Discrimination is a form of stress that can affect both physical and mental well-being. Racism and discrimination are fundamental determinants of health and illness. Additionally, racism can operate at the interpersonal level whereby racial bias occurs between individuals at the institutional level (schools, workplaces, etc.) where discriminatory policies can routinely produce racial inequities and at the structural level, which accounts for the cumulative historical and societal factors that have led to systematic disadvantage of particular racial groups. Racism can be internalized and manifest as lower scores on standardized testing when students are reminded of their racial/ethnic group (stereotype threat). Racism operates at various levels in society, and it is important to understand the many ways that racism manifests. While the focus is on discussing experiences of racism with patients, these approaches can also be applied to discussions with patients about experiences of discrimination related to sex, gender identity, sexual orientation, disability, immigration status, etc.Ĭamara Phyllis Jones, MD, MPH, former president of the APHA, stated that “racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks (race),” that unfairly disadvantages some individuals and communities and unfairly advantages others. We draw on various theoretical frameworks to illustrate possible approaches for integrating such discussions in the clinical encounter. In this review, we aim to demonstrate the importance of acknowledging and addressing experiences of racism directly with patients. However, outside of psychotherapy and pediatric literature, there is a dearth of research and resources in the medical field that is dedicated to assisting clinicians with having these conversations. In particular, increased attention is being given to discussing the impact of racism and other forms of discrimination directly with patients. Healthcare organizations have approached this commitment in a variety of ways, from seeking to address racial biases and inequities within their institutions, to tackling structural racism by addressing social determinants of health in the community. Indeed, many healthcare organizations and professional medical societies have reaffirmed their commitment to addressing racism and promoting health equity. The American Public Health Association (APHA) considers racism a public health crisis. Breonna Taylor in 2020 sparked a conversation on how structural racism, bias and discriminatory policies and practices that result in inequitable distribution of resources and opportunities, and interpersonal racism ,bias and discriminatory behaviors and attitudes that occur between individuals, result in disproportionate harm to Black communities in the US. Disturbingly, the COVID-19 pandemic has been associated with a significant rise in anti-Asian racism, which has culminated in almost 3800 attacks on people of Asian descent. Such disparities can be attributed to a long history of US policies and practices that resulted in members of these communities living in multigenerational households, having greater reliance on public transportation, and having more front-line occupations with higher risk of COVID-19 exposure. 2020 was marked by local and global events that created a national reckoning with the impact of racism on the health and well-being of people of color in the United States (US). The COVID-19 pandemic has inflicted excess harm on Asian, Black, Latinx, and Indigenous communities.
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