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?

 

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!

Police Violence and Public Health

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In the wake of Sandy Hook, the response from physicians, and pediatricians in particular, was astounding. The tragic deaths moved doctors to address gun violence and its health consequences.

But week after week, as black boys who could be my sons and black men who could be my father, are shot and killed by police, doctors remain silent. As a pediatrician, I’m appalled.

We are watching a public health problem unfold in front of us and we aren’t doing anything to stop it.

When someone is involved in a police shooting, they are at risk for injury, disability, and as we’ve seen, death. But those who witness the trauma may also be affected. And if they are children, that effect may follow them into adulthood.

Public police shootings turn neighborhoods into minefields where African-Americans fear suddenly finding themselves in harms-way. Those who escape the line of fire are then victimized by the ever-present fear of harassment, incarceration, injury or death.

Like the trauma experienced by war veterans, living under the threat of unprovoked police violence triggers intense emotional and physical stress, even in moments of relative safety.

The chronic stress that fear generates, may place African-Americans at increased risk for health problems like heart and lung disease, and depression.

If we’re going to understand and address the impact police violence has on community safety and health, particularly for communities of color who are disproportionately victimized, we have to treat it the way we treat all threats to health. That means collecting data to quantify the magnitude of the problem, developing screening guidelines to identify those at risk, training medical staff to refer those at risk of impending danger, and funding interventions that address community violence including police violence.

Tonight, too many parents will tuck their children into bed, only to worry that tomorrow, their curious 10-year-old may be the victim of a police shooting because the combination of a growth spurt and black skin threatened their life. Today, we have to do
more to recognize the worry in our community and prevent those fears from becoming reality.

* This piece was featured on Northern California’s NPR affiliate KQED as a perspectives piece. It airs live on April 29th at 6:43am, 8:43am, and 11:30pm. To hear an audio reading of the piece on KQED’s website, click here.

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.