POLICY STATEMENT Organizational Principles to Guide and Define the Child Health

Care System and/or Improve the Health of all Children

The Impact of Racism on Child and

Adolescent Health
Maria Trent, MD, MPH, FAAP, FSAHM,a Danielle G. Dooley, MD, MPhil, FAAP,b Jacqueline Dougé, MD, MPH, FAAP,c SECTION ON
ADOLESCENT HEALTH, COUNCIL ON COMMUNITY PEDIATRICS, COMMITTEE ON ADOLESCENCE

The American Academy of Pediatrics is committed to addressing the abstract

factors that affect child and adolescent health with a focus on issues that may
leave some children more vulnerable than others. Racism is a social
a
determinant of health that has a profound impact on the health status of Division of Adolescent and Young Adult Medicine, Department of
Pediatrics, School of Medicine, Johns Hopkins University, Baltimore,
children, adolescents, emerging adults, and their families. Although progress Maryland; bDivision of General Pediatrics and Community Health and
has been made toward racial equality and equity, the evidence to support Child Health Advocacy Institute, Children’s National Health System,
Washington, District of Columbia; and cMedical Director, Howard
the continued negative impact of racism on health and well-being through County Health Department, Columbia, Maryland
implicit and explicit biases, institutional structures, and interpersonal
Drs Trent, Dooley, and Dougé worked together as a writing team to
relationships is clear. The objective of this policy statement is to provide an develop the manuscript outline, conduct the literature search, develop
evidence-based document focused on the role of racism in child and the stated policies, incorporate perspectives and feedback from
American Academy of Pediatrics leadership, and draft the final version
adolescent development and health outcomes. By acknowledging the role of of the manuscript; and all authors approved the final manuscript as
submitted.
racism in child and adolescent health, pediatricians and other pediatric health
professionals will be able to proactively engage in strategies to optimize This document is copyrighted and is property of the American
Academy of Pediatrics and its Board of Directors. All authors have filed
clinical care, workforce development, professional education, systems conflict of interest statements with the American Academy of
Pediatrics. Any conflicts have been resolved through a process
engagement, and research in a manner designed to reduce the health effects approved by the Board of Directors. The American Academy of
of structural, personally mediated, and internalized racism and improve the Pediatrics has neither solicited nor accepted any commercial
involvement in the development of the content of this publication.
health and well-being of all children, adolescents, emerging adults, and their
Policy statements from the American Academy of Pediatrics benefit
families. from expertise and resources of liaisons and internal (AAP) and
external reviewers. However, policy statements from the American
Academy of Pediatrics may not reflect the views of the liaisons or the
organizations or government agencies that they represent.

The guidance in this statement does not indicate an exclusive course

STATEMENT OF THE PROBLEM of treatment or serve as a standard of medical care. Variations, taking
Racism is a “system of structuring opportunity and assigning value based into account individual circumstances, may be appropriate.

on the social interpretation of how one looks (which is what we call ‘race’) All policy statements from the American Academy of Pediatrics
automatically expire 5 years after publication unless reaffirmed,
that unfairly disadvantages some individuals and communities, unfairly revised, or retired at or before that time.
advantages other individuals and communities, and saps the strength of
DOI: https://doi.org/10.1542/peds.2019-1765
the whole society through the waste of human resources.”1 Racism is
a social determinant of health2 that has a profound impact on the health Address correspondence to Maria Trent, MD. E-mail: [email protected]

status of children, adolescents, emerging adults, and their families.3–8

Although progress has been made toward racial equality and equity,9 the To cite: Trent M, Dooley DG, Dougé J, AAP SECTION ON
evidence to support the continued negative impact of racism on health and ADOLESCENT HEALTH, AAP COUNCIL ON COMMUNITY PEDIATRICS,
AAP COMMITTEE ON ADOLESCENCE. The Impact of Racism on
well-being through implicit and explicit biases, institutional structures,
Child and Adolescent Health. Pediatrics. 2019;144(2):e20191765
and interpersonal relationships is clear.10 Failure to address racism will

