nurse, or medical staff.
  • Preventative health screening guidelines for children and adults should include risks of gun violence, including police violence.
  • Training will be needed for physicians to appropriately discuss these concerns with families, screen youth for risk behaviors, and refer at-risk individuals to further services.
  • Funding for clinical interventions to address police killings should also support local organizations that work to decrease community violence.

Too many parents tuck their children into bed, only to worry that tomorrow, their curious 10-year-old may be the victim of police-related violence because the combination of a growth spurt and black skin threatened their life. Too many physicians either don’t know that, or don’t care. Because I’d have to imagine that if we knew and cared, we’d be doing something very different in medicine.

This is my plea for us to do something different. Silence is not okay. This is our responsibility, just as it is for all Americans to re-think what these deaths mean for our society. Because if this legacy of violence isn’t weighing on everyone’s conscience, we are all doing something wrong.

The Arc of Injustice: How Racism Kills

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The tragic deaths of Oscar Grant, Michael Brown, Eric Garner, Tamir Rice, Walter Scott, and untold others, deeply grieve our national conscience. But more black men die in America from heart disease than from police brutality, and we never mention those parallel realities in the same breath, let alone collectively mourn those dead.

Why is that?

Because it’s not just that African-Americans have higher rates of heart disease and its related risk factors. It’s that being black IS a risk factor for dying from heart disease in America. Yet few connect the dots between black death by police and black death by disease, although both disproportionately take of black lives.

Just look at the data.

Evidence shows African-Americans have a shorter life expectancy and higher rates of illness and disease than any other racial or ethnic group in the country. Even black babies are more than twice as likely to die before their 1st birthday than other infants in the US. Considering America’s overall infant mortality rate ranks behind its first world peers, that finding is far from benign. In fact, it makes African-American babies less likely to survive the first 12 months of life, than babies born in Botswana, Cuba, or Kuwait; to name a few of the 94 countries who have better infant mortality rates than black newborns in the United States.

And these gaps are far from new. Back in 2004 Congress asked the Institute of Medicine to investigate these racial disparities. After reviewing more than 100 studies,

“The committee was struck by the consistency of the research findings [that] indicated minorities are less likely than whites to receive needed services, including clinically necessary procedures.”

For almost every disease studied, black patients received less effective care than white patients, including routine treatments for common health problems; from cancer and diabetes to, you guessed it, heart disease.

Now, I know what you’re thinking. Just because African-Americans are disproportionately sicker and die younger, doesn’t mean common medical practice added to the disparity, right?

Wrong. Titled Unequal Treatment, the authors concluded,

“(Al)though myriad sources contribute to these disparities, evidence suggests bias, prejudice, and stereotyping on the part of healthcare providers may contribute to differences in care. “

There is something about being black in America, that places African-Americans at increased risk of death; and that something is a quantifiable systemic bias.

So while it is important to scrutinize policing practices that disproportionately harass and kill black males, we must also critically appraise equity in health and healthcare.

How else will we explore the extent of the injustice weathered by Eric Garner who ultimately died of a heart attack? Police training may prevent his unprovoked asphyxiation, but it would do little to address an already shortened lifespan. And yes, the banned chokehold and subsequent failure to indict seemed unjust, on the surface. But is it right to invoke Garner’s haunting last words as a rally cry, if we ignore the inequity that may have pulsed beneath the surface?

And how can we learn from Darren Wilson’s description of Michael Brown as a “demon…bulking up to run through the shots, like it [made] him mad that I [shot] him”? Could the former officer’s misinterpretation of anguish, on the face of a black youth who sustained multiple gunshots, be related to medicine’s well-documented racial disparities in pain management? Because in healthcare, data indicates black children and adults are less likely to have their pain accurately perceived and appropriately treated; and this mistreatment limits medicine’s ability to protect and serve black patients well.

