The Impact of Racism on Children’s Health

The Impact of Racism on Children’s Health

A new statement from the American Academy of Pediatrics looks at the effects of racism on children’s development, starting in the womb.

 

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CreditEdwin J. Torres for The New York Times

This month the American Academy of Pediatrics put out its first policy statement on how racism affects the health and development of children and adolescents.

“Racism is a significant social determinant of health clearly prevalent in our society now,” said Dr. Maria Trent, a professor of pediatrics at Johns Hopkins School of Medicine, who was one of the co-authors of the statement.

Racism has an impact on children and families who are targeted, she said, but also on those who witness it. “We call it a socially transmitted disease: It’s taught, it’s passed down, but the impacts on children and families are significant from a health perspective,” said Dr. Trent, who is the chairwoman of the A.A.P. section on adolescent health. Social transmission makes sense here, because race itself is a social construct, she said: “Genetically, we’re very much the same.”

But the impact of bias on children’s health starts even before they’re born, Dr. Trent said. Persistent racial disparities in birth weight and maternal mortality in the United States today may in part reflect the deprivations of poverty, with less availability of good prenatal care, and poorer medical care in general for minority families, sometimes shaped by unacknowledged biases on the part of medical personnel. High rates of heart disease and hypertension also persist among African-Americans.

There is also increasing attention to the ongoing stress of living with discrimination and racism, and the toll that takes on body and mind throughout life.

That kind of chronic stress can lead to hormonal changes and inflammation, which set people up for chronic disease. Studies show that mothers who report experiencing discrimination are more likely to have infants with low birth weight.

Dr. Nia Heard-Garris, an attending physician at Ann & Robert H. Lurie Children’s Hospital of Chicago, was the lead author of a 2017 review of research studies looking at the impact of racism on children’s health. Too often, she said, studies control for race without considering what experiences are structured into society by race.

The experiences that shape parents also resonate in their children’s lives, Dr. Trent said; parents and caregivers who reported they had been treated unfairly were more likely to have children with behavioral issues such as attention deficit hyperactivity disorder. In another study, African-American boys from 10 to 15 who had experiences with racism were more likely to have behavior problems like aggression. During childhood, she said, stress can create hypervigilance in children who sense that they are living in a threatening world.

And though the A.A.P. has been preparing the statement for almost two years, it comes at a moment when discussions of racism are often in the news, and children may need extra support and care. “While I think society has made tremendous leaps, the reality is we’re seeing a bump in these issues right now,” Dr. Trent said.

The statement directs pediatricians to consider their own practices from this perspective. “It’s not just the academy telling other people what to do, but examining ourselves,” Dr. Trent said. Pediatricians and others involved in children’s health need to be aware of the effects of racism on children’s development, starting in the womb, she said.

Pediatric clinical settings need to make everyone feel explicitly welcome, with images of diverse families up on the wall and with the capacity to provide care in different languages. Those efforts can also include the reception families get at the front desk — and who is staffing that front desk — as well as who is seeing patients in the exam rooms.

“The toys you have in your waiting room should be multicultural,” said Dr. Adiaha I.A. Spinks-Franklin, an associate professor of pediatrics at Baylor College of Medicine. “Bring in multicultural dolls, multicultural figurines, books, videos.”

And the pediatric office needs to be a “safe space” to talk about anything that is worrying the child or the parents, such as whether a child is being bullied, or is bullying.

The statement calls on pediatricians to improve their own practices, but also to get involved in their communities. “Many of us work in education settings and then also justice settings — the goal is really community change,” Dr. Trent said, citing collaborations with emergency medical workers, for example, or advocacy for clean and safe water for the children of Flint, Mich.

“I think there are times where racism is super explicit: Somebody called my kid a name, wrote something on a wall, said something at school,” said Dr. Heard-Garris, who heads an A.A.P. group working on minority health, equity and inclusion. But children may also face more insidious bias in terms of lowered expectations from teachers.

Dr. Spinks-Franklin, a developmental-behavioral pediatrician, said that racial awareness in children follows a set of milestones. By the time children are 3, she said, they begin to recognize normal human variations, including skin color, but without assigning value to them. “A 4-year-old recognizes basic racial stereotypes,” she said. Parents need to be aware of what their children are watching, and provide diverse books and stories with strong positive models.

And then in adolescence, as children explore racial and cultural identity, they tend to show strong preferences for their own groups, sorting themselves out by table in the cafeteria.

The goal of racial identity development, Dr. Spinks-Franklin said, is by young adulthood to have a healthy sense of who you are, recognizing your own cultural group without demonizing others. But not everyone gets there.