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PEDIATRICS Volume 144, number 2, August 2019:e20191765 FROM THE AMERICAN ACADEMY OF PEDIATRICS
continue to undermine health equity The objective of this policy statement of low birth weight have been
for all children, adolescents, emerging is to provide an evidence-based associated with perceived
adults, and their families. document focused on the role of racial discrimination and maternal
racism in child and adolescent stress.25,33,34
The social environment in which development and health outcomes.
children are raised shapes child and Investments in policies to address
This policy statement will allow
adolescent development, and social determinants of health, such as
pediatricians to implement
poverty, have yielded improvements
pediatricians are poised to prevent recommendations in practice that will
in the health of children. The Food
and respond to environmental better address the factors that make
Stamp Program, a War on Poverty
circumstances that undermine child some children more vulnerable than
initiative first developed in the 1930s
health. Pediatrics as a field has yet to others.13 The statement also builds
during the Great Depression and later
systematically address the influence on existing AAP policy
revived in the 1960s, is linked to
of racism on child health outcomes recommendations associated with
improvements in birth outcomes.35
and to prepare pediatricians to other social determinants of health,
Efforts in education, housing, and
identify, manage, mitigate, or prevent such as poverty, housing insecurity,
child health insurance have also led to
risks and harms. Recognizing that child health equity, immigration
improved health outcomes for issues
racism has significant adverse effects status, and early childhood
such as lead poisoning, injuries,
on the individual who receives, adversity.9,17–19
asthma, cancer, neurotoxicity,
commits, and observes racism,11,12
cardiovascular disease, and mental
substantial investments in RACISM AS A CORE DETERMINANT OF health problems.20,36,37 Expansion of
dismantling structural racism are CHILD HEALTH child health insurance has improved
required to facilitate the societal
Racism is a core social determinant of health care access for children, with
shifts necessary for optimal
health that is a driver of health significant gains for African American
development of children in the United
inequities.20–22 The World Health and Hispanic children in terms of
States. The American Academy of
Organization defines social access to well-child, doctor, and
Pediatrics (AAP) is committed to
determinants of health as “the dental visits.38 Despite these
reducing the ongoing costs and improvements, it is important to
conditions in which people are born,
burden of racism to children, the recognize that children raised in
grow, live, work, and age.” These
health care system, and society.13,14 African American, Hispanic, and
determinants are influenced by
economic, political, and social factors American Indian populations
Today’s children, adolescents, and
linked to health inequities (avoidable continue to face higher risks of
emerging adults are increasingly
inequalities in health between groups parental unemployment and to reside
diverse. Strategies to address health
of people within populations and in families with significantly lower
and developmental issues across the
between countries). These health household net wealth relative to
pediatric life span that incorporate
inequities are not the result of white children in the United States,
ethnicity, culture, and circumstance
individual behavior choices or genetic posing barriers to equal opportunities
are critical to achieving a reduction in
predisposition but are caused by and services that optimize health and
health disparities. Accordingly,
economic, political, and social vocational outcomes.39–45
pediatrics should be at the forefront
of addressing racism as a core social conditions, including racism.23 Juvenile justice involvement is also
determinant. The inclusion of racism The impact of racism has been linked a critical social determinant of health.
is in alignment with the health equity to birth disparities and mental health Because racial inequity continues to
pillar of the AAP strategic plan.15 In problems in children and shape the juvenile justice system, this
a series of workshops in 2016 during adolescents.6,24–30 The biological area is a modern example of race
national meetings of pediatricians, 3 mechanism that emerges from being an important determinant of
strategic actions were identified: (1) chronic stress leads to increased and short- and long-term outcomes. The
development of a task force within prolonged levels of exposure to stress AAP published a statement in 201146
the AAP to address racism and other hormones and oxidative stress at the focusing on key health issues of
forms of discrimination that impact cellular level. Prolonged exposure to justice-involved youth, which was
the health status and outcomes of stress hormones, such as cortisol, recently revised to include an in-
minority youth, (2) development of leads to inflammatory reactions that depth discussion on racial and ethnic
a policy statement on racism, and (3) predispose individuals to chronic inequalities for this population.47
integration of evidence-based disease.31 As an example, racial Although the overall rates of youth
anticipatory guidance about racism disparities in the infant mortality incarceration have decreased, African
into Bright Futures.16 rate remain,32 and the complications American, Hispanic, and American

