Advertisement

How can Pediatric Surgeons Address Racism and Become Actively Anti-Racist?

      Summary

      This is an article submitted on behalf of the Canadian Association of Pediatric Surgeons. We assert that Pediatric Surgeons must work to dismantle systemic racism. Pediatric Surgeons have expertise in both common and rare surgical diseases affecting patients ranging from premature neonates to adolescents. Thus, our professional obligation is to transform our health and social systems to prevent the harms of racism to our patients. Specific to the Canadian context, we describe a brief history, the ongoing impact on individuals and communities, and the harmful effect on the surgical community and trainees. Finally, we conclude with a series of practical recommendations to help surgeons become actively anti-racist.

      Keywords

      Abbreviations:

      BIPOC (Black Indigenous and People of Colour)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Allen L.
        • Hatala A.
        • Ijaz S.
        • Courchene E.D.
        • Bushie E.B.
        Indigenous-led health care partnerships in Canada.
        CMAJ. 2020; 192: E208-E216https://doi.org/10.1503/cmaj.190728
        • Frohlich K.L.
        • Ross N.
        • Richmond C.
        Health disparities in Canada today: some evidence and a theoretical framework.
        Health Policy. 2006; 79: 132-143https://doi.org/10.1016/j.healthpol.2005.12.010
        • Smylie J.
        • Fell D.
        • Ohlsson A.
        Joint Working Group on First Nations Indian Inuit, Métis Infant Mortality of the Canadian Perinatal Surveillance System. A review of Aboriginal infant mortality rates in Canada: striking and persistent Aboriginal/non-Aboriginal inequities.
        Can J Public Health. 2010; 101: 143-148
        • Nafiu O.O.
        • Mpody C.
        • Kim S.S.
        • Uffman J.C.
        • Tobias J.D.
        Race, Postoperative Complications, and Death in Apparently Healthy Children.
        Pediatrics. 2020; 146e20194113https://doi.org/10.1542/peds.2019-4113
        • Morris M.I.
        • Sioui R.
        • Sioui M.
        Conference proceeding from the annual meeting of the Canadian Association of Pediatric Surgeons: "Caring for indigenous children: A CAPS perspective.
        Journal of Pediatric Surgery. 2020; 55: 793-795https://doi.org/10.1016/j.jpedsurg.2020.01.029
        • McNally M.
        • Martin D.
        First Nations, Inuit and Métis health: Considerations for Canadian health leaders in the wake of the Truth and Reconciliation Commission of Canada report.
        Healthc Manage Forum. 2017; 30: 117-122https://doi.org/10.1177/0840470416680445
        • Greenwood M.L.
        • de Leeuw S.N.
        Social determinants of health and the future well-being of Aboriginal children in Canada.
        Paediatr Child Health. 2012; 17: 381-384
        • Johnson S.
        Jordan's principle and Indigenous children with disabilities in Canada: jurisdiction, advocacy, and research.
        J Soc Work Disabil Rehabil. 2015; 14: 233-244https://doi.org/10.1080/1536710X.2015.1068260
        • Auer A.M.
        • Andersson R.
        Canadian Aboriginal communities and medical service patterns for the management of injured patients.
        Public Health. 2001; 115: 44-50https://doi.org/10.1038/sj.ph.1900712
        • Alegria M.
        • Vallas M.
        • Pumariega A.J.
        Racial and Ethnic Disparities in Pediatric Mental Health.
        Child and Adolescent Psychiatric Clinics. 2010; 19: 759-774https://doi.org/10.1016/j.chc.2010.07.001
        • Lawrence H.P.
        • Binguis D.
        • Douglas J.
        • et al.
        Oral health inequalities between young Aboriginal and non-Aboriginal children living in Ontario, Canada.
        Community Dent Oral Epidemiol. 2009; 37: 495-508https://doi.org/10.1111/j.1600-0528.2009.00497.x
        • Blackstock C.
        Toward the full and proper implementation of Jordan's Principle: An elusive goal to date.
        Paediatr Child Health. 2016; 21: 245-246https://doi.org/10.1093/pch/21.5.245
      1. Adjei PB, Minka E. Black parents ask for a second look: Parenting under “White” Child Protection rules in Canada. Child Youth Serv Rev. doi:10.1016/j.childyouth.2018.08.030.