In reality, the threat of police violence that endangers black lives is intimately related to the threat of death and disease that disproportionately burdens communities of color. These are not isolated issues. Together, they tell of a nation that remains profoundly influenced by race, from the mandates of justice to the delivery of healthcare. In time, that influence ceases to publicly alarm. So while some black deaths are made a media spectacle, the vast majority go unacknowledged and unaddressed; the collective impact of which subtly normalizes inequity and codifies injustice.

In the end, there will be no justice without accountability. To save black lives, we have to change how we think about black life – not just how or if, it matters, but where and when, it is most at risk. Now the arc of injustice includes the well-intentioned and malicious alike, each of whom may harbor attitudes and preferences that ripple across systems and threaten the lives of people of color. These threats expose the reality that racism kills and the death toll is much greater than you think.

On Ferguson: A Call to Medicine

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There is little to say once you’ve said this before. Although the sadness brings fresh tears, they are also old tears. The grief becomes familiar and so too the inevitable resumption of everyday life. The pain bores to the soul but settles in the subconscious, where it rests, privately born and quietly hidden, lest frustration and bitterness mire the work we do – trying to forget, but ever-reminded. So although there is nothing new to say, perhaps there is something new to do.

Here, I am looking squarely at you, my fellow physicians. We, who deal in health and disease must think critically and act effectively to address the issues raised by the death of Michael Brown and those who came before him. We are the trusted public servants charged with protecting the populations in our care, to promote health and prevent and treat disease. But are not health and disease simply the crude boundaries of life and death? Then, how will we move to protect the lives of black and brown youth that are threatened by violence? How will we confront the reality that the #1 cause of death for black males aged 10-24 is homicide? What are we doing about the death rate for young black males that is the highest among all adolescents in America? Black male teenagers are 37% more likely to die than any of their peers. And according to the CDC, because these deaths are secondary to external injury, they are by definition, preventable.

So I will ask again, what are we doing about it?

Because, despite the vaccines given to ward off the threat of disease, and the medications prescribed to prevent seizures, kill cancer, and treat infections, black males may not make it out of adolescence alive if we don’t address the violence.

In preventative medicine, we talk about risk factors to identify patients who may suffer from an illness in the future, and prevent it, before suffering and/or death could ever occur. In oncology, we talk about getting to the diagnosis and treatment early, so that in cases where it makes a difference, everything that can be done, will be done. And yet, as black youth die in the streets because of where they live, and how they dress, and the volume at which they listen to their music, we are silent. We, as a collective field, say nothing and we do nothing.

Black lives matter because all lives matter and no one gets that more than we do. So as young black bodies line our streets without reason or recourse, we must start asking what that means for all of us. We must start changing the way we teach and practice medicine. Because if we fail to protect these youth, because we don’t understand their music, or we don’t like the way they dress, or we don’t feel comfortable with the way they speak – whatever the because – then we fail ALL of our youth. We fail to do service to the highest honor of our profession, to protect the lives we care for.

Now, this issue is complicated and deeply rooted in the legacy of discrimination that defines American history and continues to inform America’s present. And you may even avoid talking about it in your personal life, let alone your clinical practice. But your, or my, discomfort does not make it any less our responsibility.

So let’s start dealing with it. I’m talking about poverty. I’m talking about racism. I’m talking about structural inequality. I’m talking about the gender wage gap, the academic achievement gap, and the housing equity gap so wide whole generations fell in and got lost. It is time to engage these topics as legitimate and enduring parts of medical education, public health messaging, and clinical prevention strategy.

No excuses.

If you don’t have the faculty to teach this material, call upon our colleagues in the social sciences to share their expertise. If you don’t know how to address community violence, reach out to non-profits who have made this struggle their life’s work. And if you shy away from the institutional failings that underlie the policies that contribute to the disparities, then call on your local, state, and federal policy makers to change the law.

There is literally no time to waste. Every faceless, nameless brown child who drops dead in the streets could have and should have been prevented. Let this issue not settle in the subconscious recess of our field while children suffer. Because in the end, it is not about Ferguson, it is not about Michael Brown, it is not about the countless others who met a similar fate, it is about what we are doing to ensure that all lives matter, regardless of the color of that life’s skin.