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2 FROM THE AMERICAN ACADEMY OF PEDIATRICS
Indian youth continue to be discovery, innovation, and medical- Through these underpinnings, racism
disproportionately represented.48 pharmaceutical collaborations.56 became a socially transmitted disease
While incarcerated, youth experience Rather than focusing on preventing passed down through generations,
additional adverse experiences, such the social conditions that have led to leading to the inequities observed in
as solitary confinement and abuse, racial disparities, science and society our population today. Although the
that have the potential to undermine continue to focus on the disparate endemic nature of racism has
socioemotional development and outcomes that have resulted from powerful impacts on perceived and
general developmental outcomes.49–51 them, often reinforcing the posited actual health outcomes, it is also
Differential treatment of youth biological underpinnings of flawed important to note that other forms of
offenders on the basis of race shapes racial categories.57 Although race discrimination (eg, sex, religion,
an individual’s participation and used in these ways has been sexual orientation, immigrant status,
ultimate function in society. This type institutionalized, linked to health and disability status) are actively at
of modern racism must be recognized status, and impeded our ability to play and have created a syndemic
and addressed if the United States improve health and eliminate health with the potential to undermine child
seeks to attain health equity.52 disparities,58,59 it remains a powerful and family health further. It is
measure that must be better important to address racism’s impact
measured, carefully used, and on the health and well-being of
THE DEVELOPMENT OF RACE AS potentially replaced to mark progress children, adolescents, and emerging
A CONSTRUCT in pediatric health disparities adults to avoid perpetuating a health
Race as a social construct is rooted in research.60,61 system that does not meet the needs
history and remains a mechanism of all patients.52 Pediatricians are
through which social class has been As such, it is important to examine uniquely positioned to both prevent
controlled over time. Flawed science the historical underpinnings of race and mitigate the consequences of
was used to solidify the permanence used as a tool for subjugation. racism as a key and trusted source of
of race, reinforce the notions of American racism was transported support for pediatric patients and
racial superiority, and justify through European colonization. It their families.
differential treatment on the basis of began with the subjugation,
phenotypic differences as people displacement, and genocide of
from different parts of the world American Indian populations and was CHILDHOOD EXPERIENCES OF RACISM
came in contact with each other.53 subsequently bolstered by the Children can distinguish the
Race emerged as a social importation of African slaves to frame phenotypic differences associated
classification used to assign the economy of the United States. with race during infancy73–75;
dominance of some social classes Although institutions such as slavery therefore, effective management of
over others.53 Scientific, were abolished more than a century difference as normative is important
anthropologic, and historical inquiry ago, discriminatory policies, such as in a diverse society. To identify,
further solidified race as a social Jim Crow laws, were developed to address, and manage the impacts of
construct.54 Modern science, legalize subjugation. As the United racism on child health, it is critical
however, has demonstrated that there States expanded west in North that pediatricians understand 3 key
is only 1 biological race and that the America and into Alaska and the levels through which racism operates:
clines (phenotypic differences in skin Pacific Islands, the diversity of (1) institutional, (2) personally
and eye color, hair texture, and bone populations encompassing the United mediated, and (3) internalized. The
structure) at the core of early States also expanded. Native experience of race is also impacted by
anthropologic research were Hawaiian and Pacific Islander, other identities that people have
insufficient to establish different Alaskan native, Asian American, and related to ethnicity, sex, religious
races among human beings. Dr Latino American populations have affiliation, immigrant status, family
Francis Collins, former director of the experienced oppression and similar composition, sexuality, disability, and
National Human Genome Project and exclusions from society.62–65 others that must be navigated
presently the director of the National Although some racial and/or ethnic alongside race. Much of the
Institutes of Health, has affirmed that groups have received reparations66 discussion to date related to the
humans are 99.9% the same at the and fared better than others over historical underpinnings of race deals
level of their genome.55 Despite this, time, remnants of these policies with institutionalized (or structural)
efforts to collect, organize, and remain in place today and continue racism, expressed through patterns of
categorize individuals on the basis of to oppress the advancement of social institutions (eg, governmental
the plausibility of the 0.01% human people from historically aggrieved organizations, schools, banks, and
variation remain a force of scientific groups.67–72 courts of law) that implicitly or