        • King B.
        • Fallon B.
        • Boyd R.
        • Black T.
        • Antwi-Boasiako K.
        • O'Connor C.
        Factors associated with racial differences in child welfare investigative decision-making in Ontario, Canada.
        Child Abuse Negl. 2017; 73: 89-105https://doi.org/10.1016/j.chiabu.2017.09.027
        • Chamberlain J.M.
        • Joseph J.G.
        • Patel K.M.
        • Pollack M.M.
        Differences in severity-adjusted pediatric hospitalization rates are associated with race/ethnicity.
        Pediatrics. 2007; 119: e1319-e1324https://doi.org/10.1542/peds.2006-2309
        • Baetzel A.
        • Brown D.J.
        • Koppera P.
        • Rentz A.
        • Thompson A.
        • Christensen R.
        Adultification of Black Children in Pediatric Anesthesia.
        Anesth Analg. 2019; 129: 1118-1123https://doi.org/10.1213/ANE.0000000000004274
        • Stone M.L.
        • LaPar D.J.
        • Mulloy D.P.
        • et al.
        Primary payer status is significantly associated with postoperative mortality, morbidity, and hospital resource utilization in pediatric surgical patients within the United States.
        Journal of Pediatric Surgery. 2013; 48: 81-87https://doi.org/10.1016/j.jpedsurg.2012.10.021
        • Doucette E.
        • Antonacci R.
        • Chevrier A.
        • et al.
        Exploring Indigenous Cultural Bias and the Impact on the Mother-Nurse Dynamic and Care within a Tertiary Neonatal Intensive Care Unit (NICU).
        Canadian Journal of Critical Care Nursing. 2017; 28 (32-32)
        • Capers Q.
        • Clinchot D.
        • McDougle L.
        • Greenwald A.G.
        Implicit Racial Bias in Medical School Admissions.
        Acad Med. 2017; 92: 365-369https://doi.org/10.1097/ACM.0000000000001388
        • Hu Y.-Y.
        • Ellis R.J.
        • Hewitt D.B.
        • et al.
        Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training.
        N Engl J Med. 2019; 381: 1741-1752https://doi.org/10.1056/NEJMsa1903759
        • Mocanu V.
        • Kuper T.M.
        • Marini W.
        • et al.
        Intersectionality of Gender and Visible Minority Status Among General Surgery Residents in Canada.
        JAMA Surg. August 2020; (e202828)e202828https://doi.org/10.1001/jamasurg.2020.2828
        • Anderson C.T.M.
        Taking Back Our Voices - #HumanityIsOurLane.
        N Engl J Med. June. 2020; (NEJMp2021291)https://doi.org/10.1056/NEJMp2021291
        • Yuce T.K.
        • Turner P.L.
        • Glass C.
        • et al.
        National Evaluation of Racial/Ethnic Discrimination in US Surgical Residency Programs.
        JAMA Surg. 2020; 155: 526-528https://doi.org/10.1001/jamasurg.2020.0260
        • Filut A.
        • Alvarez M.
        • Carnes M.
        Discrimination Toward Physicians of Color: A Systematic Review.
        J Natl Med Assoc. 2020; 112: 117-140https://doi.org/10.1016/j.jnma.2020.02.008
        • MacDonald R.
        Discrimination in medicine.
        BMJ. 2002; 324 (1112-1112)https://doi.org/10.1136/bmj.324.7346.1112
        • Patel V.M.
        • Warren O.
        • Ahmed K.
        • et al.
        How can we build mentorship in surgeons of the future?.
        ANZ J Surg. 2011; 81: 418-424https://doi.org/10.1111/j.1445-2197.2011.05779.x
        • Filut A.
        • Alvarez M.
        • Carnes M.
        Discrimination Toward Physicians of Color: A Systematic Review.
        J Natl Med Assoc. 2020 Apr; 112: 117-140https://doi.org/10.1016/j.jnma.2020.02.008
        • Vogel L.
        Doctors on their own when dealing with racism from patients.
        CMAJ. September. 2018; 17: E1118-E1119
        • Yu P.T.
        • Parsa P.V.
        • Hassanein O.
        • Rogers S.O.
        • Chang D.C.
        Minorities struggle to advance in academic medicine: A 12-y review of diversity at the highest levels of America's teaching institutions.
        J Surg Res. 2013; 182: 212-218https://doi.org/10.1016/j.jss.2012.06.049
        • Banks L.
        • Randhawa V.K.
        • Caterini J.
        • Colella T.
        • Dhanvantari S.
        • McMurtry S.
        • Connelly K.A.
        • Robinson L.
        • Anand S.S.
        • Ouzounian M.
        • Zieroth S.
        • Mak S.
        • Straus S.
        • Graham M.M.
        Sex, Gender, and Equity in Cardiovascular Medicine, Surgery, and Science in Canada: Challenges, Successes, and Opportunities for Change.
        CJC open. 2020; 2: 522-529https://doi.org/10.1016/j.cjco.2020.06.016
        • Julien J.S.
        • Lang R.
        • Brown T.N.
        • Aldrich M.C.
        • Deppen S.A.
        • Wu H.
        • Feurer I.D.
        • Tarpley M.
        • Hill G.
        • Tarpley J.
        • Beauchamp R.D.
        • Grogan E.L.
        Minority Underrepresentation in Academia: Factors Impacting Careers of Surgery Residents.
        Journal of racial and ethnic health disparities. 2014; 1: 238-246https://doi.org/10.1007/s40615-014-0030-6