The most harmful thing is when children internalize racism. “They see so much negativity about people like them they develop negativity about themselves,” Dr. Trent said.

As children are growing and developing, race and racism are tricky topics for parents to navigate, Dr. Heard-Garris said. She wrote an essay in the journal JAMA Pediatrics about her “4-year-old caramel-skinned son” telling her that he was white sometimes, because he had a friend in preschool who played only with white kids. “We may not always get this right — here I am, a person who studies the effect of racism on kids,” she said. “I totally missed the mark.”

[Read the A.A.P.’s guidance on discussing racial bias with children and tipsheets for parents from EmbraceRace.]

These conversations aren’t only for families of color. Dr. Heard-Garris said that one important message parents can convey to their children is, “We’re not perfect, we’re going to mess up when we talk about this, but I think it’s important that we talk about this, and please come back and talk about this when you see things.”

Children, Dr. Trent said, are watching.

“They’re watching our words, our behavior — they’re waiting for us to teach them differently for a healthy future.”

Multiracial Health Risks

Understudied Racial Minority Groups Show Alarmingly High Rates of Obesity and Diabetes

UC Riverside study highlights major health problems affecting historically ignored racial group

More than 78 million adult Americans are considered obese.Photo credit: Buclin.

RIVERSIDE, Calif. – Some of the smallest and historically neglected racial groups in the United States experience far more obesity, diabetes, and other health conditions than non-Hispanic white adults, a study by researchers at the University of California, Riverside has found.

Using data for nearly 185,000 adults from the California Health Interview Survey (CHIS), the study reports that multiracial, Native Hawaiian and Other Pacific Islander (NHOPI), and American Indian and Alaskan Native (AIAN) adults in California endure large obesity and diabetes-related health disparities that exceed those experienced by non-Hispanic white adults, and, in many cases, other racial minorities such as African Americans and Hispanics.

The study, published in the journal Obesity, is among the first large-scale, population-based investigations to explore the presence of major health disparities affecting multiracial, NHOPI and AIAN adults. Drawing from years of statewide California data, it is also one of the most accurate estimates to date of obesity-related health disparities affecting these understudied groups.

Most health data only code participants into standard non-Hispanic white, Hispanic, African American and Asian American racial categories, while excluding multiracial, NHOPI and AIAN individuals from analysis. For example, almost all health data about Pacific Islanders are grouped with Asian Americans, who tend to be healthier.

“This poses a problem because Pacific Islanders are at very high risk for poor health, yet receive few targeted services or research attention,” said Andrew M. Subica, Ph.D., an assistant professor of social medicine, population, and public health in the School of Medicine. “In general, the small population sizes of multiracial, NHOPI and AIAN populations make it hard to examine these groups individually. As a result, comparatively little is known about the health disparities of these neglected minority populations – a gap that could hide potential problems and impede the delivery of effective care.”

Andrew Subica.
UCR File

Using the CHIS data (2005 to 2011), Subica and his colleagues examined the prevalence of obesity, diabetes, physical disability, and poor/fair health in adults from each of the major U.S. racial minority groups (African American, Asian American, Latino, multiracial, NHOPI, and AIAN), and then compared these estimates to those of non-Hispanic whites, the dominant racial group in the U.S.

They found a rising trend in obesity and diabetes over time across all groups, with NHOPIs, AIANs, and African Americans reporting the highest obesity and diabetes rates. For multiracial, NHOPI, and AIAN adults, the odds of being obese were 1.2 to 1.9 times greater than for non-Hispanic white adults, and the odds of having diabetes were 1.6 to 2.4 times greater.

“What makes NHOPIs and AIANs important to study is that they are frequently overlooked and marginalized within the U.S. despite many of their native homelands or tribal nations suffering significant historical trauma and loss at the hands of the U.S. government,” Subica said. “For multiracial individuals, they compose the second fastest growing U.S. racial group, yet we know very little about their health. Our findings are surprising in showing that multiracial adults in California are quite health-poor, displaying a pattern of health disparities that is most similar to AIANs, who have the worst health outcomes in our study.”

To explain these disparities, Subica and his colleagues examined possible differences in social factors. They found that adults from every racial minority group studied had lower levels of education, health insurance coverage, and greater poverty than non-Hispanic white adults, but that these factors only partially contributed to health disparities. Subica speculated that exposure to racism and its negative health impact may play a greater role in driving obesity-related racial disparities than previously anticipated by suppressing minorities’ social and economic opportunities, capital, and health care access. More research is needed, he said, to examine the influence of racism and other race-related social factors on health disparities.

“Doctors, hospitals, public health officials, and health researchers should consider not only what our findings reveal about historically neglected racial groups and their health,” Subica said, “but also the need to learn more about their health issues and strengths in order to provide better care.”