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PEDIATRICS Volume 144, number 2, August 2019 3
explicitly discriminate against is repetitive, causing stress levels to sleep and time spent at home,
individuals from historically increase because of anticipation of children spend a significant portion of
marginalized groups.22,52,76,77 future events.11 Internalized negative their time in educational settings.95–97
Children experience the outputs of stereotypes related to race can Educational achievement is an
structural racism through place unconsciously erode self-perception important predictor of long-term
(where they live), education (where and capacity and may later play out in health and economic outcomes for
they learn), economic means (what the form of stereotype threat or the children. Adults with a college degree
they have), and legal means (how fear of confirming a negative live longer and have lower rates of
their rights are executed). Research stereotype of one’s race.91 Stereotype chronic disease than those who did
has identified the role of implicit and threats can undermine academic and not graduate from college.98 It is
explicit personally mediated racism vocational attainment, key critical for pediatricians to recognize
(racism characterized by assumptions developmental milestones for the the institutional, personally mediated,
about the abilities, motives, or intents victim. Underachievement then and internalized levels of racism that
of others on the basis of race)78 as reinforces the stereotype held by both occur in the educational setting
a factor affecting health care delivery the perpetrator and victim, further because education is a critical social
and general health outcomes.79–86 enhancing the vulnerability of the determinant of health for children.99
The impacts of structural and victim and the bystander to repeated
personally mediated racism may acts of overt or covert victimization. Disparities in educational access and
result in internalized racism These observations suggest that attainment, along with racism
(internalizing racial stereotypes universal interventions to eliminate experienced in the educational
about one’s racial group). A positive racism (experienced as a victim or setting, affect the trajectory of
racial identity mediates experiences bystander) from the lives of children academic achievement for children
of discrimination and generates and to engage in active societal and adolescents and ultimately
optimal youth development antiracism bystander behavioral impact health. Chronic absenteeism,
outcomes.12,87,88 The importance of intervention may optimize well-being defined as missing $10% of school
a prosocial identity is critical during for all children and the adults who days in an academic year, is a strong
adolescence, when young people care for them. For individual predictor of educational achievement.
must navigate the impacts of social intervention to occur, however, Chronic absenteeism
status and awareness of personally bystanders must identify critical disproportionately affects children of
mediated discrimination based on situations, view them as an color, children living in poverty,
race.89–91 emergency, develop a sense of children with disabilities, and
personal responsibility, have self- children with chronic diseases.100 In
Although children and adolescents efficacy to succeed with the high school, 21.2% of Hispanic, 23.4%
who are the targets of racism intervention, perceive the costs of of African American, and 27.5% of
experience the most significant nonintervention as high, and American Indian children were
impact, bystanders are also adversely consciously decide to help.11,92 chronically absent in 2013–2014
affected by racism. As an example, Research has demonstrated that compared with 17.3% of white
young adults who were bystanders to racism has an effect on health across children.101 Immigration enforcement
racism and other forms of racial groups in communities and the fear of apprehension by
victimization as youth experience reporting high levels of racism93 but authorities can negatively affect
profound physiologic and that racially diverse environments, school attendance for Hispanic and
psychological effects when asked to such as schools, can benefit all youth black immigrants, thereby
recall the memory of a past anchoring by improving cognitive skills such as perpetuating inequalities in
event as a victim or bystander that critical thinking and problem- attendance.102 According to the
are comparable to those experienced solving.94 National Center for Education
by first responders after a major Statistics, the graduation rate for
disaster. Three core features that white students nationally in
characterized the abusive event(s) RACISM AT THE INTERSECTION OF 2015–2016 was 88% compared with
were as follows: (1) an individual gets EDUCATION AND CHILD AND 76% for African American students,
hurt psychologically or physically, (2) ADOLESCENT HEALTH 72% for American Indian students,
a power differential exists (eg, age, Educational and vocational and 79% for Hispanic students.103
size and/or stature, or status) versus attainment are key developmental Disparities in chronic absenteeism
the target individual resulting in outcomes that pediatricians monitor and high school graduation rates
domination and erosion of the to assess for successful growth and prevent children from realizing the
target’s self-esteem, and (3) the abuse development. After accounting for full benefits of educational attainment

