Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 5018, Cincinnati, OH 45229, USA.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Curr Probl Pediatr Adolesc Health Care. 2021 Oct;51(10):101087. doi: 10.1016/j.cppeds.2021.101087. Epub 2021 Oct 25.
Racism- a system operating at the intrapersonal, interpersonal, institutional, and structural levels- is a serious threat to the health and wellbeing of children and adolescents. This narrative review highlights racism as a social determinant of health, and describes how racism breeds disparate pediatric health outcomes in infant health, asthma, Type 1 diabetes, mental health, and pediatric surgical conditions. Key examples include the association of residential racial segregation and the alarming infant mortality rate among Black infants as well as the role of redlining and discriminatory housing practices on asthma morbidity among Black children and adolescents. Furthermore, inequitable care practices such as (1) racial and ethnic disparities in insulin pump usage in patients with Type 1 diabetes, (2) lower rates pharmacotherapy initiation in racialized children with mental health disorders, and (3) decreased pain medication management and confirmatory imaging in Black children with acute appendicitis, highlight the role of interpersonal racism in propagating poor health outcomes. An urgent call to action is needed to address pediatric health inequities and ensure all children can live healthy lives. Key strategies must tackle racism at the individual, institutional, and structural levels and include building a diverse workforce, prioritizing research to describe the impact of racism on pediatric health outcomes, initiating improvement efforts to close equity gaps, building community partnerships, co-designing solutions alongside patients and families, and advocating for policy change to address the social conditions that impact children and adolescents of color.
种族主义——一种存在于个人、人际、机构和结构层面的体系——严重威胁着儿童和青少年的健康和福祉。本综述强调了种族主义作为健康的社会决定因素，并描述了种族主义如何在婴儿健康、哮喘、1 型糖尿病、心理健康和儿科手术状况等方面造成不同的儿科健康结果。关键示例包括居住种族隔离与黑人婴儿惊人的婴儿死亡率之间的关联，以及红线政策和歧视性住房做法对黑人和青少年哮喘发病率的影响。此外，不平等的护理实践，如（1）1 型糖尿病患者中胰岛素泵使用的种族和民族差异，（2）患有精神健康障碍的种族化儿童药物治疗开始率较低，以及（3）急性阑尾炎黑人儿童的疼痛药物管理和确认性成像减少，突显了人际种族主义在传播不良健康结果方面的作用。需要采取紧急行动来解决儿科健康不平等问题，确保所有儿童都能过上健康的生活。关键策略必须在个人、机构和结构层面上解决种族主义问题，包括建立多元化的劳动力队伍、优先进行研究以描述种族主义对儿科健康结果的影响、开展改善工作以缩小公平差距、建立社区伙伴关系、与患者和家庭共同设计解决方案，以及倡导政策变革以解决影响有色人种儿童和青少年的社会条件。
