Drawing the Curtain

A Racial Equity Framework for Pediatric Professionals

Kia Ferrer, MS, CCLS, GC-C


Pediatr Nurs. 2021;47(3):149-155,148. 

In This Article

The Effects of Racism on Children's Health

Research over the last 30 years has proven that the color of a child's skin has been directly linked to birth disparities and mental health problems (Marks et al., 2020). Furthermore, discriminatory behavior (racism) continues to be pervasive and is a daily stressor in the lives of people of color, causing serious consequences for children's health and wellness (Trent et al., 2019). In fact, biological research shows us that chronic stress leads to increased and prolonged levels of exposure to stress hormones and oxidative stress at the cellular level (Mariotti, 2015); and prolonged exposure to stress hormones, such as cortisol, leads to inflammatory reactions that predispose individuals to chronic disease (Cohen & Janicki-Deverts, 2012). As an example, racial disparities in the infant mortality rate remain (Riddell et al., 2017), even when controlling for factors, such as social class and access to prenatal care; likewise, complications of low birth weight have been associated with perceived racial discrimination and maternal stress (Gadson et al., 2017; Lu et al., 2010).

Based on these studies, the AAP released an evidence-based policy statement calling racism a "socially transmitted disease" that has significant adverse effects on the "individual who receives, commits and observes racism" (Trent et al., 2019, p. 3). In August 2019, the AAP urged the pediatric workforce to substantially invest in dismantling structural racism to facilitate the optimal development of children in the United States:

The pediatric [workforce] must examine and acknowledge their own biases and embrace and advocate for innovative policies and cross-sector partnerships designed to improve medical, economic, environmental, housing, judicial, and educational equity for optimal child, adolescent and emerging adult developmental outcomes (Trent et al., 2019, p. 7).

This policy statement became a call to action urging nurses, physicians, and allied health professionals to recognize the evidence of inequitable institutional structures and explicit biases present in the interpersonal relationships between health care providers and the families of color they support. To this end, each of us is called to optimize clinical practice through a reflective, critical racial lens by a) examining our own racial identity (as it relates to culture and ethnicity), b) acknowledging and addressing health and developmental issues across a child's lifespan, c) embracing the daunting task of culturally conscious workforce training, and d) advocating for partnerships across allied health providers with those who are specifically trained in addressing the deleterious effects of racism on children's development (see Figure 3). This collaborative approach can help us "draw the curtain" on racism. This can be accomplished by creating entry points for untangling oppression through an evidence-informed professional learning framework that can be used to build conversations and create solidarity in practice.

Figure 3.

Drawing the Curtain
Source: Kia Ferrer. Used with permission.