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4 FROM THE AMERICAN ACADEMY OF PEDIATRICS
and can increase the development of teachers’ expectations of their suspended 3 times more and expelled
chronic disease and reduce overall students, with data demonstrating 1.9 times more than white
life expectancy.104 that white and other non–African students.120 To mediate the effects of
American teachers are more likely institutional and personally mediated
Although the landmark US Supreme
than African American teachers to racism in the educational setting and
Court case Brown v Board of
predict that African American prevent internalized racism, studies
Education banned government-
students would not finish high show that a positive, strong racial or
sponsored segregation and laid
school.113 Similarly, data indicate that ethnic identity and parental
a foundation for equal access to
teachers may underestimate the engagement in families is protective
a quality public education, the US
ability of African American and Latino against the negative effects of racial
Department of Education continues to
students, which can lead to lower discrimination on academic
report institutional or structural
grade point averages and fewer years outcomes.121–123
inequality in educational access and
of schooling.114 African American
outcomes,105 even in the most diverse
students who have 1 African
and well-resourced communities in HOW PEDIATRICIANS CAN ADDRESS
American teacher in elementary
the United States. Students from AND AMELIORATE THE EFFECTS OF
school are more likely to graduate
historically aggrieved groups have RACISM ON CHILDREN AND
from high school and enroll in college ADOLESCENTS
less access to experienced teachers,
than their peers who do not have an
advanced coursework, and resources Pediatricians and other child health
African American teacher; the
and are also more harshly punished professionals must be prepared to
proposed mechanism for this
for minor behavioral infractions discuss and counsel families of all
improved long-term educational
occurring in the school setting.105 races on the effects of exposure to
outcome is the exposure to a role
They are less likely to be identified racism as victims, bystanders, and
model early in the educational
for and receive special education perpetrators.124–126 Pediatricians can
experience.115 These findings indicate
services,106 and in some states, school implement systems in their practices
the importance of ensuring a diverse
districts with more nonwhite children that ensure that all patients and
teacher workforce, particularly as the
receive lower funding at any given families know that they are welcome,
population of students in US schools
poverty level than districts with more that they will be treated with mutual
continues to diversify.116 School racial
white children.107 respect, and that high-quality care
climate, which refers to norms,
Children may also experience curricula, and interactions around will be delivered regardless of
personally mediated racism early in race and diversity within the school background using the tenets of
their schooling, which may be setting, also impacts educational family- and patient-centered care.127
internalized and ultimately affect outcomes for students.117 Students To do this, it is critical for
their interactions with others.108 who had a positive perception of pediatricians to examine their own
Early teacher-child interactions are school racial climate had higher biases.128 Pediatricians can advocate
important for long-term academic academic achievement and fewer for community initiatives and
outcomes. The relationship of teacher disciplinary issues.118 Racial collaborate with government and
to student across ages and grade inequities in school discipline begin community-based organizations to
levels influences school adjustment, early, and school discipline has long- help redress biases and inequities in
literacy, math skills, grade point term consequences for children. the health, justice, and educational
average, and scholastic aptitude test Although federal civil rights laws systems. These strategies may
scores.109–111 Given the critical prohibit discrimination in the optimize developmental outcomes
nature of the student-teacher administration of discipline in public and reduce exposure to adverse
relationship, it is important to explore schools, the US Government events that dramatically alter the
how racism and implicit bias affect Accountability Office found that lived experiences, health, and
this dynamic. Student-teacher racial African American and American perceived self-value of youth.48,129,130
mismatch can impact academic Indian students are overrepresented
performance, with studies showing among students experiencing Optimizing Clinical Practice
that African American children are suspension.119 Data from the US In practice, pediatricians and other
more likely to receive a worse Department of Education confirm child health care providers encounter
assessment of their behavior when that a disproportionate number of children every day who have
they have a non-Hispanic white African American children receive experienced racism. There are
teacher than when they have an more than 1 out-of-school suspension interventions available for use in the
African American teacher.112 This in preschool and overall in medical home that can identify and
finding may result from racial bias in kindergarten through grade 12 are potentially ameliorate inequities.