Credit: UCR Today

Multiracial Health Study

Self-rated health among multiracial young adults in the United States: findings from the add health study

 ABSTRACT

Objective: The multiracial adult population is one of the fastest growing segments of the U.S. population, yet much remains to be learned about multiracial health. Considerable research finds racial/ethnic disparities in self-rated health, however subgroups within the multiracial population have not been consistently described.

Design: We use data from the National Longitudinal Survey of Adolescent Health (Add Health) and multivariate logistic regression analyses to compare self-rated health of multiracial and monoracial young adults (n = 7880).

Results: Overall, there were no significant differences in poor self-rated health status of multiracial adults as a single group odds ratio 0.84 (95% CI: 0.52–1.36) compared to monoracial White adults. Analyses further revealed important variations in health-status by specific subgroups and show that some multiracial subgroups may not fit existing patterns of health disparities. For instance, Asian-White multiracial adults do not fit documented patterns of health disparities and report better health than monoracial Asian and monoracial White adults.

Conclusion: This study illustrates that the inclusion of specific multiracial categories provides evidence to enhance understanding of the pathways that are linked to health outcomes and the implications for health disparities.

Medical Monday

Medical 7-18-16

Medical Monday – September 12, 2016

Medical Monday is a service of Project RACE for the multiracial community. We seek, gather, and list health articles of interest to interracial families and people of all races. We welcome health information from outside sources as long as the original source is cited.

1.   Multiracial people in Kentucky are 30 percent more likely to have asthma, according to a new report from the Foundation for a Healthy Kentucky and the University of Kentucky released on Tuesday.

 

Source: WFPL

 

http://wfpl.org/report-stark-disparities-health-outcomes-race-kentucky/

 

2.    Racial Disparities in Melanoma Survival – The majority of patients diagnosed with melanoma are white, but non-white patients have worse overall survival and are diagnosed at later stages. Greater melanoma awareness is needed in non-white populations.

 Source: Practice Update  

 

http://www.practiceupdate.com/c/42633/2/4/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_derma&elsca4=dermatology&elsca5=newsletter&rid=NTk3MzgyODQ0ODIS1&lid=10332481

 

3.    Study into black people’s health is launched- PhD student wants to understand why African Caribbeans are disproportionately affected by certain diseases

Source:  The Voice

 

http://www.voice-online.co.uk/article/study-black-peoples-health-launched

 

If you have current medical news to contribute, please email it with the source and your contact information with MEDICAL NEWS SUBMISSION in the subject line to:

projectrace@projectrace.com

Medical Monday

Medical Monday – August 8, 2016

Medical 7-18-16Medical Monday is a service of Project RACE for the multiracial community. We seek, gather, and list health articles of interest to interracial families and people of all races. We welcome health information from outside sources as long as the original source is cited.

1.   Minorities less likely to have knee replacement surgery, more likely to have complications

 

American Academy of Orthopaedic Surgeons

 

http://www.eurekalert.org/pub_releases/2016-08/aaoo-mll080316.php

 

 

  1. Morphology and Prevalence Study of Lumbar Scoliosis in 7,075 Multiracial Asian Adults

 

The Journal of Bone and Joint Surgery

 

http://jbjs.org/content/98/15/1307

3.     Diversity in the Ophthalmologist Workforce

Source:  JAMA ophthalmology

 

http://www.practiceupdate.com/c/41844/2/5/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_eye&elsca4=eye-care&elsca5=newsletter&rid=NTk3MzgyODQ0ODIS1&lid=10332481

 

If you have current medical news to contribute, please email it with the source and your contact information with MEDICAL NEWS SUBMISSION in the subject line to:

projectrace@projectrace.com

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Medical Monday

The Other Jewish Genetic Diseases

With Ashkenazic Disorders Getting All the Attention, America’s Sephardic Jews Often Lack Specialized Screening Programs

 

Randall Belinfante was a bit baffled.

KURT HOFFMAN

When he and his wife went to take blood tests in preparation for starting a family in 2003, he discovered that the screening included a panel of tests for Ashkenazic Jewish genetic disorders. But Belinfante is Sephardic.

“We told them at the time that we were not Ashkenazi, but they told us they don’t do testing for Sephardic diseases, just for Ashkenazi ones,” recalled Belinfante, who traces his ancestry to the Iberian Peninsula via the Balkans, Holland and England. “So they went ahead and did the Ashkenazi tests anyway.”

With a note of bemusement, Belinfante, who is the librarian and archivist at the New York-based American Sephardi Federation, added, “Surprisingly enough, they found we did not have any of the Ashkenazi Jewish diseases.”

