Reflecting on the Heart of Our Work: Racial and Social Justice

By: Nancy Caperino, LCSW, ACSW and Lauren Dominique

Racial and social justice is at the hearrt of our work with children, families and community.

That’s why Connecticut Children’s and Connecticut Children’s Office for Community Child Health (the Office) have an ongoing commitment to racial and social justice. As part of our organization’s Diversity, Equity and Inclusion Framework, leadership at Connecticut Children’s and within the Office have invited several esteemed leaders and colleagues to participate in our Grand Rounds sessions to shed light on health inequities and racial injustice.

In solidarity with the Black Lives Matter movement, in December, the Office invited Dr. Wizdom Powell, PhD, MPH, director of the UConn Health Disparities Institute, who presented a powerful lecture titled Speak to the Wounds: What We Need to Know about Racial Trauma and Radical Healing during Uncertain Times. In March, the Office invited Dr. Renée Boynton Jarrett, MD, ScD of Boston University, who presented a dynamic lecture titled Restoring Dignity: Addressing Structural Racism, Childhood Adversity and Child Health through Reimagined Community Partnerships.

As we continue on our ongoing personal and professional journey, each of these educational sessions offers us the opportunity to more deeply understand and identify racism in all its forms while reflecting on our own personal and professional experiences. With each opportunity, we discover just how much more there is to learn.

Most recently, our colleagues in Developmental Pediatrics invited Dr. Adiaha Spinks-Franklin, MD, MPH, FAAP of Baylor College of Medicine, to present an inspiring talk titled Racism: A Societal Pathogen.

While we cannot truly do justice to the content or message that Dr. Spinks-Franklin and the other presenters have provided, we were so inspired by these three lectures and feel called to share a few words about this most recent presentation. This article includes some of the teachings and data from Dr. Spinks-Franklin’s presentation as we understand them, in hopes that this information may reinforce and nourish the seed of anti-racism efforts that can lead us to address the issues with focus and intention.

The ideas within this article are intellectual property of Dr. Spinks-Franklin, and we look forward to her future publications on these topics.

Becoming Comfortable with Being Uncomfortable to Advance Racial and Social Justice

From the start of Dr. Spinks-Franklin’s lecture, she reminds us that we, in the United States, live on the stolen land of Indigenous people, their ancestors and elders. She also reminds us that when individuals from the Black, Indigenous, and Persons of Color (BIPOC) community stand up and speak out against discrimination, they are taking a major risk in doing so – and that’s why it’s time to rise up and meet this moment when we are all called to stand up and speak out. Knowledge and activism is critical to combat the racism that has infected our society.

Dr. Spinks-Franklin also points out that to grow in this experience of learning about and challenging racism, we have to become comfortable with being uncomfortable. When exploring and confronting issues of race and racism, those who identify as white or have certain innate advantages or privileges may feel judged, silenced, or shamed which may lead to defensiveness. In those instances, it is important to pause and reflect on where those feelings are coming from and why. Being in-tune and aware of our reactions to discussions of racism is key to moving beyond those uncomfortable feelings to learn and participate in meaningful change.

Dr. Spinks-Franklin emphasizes that we must be sensitive to the needs of our BIPOC community who have experienced racial stress and trauma, including when we make trainings on racial injustice available to team members. We must let individuals from the BIPOC community participate or lead in a way that is best for them and recognize that reviewing information or photos that highlight historical trauma can be further traumatizing to BIPOC team members in the audience.

This work is challenging for everyone, which is why self-care strategies, such as mindfulness meditation, prayer, and other relaxation approaches can be helpful to manage symptoms and to sustain our efforts.

The Composition of Racism

Racism, like a glacier, has only certain parts that are visible to others. Racism is often largely hidden under the surface, and this can sometimes make it hard to identify or decipher.

Dr. Spinks-Franklin describes Dr. Camara Phyllis Jones’ theoretical framework for understanding the three levels of racism – institutionalized racism (systemic); interpersonal racism or personally mediated racism (acts of prejudice and discrimination; implicit bias; micro-aggressions, etc.) and internalized racism (accepting the racist notion that white people are superior and people of color are inferior).