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PEDIATRICS Volume 144, number 2, August 2019 5
• Create a culturally safe medical youth and families for protective • Encourage policies to foster
home131 where the providers factors,9 such as a supportive interactive learning communities
acknowledge and are sensitive to extended family network, that can that promote cultural humility (eg,
the racism that children and help mitigate exposure to racist self-awareness, lifelong
families experience by integrating behaviors.138 commitment to self-evaluation, and
patient- and family-centered • Infuse cultural diversity into AAP- commitment to managing power
communication strategies and recommended early imbalances)150,151 and provide
evidence-based screening tools that literacy–promotion programs147 to simulation opportunities to ensure
incorporate valid measures of ensure that there is new pediatricians are competent to
perceived and experienced racism a representation of authors, images, deliver culturally appropriate and
into clinical practice.132–136 and stories that reflect the cultural
patient- and family-centered
care.152–155
• Use strategies such as the Raising diversity of children served in
Resisters approach during pediatric practice. • Integrate active learning strategies,
anticipatory guidance to provide such as simulation156 and language
• Encourage pediatric practices and
support for youth and families to immersion,157 to adequately
local chapters to embrace the
(1) recognize racism in all forms, prepare pediatric residents to serve
challenge of testing best practices
from subversive to blatant displays the most diverse pediatric
using Community Access to Child
of racism; (2) differentiate racism population to date to exist in the
Health grants and participation in
from other forms of unfair United States158 and lead diverse
national quality-improvement
treatment and/or routine and interdisciplinary pediatric care
projects to examine the teams.159
developmental stressors; (3) safely effectiveness of office-based
oppose the negative messages and/ • Advocate for policies and programs
interventions designed to address
or behaviors of others; and (4) that diversify the pediatric
the impact of racism on patient
counter or replace those messages workforce and provide ongoing
outcomes.
and experiences with something professional education for
positive.137,138
• Encourage practices and chapters pediatricians in practice as
to develop resources for families a strategy to reduce implicit
• Train clinical and office staff in with civil rights concerns, including
culturally competent care biases and improve safety and
medicolegal partnerships and quality in the health care delivery
according to national standards for
referrals to agencies responsible system.160–162
culturally and linguistically
for enforcing civil rights laws.
appropriate services.139,140 Optimizing Systems Through
• Encourage pediatric-serving
• Assess patients for stressors (eg, organizations within local Community Engagement, Advocacy,
bullying and/or cyberbullying on and Public Policy
communities, including pediatric
the basis of race)141 and social • Acknowledge that health equity is
practices, hospitals, and health
determinants of health often unachievable unless racism is
maintenance organizations, to
associated with racism (eg, addressed through
conduct internal quality-assurance
neighborhood safety, poverty, interdisciplinary partnerships with
assessments that include analyses
housing inequity, and academic other organizations that have
of quality of care and patient
access) to connect families to developed campaigns against
satisfaction by race and to initiate
resources.9,142,143 racism.163,164
improvement protocols as needed
• Assess patients who report to improve health outcomes and • Engage community leaders to
experiencing racism for mental community trust. create safe playgrounds and
health conditions, including signs of healthy food markets to reduce
posttraumatic stress, anxiety, grief, disparities in obesity and
and depressive symptoms, using Optimizing Workforce Development undernutrition in neighborhoods
validated screening tools and and Professional Education affected by poverty.
a trauma-informed approach to • Advocate for pediatric training • Advocate for improvements in the
make referrals to mental health programs that are girded by quality of education in segregated
services as needed.144 competencies and subcompetencies urban, suburban, and rural
• Integrate positive youth related to effective patient and communities designed to better
development approaches,145 family communication across optimize vocational attainment and
including racial socialization,123,146 differences in pediatric educational milestones for all
to identify strengths and assess populations.148,149 students.