Since screening for Tay-Sachs disease began close to 40 years ago, Ashkenazic Jews have dominated the scene when it comes to Jewish genetic disorders. Having been reproductively isolated for centuries — and having grown from just a handful of founders into a population of millions in a relatively short span of time — Ashkenazic Jews are a relatively homogeneous group that has inherited a host of rare genetic disorders and has proved to be a rich source of information for geneticists.

But what about the others in the Jewish community? What about Sephardic Jews? Are they also susceptible to a unique group of genetic disorders rarely shared by other groups? Does a Sephardic couple planning on having children also need to be screened for certain diseases?

“There is no disease that you can call a Sephardic genetic disease,” said Rabbi Elie Abadie, who is a physician and director of the Jacob E. Safra Institute of Sephardic Studies at Yeshiva University. Why this would be so and what this means — as is so often the case with genetics — has as much to do with history as with biology.

“Non-Ashkenazi Jews are collectively much more diverse than Ashkenazi Jews,” explained Aviva Ben-Ur, a professor in the Judaic and Near Eastern Studies department at the University of Massachusetts Amherst who authored the new book “Sephardic Jews in America: A Diasporic History” (NYU Press).

The term “Sephardic” itself often tends to obscure this diversity. At its root, the word refers to Jews who can trace their origins back to the Iberian Peninsula, but it is often used as a catchall label for any Jew who is simply not Ashkenazic. Although even many non-Ashkenazic Jews themselves may employ the label, it glosses over a diversity of communities stretching from the Balkans, to North Africa, to the Arab world, to the Caucasus and beyond. The genetic picture is not far behind.

“You can’t say ‘Sephardic genetic diseases,’ because most of the disorders are specific to the community of birth,” said Dr. Joël Zlotogora, a professor of human genetics at the Hebrew University of Jerusalem and an expert in the field of Jewish population genetics. “Moroccan Jews are different from Tunisian Jews and so on. For non-Ashkenazi Jews you have to look by country of birth.”

In Israel today, where non-Ashkenazic Jews represent a much larger proportion of the Jewish population than they do in North America, the medical establishment is very attuned to this reality. When an Israeli Jew comes for genetic screening, if the individual is not Ashkenazic, he or she is tested for the disorders known to exist among the Jews within his or her country of origin or the country of origin of the individual’s parents or grandparents and great-grandparents.

Several years ago, Israel’s Ministry of Health put up a Web site dedicated to genetics that publishes a list of disorders. A quick review of the list reveals the distinctions and distinctiveness of which Zlotogora speaks. Separate lists exist for Ashkenazic Jews, as well as for Algerian, Libyan, Tunisian, Moroccan, Iraqi, Iranian, Syrian, Yemenite, Kurdish, Bukharan, Georgian, Indian, Ethiopian, Caucasian and Karaite Jews.

There are a small number of disorders listed that are shared across several communities, in particular among Jews from North Africa. These diseases, explained Zlotogora, became common because they conferred some advantage to a person who is just a carrier — i.e. has one mutated and one healthy gene — for the disease but does not get sick. Beta-thalassemia and glucose-6-phosphate dehydrogenase deficiency (G6PD), both blood disorders that can cause certain types of anemia, are prime examples. Being a carrier for one of these diseases provides some protection against malaria.

Like their Ashkenazic counterparts, non-Ashkenazic communities developed unique sets of genetic disorders because they were isolated reproductively from the populations around them. But they were also, for the most part, isolated geographically and thus reproductively, from each other. The acceptance of marriage between relatives, even between first cousins, also contributed to the spread of some genetic mutations, as it did in the Ashkenazic world.

According to a 2001 survey by the World Sephardi Federation, non-Ashkenazic Jews account for approximately 26% of world Jewry. In Israel today, they are about half of the Jewish population. Their sizable presence since Israel’s founding has led to a growth in the study, understanding and awareness of the genetic disorders affecting their communities. “With time we have more and more disordersamong non-Ashkenazim that we are able to test for,” Zlotogora said.

Statistics on the number of non-Ashkenazic Jews in the United States are more difficult to come by. Those that do exist, explained Ben-Ur, “are not based on any kind of systematic survey.” The World Sephardi Federation survey estimates that only 4.5% of American and Canadian Jews are not Ashkenazic. But some have claimed that this estimate may be too low.

Most of America’s non-Ashkenazic Jews arrived over the past half-century from the Middle East and Central Asia. “Because they make up a very small percentage of American Jewry, much more attention is paid to Ashkenazi Jews in all areas of society,” said Abadie, who is also the founding rabbi at Congregation Edmond J. Safra in New York. This, he said, includes the area of genetic disorders.