She also outlines the many forms of racism, which include:

colorblind racism (when we deny and ignore the ongoing discrimination and oppression that stigmatized racial groups in the United States experience daily);
gendered racism (the intersection of racism and sexism that women of color experience);
environmental racism (policies that place non-white people at higher risk for poor environmental outcomes such as redlining housing practices);
cultural racism (‘whiteness’ as the norm); and
medical racism (the historical abuse and maltreatment of people of color by healthcare providers and a healthcare system that devalues them).

She noted that these forms of racism are just part of the many reasons why racism is so deeply embedded in our society.

Racism as a Pathogen

What really stands out about Dr. Spinks-Franklin’s presentation is how she brilliantly describes racism as society’s pathogen and how we can combat it.

She states that race is not biological, but rather a social construct – a human invention established in the late 1600s that, just as other pathogens, has survived over the years. To survive, a pathogen needs a host, a way to transmit, the ability to replicate, and the ability to elicit a response in its host. The only way to destroy a pathogen is with treatment. In the case of racism, society is the host and it is transmitted through unconscious bias and other racist behaviors and mindsets that occur both in hidden or plain sight.

Dr. Spinks-Franklin highlights how racism continues to replicate by discussing the history of medical racism, such as the Tuskegee Study, which famously withheld treatment for syphilis in African American or Black men over a 40-year period from 1932 to 1972. In order to know where we’re going, we have to remember where we’ve been and how that currently impacts where we are today. Racism is actively replicated through negative implicit racial bias, which continues to exist in health care.

When these biases contribute to inequities in health care access, quality, and delivery, it can have a negative influence on the way providers administer health care to patients, including the standards of testing, prevention, care, communication, referrals, intervention and treatment.

Dr. Spinks-Franklin spoke to how false health beliefs can lead to inappropriate assessment and treatment of pain. She cited a study demonstrating that many pediatric medical students and residents actually believed there were biological differences between Black and white persons. The participants were given case vignettes, and it was found that those who believed in this false health belief rated Black patients’ pain as lower and made inappropriate treatment plans based on this false health belief.

Racism is also replicated and sustained through social determinants of health (SDOH), which are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks. The five domains of SDOH (Health Care Access and Quality; Education Access and Quality; Social and Community Context; Neighborhood and Built Environment; and Economic Stability) often leave people of color with less access to family-centered care in a medical home, unequal educational funding, more frequent contact with legal systems, housing segregation and redlining, and higher rates of unemployment and underemployment.

According to Dr. Spinks-Franklin, racism perpetuated by false beliefs and sustained by social determinants of health has a means of causing disease.

Interrupting and Destroying the Systems of Racism to Advance Racial and Social Justice

Dr. Spinks-Franklin also highlights that there are many responses we may have to racism. While we can internalize or perpetuate it, we can also resist it by actively working to interrupt and dismantle the systems of racism and white supremacy through anti-racist actions.

Anti-racism recognizes that systems that perpetuate racism and white supremacy are not only inherently wrong, but are the reason for inequality and the need for social change. In order to destroy racism and advance racial and social justice, treatment is necessary. In this case, active resistance is the treatment our society needs.

In the closing of Dr. Spinks-Franklin’s presentation, a question from the audience focused on organizational efforts, both at Connecticut Children’s and beyond. In response, Dr. Spinks-Franklin noted the importance of leadership in any organization seeing anti-racist efforts as a priority through ongoing training for team members, emphasizing that all voices need to be invited to the table to discuss and to find solutions.

In these efforts, we must be honest in noticing who has not been at the table. The voices who have been silenced or ignored must be invited to participate in conversations around diversity, equity and inclusion, without placing an undue burden on our BIPOC peers, colleagues and leaders to be the sole champions of racial justice. Only when we join together can we truly work to dismantle racism with goal for true equity, justice, and dignity for all.