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6 FROM THE AMERICAN ACADEMY OF PEDIATRICS
• Support local educational systems • Collaborate with first responders important to begin untangling the
by connecting with and supporting and community police to enhance thread of racism sewn through the
school staff. The AAP Council on positive youth engagement by fabric of society and affecting the
School Health provides resources to sharing expertise on child and health of pediatric populations.
help physicians engage and interact adolescent development and Pediatricians must examine and
with their school system and mental health, considering acknowledge their own biases and
provides guidelines around the role potential differences in culture, sex, embrace and advocate for innovative
of school physicians and school and background.178 policies and cross-sector partnerships
health personnel.165,166 • Advocate for fair housing practices, designed to improve medical,
• Advocate for federal and local including access to housing loans economic, environmental, housing,
policies that support implicit-bias and rentals that prohibit the judicial, and educational equity for
training in schools and robust persistence of historic optimal child, adolescent, and
training of educators in culturally “redlining.”179 emerging adult developmental
competent classroom management outcomes.
to improve disparities in academic Optimizing Research
outcomes and disproportionate • Advocate for funding and SECTION ON ADOLESCENT HEALTH
rates of suspension and expulsion dissemination of rigorous research EXECUTIVE COMMITTEE, 2018–2019
among students of color, reflecting that examine the following: Maria E. Trent, MD, MPH, FAAP, Chairperson
a systemic bias in the educational Robert M. Cavanaugh Jr, MD, FAAP
1. the impact of perceived and
system.167 Amy E. Lacroix, MD, FAAP
observed experiences of Jonathon Fanburg, MD, MPH, FAAP
• Advocate for increased access discrimination on child and Maria H. Rahmandar, MD, FAAP
to support for mental health family health outcomes180; Laurie L. Hornberger, MD, MPH, FAAP
services in schools designed Marcie B. Schneider, MD, FAAP
2. the role of self-identification Sophia Yen, MD, MPH, FAAP
to help teachers better manage
versus perceived race on child
students with disruptive
health access, status, and
classroom behaviors and to STAFF
outcomes52;
reduce racial disparities in school Karen S. Smith
expulsion.144,168,169 3. the impact of workforce
development activities on
• Advocate for curricula that are
patient satisfaction, trust, care COUNCIL ON COMMUNITY PEDIATRICS
multicultural, multilingual, and
use, and pediatric health EXECUTIVE COMMITTEE, 2018–2019
reflective of the communities in
outcomes161; Lance Alix Chilton, MD, FAAP, Chairperson
which children in their practices
Andrea E. Green, MD, FAAP
attend school.170 4. the impact of policy changes and
Kimberley Jo Dilley, MD, MPH, FAAP
community-level interventions
• Advocate for policies and programs Juan Raul Gutierrez, MD, FAAP
on reducing the health effects of James H. Duffee, MD, MPH, FAAP
that diversify the teacher
racism and other forms of Virginia A. Keane, MD, FAAP
workforce to mitigate the effects of Scott Daniel Krugman, MD, MS, FAAP
discrimination on youth
the current demographic mismatch Carla Dawn McKelvey, MD, MPH, FAAP
development; and
of teachers and students that Julie Michelle Linton, MD, FAAP
affects academic attitudes and 5. integration of the human Jacqueline Lee Nelson, MD, FAAP
genome as a way to identify Gerri Mattson, MD, FAAP
attainment for all students.115,171
critical biomarkers that can be
• Advocate for evidence-based
used to improve human health LIAISON
programs that combat racism in the
rather than continue to classify
education setting at a population Donene Feist
people on the basis of their
level.172–174
minor genetic differences and
• Encourage community-level countries of origin.55 STAFF
advocacy with members of those Dana Bennett-Tejes, MA, MNM
communities disproportionately
affected by racism to develop CONCLUSIONS
policies that advance social COMMITTEE ON ADOLESCENCE, 2018–2019
Achieving decisive public policies,
justice.19,175 optimized clinical service delivery, Cora C. Breuner, MD, MPH, FAAP,
Chairperson
• Advocate for alternative strategies and community change with an Elizabeth M. Alderman, MD, FSAHM, FAAP
to incarceration for management of activated, engaged, and diverse Laura K. Grubb, MD, MPH, FAAP
nonviolent youth behavior.50,176,177 pediatric workforce is critically Janet Lee, MD, FAAP