It was just last month that the United States got its first genetic-disease screening program tailored to a specific non-Ashkenazic Jewish community. In mid-July, the Medical Genetics Institute at the Cedars-Sinai Medical Center in Los Angeles began a population-based program to screen Iranian Jews for four genetic disorders that occur with relative frequency in that community.

Beyond the program at Cedars-Sinai, however, someone trying to find information in the United States on genetic disorders for specific non-Ashkenazic communities would be a bit hard-pressed.

The American Sephardi Federation puts out a list of four diseases under the title “Sephardic Recessive Disorders,” and several Jewish genetic screening centers around the country list the same four disorders on their Web sites. These four diseases — beta-thalassemia; G6PD; familial Mediterranean fever (FMF), which causes recurrent fevers and rashes; and glycogen storage disease type III (GSD III), a severe metabolic disorder — are shared across several non-Ashkenazic communities in the Mediterranean basin and North Africa.

Yet they, too, are “erroneously called Sephardic genetic diseases,” said Abadie, because “they are diseases that manifest themselves in Sephardic Jews also.” Beta-thalassemia, G6PD and FMF are found among many populations in North Africa and the Mediterranean. And GSD III is present in other North African groups, as well.

Dr. Harry Ostrer, director of the Human Genetics Program at New York University Medical Center and a leading scholar of Jewish genetics, called this list “incomplete.”

“There is a noticeable gap in the availability of testing for Ashkenazi and non-Ashkenazi Jews” in the United States, said Ostrer, who in 2007 initiated a mapping of the Jewish genome akin to the Human Genome Project called the Jewish HapMap Project. “We’re going to have to come to grips with it pretty soon.”

When a non-Ashkenazic Jew comes to NYU’s genetics unit for screening, the staff devises a panel based on the person’s community of origin. But for some conditions it is simply not possible to find an American lab equipped to conduct the necessary test, Ostrer noted.

An informal survey by the Forward of Jewish genetic screening centers found that although many provide counseling for the four disorders commonly listed as “Sephardic,” they cannot perform the tests themselves.

“We help them, but we can’t do the testing for the Sephardic diseases through the Victor Center,” said Faye Shapiro, a genetic counselor at the Victor Center for Jewish Genetic Diseases at the Albert Einstein Medical Center in Philadelphia. The Victor Centers, of which there are three — in Philadelphia, Miami and Boston — offer screening for Jewish genetic disorders at substantially reduced rates. Their lab, however, doesn’t test for non-Ashkenazic diseases, so such tests must be sent out to commercial labs at full cost.

Shapiro went on to explain that, whereas many Ashkenazic diseases are life-threatening or very debilitating, both FMF and G6PD — so common across populations that most American hospitals screen newborns for it — can be made livable with the proper treatment and precautions. In the United States, tests for thalassemia, a disease that can become quite severe as it progresses, are also readily available, given the disease’s presence among all Mediterranean populations. GSD III is very severe, but it is extremely rare in the United States, she added.

The relative lack of attention paid to recessive disorders among non-Ashkenazic communities in the United States may be due, in part, to attitudes within the communities themselves. “They like to be private about their lives. They like to be anonymous,” Abadie commented. Abadie, who is part of the Syrian community, said that when leaders of his community were asked to participate in the Jewish HapMap Project, they declined. He added that reluctance about testing remains strong, because uncovering a carrier may stigmatize a family. “The Sephardic community is close-knit and families know each very other well,” and therefore, he added, the communities feel they know which families are carriers for certain diseases.

Ostrer, however, said that scientists would take issue with this reasoning, because since carriers do not get the disease, “you can’t rely on family history. That’s the whole point of screening.”

In speaking with Syrian, Iranian, Bukharan and other non-Ashkenazic Jewish groups for the HapMap project, Ostrer said that he and his colleagues found there to be “considerable interest” in screening.

“I think we need to be doing it,” he concluded, adding that he hopes to begin offering tailored programs soon. “We treat them as very distinct communities. I hope that others will do so in the future as well.”

Read more: http://forward.com/articles/112426/the-other-jewish-genetic-diseases/#ixzz3LJgx3SqW

Medical Monday

 

NEW BLOOD PRESSURE GUIDELINES

 

The following quote appeared in a recent AARP “Your Health” Bulletin:

“According to Jackson T. Wright Jr., M.D, author of the minority view and director of the clinical hypertension program at University Hospitals Case Medical Center in Cleveland, it could leave older adults with untreated high blood pressure at greater risk for complications—especially for African Americans and those with additional cardiovascular risk factors.”