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PEDIATRICS Volume 144, number 2, August 2019 7
Makia E. Powers, MD, MPH, FAAP Lauren B. Zapata, PhD, MSPH – Centers for Klein, Janie Ward, Michael Lindsey,
Maria H. Rahmandar, MD, FAAP Disease Control and Prevention Lance Chilton, James Duffee, Andrea
Krishna K. Upadhya, MD, FAAP
Green, Julie Linton, Virginia Keane,
Stephenie B. Wallace, MD, FAAP
STAFF Jackie Nelson, Raul Gutierrez, Lase
Ajayi, Lee Beers, Nathaniel Beers, Heidi
LIAISONS Karen S. Smith
Schumacher, and Tonya Vidal Kinlow.
Liwei L. Hua, MD, PhD – American Academy
of Child and Adolescent Psychiatry ACKNOWLEDGMENTS
Geri D. Hewitt, MD – American College of We are grateful for internal review
Obstetricians and Gynecologists and critical feedback by Drs Benard ABBREVIATION
Seema Menon, MD – North American Society
of Pediatric and Adolescent Gynecology Dreyer, Olanrewaju Falusi, Renee AAP: American Academy of
Ellie E. Vyver, MD, FRCPC, FAAP – Canadian Jenkins, Judith Palfrey, Krishna Pediatrics
Pediatric Society Upadhya, Joseph Wright, Jonathan

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2019 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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14 FROM THE AMERICAN ACADEMY OF PEDIATRICS
 The Impact of Racism on Child and Adolescent Health
Maria Trent, Danielle G. Dooley, Jacqueline Dougé, SECTION ON ADOLESCENT
HEALTH, COUNCIL ON COMMUNITY PEDIATRICS and COMMITTEE ON
ADOLESCENCE
Pediatrics 2019;144;
DOI: 10.1542/peds.2019-1765 originally published online July 29, 2019;

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 The Impact of Racism on Child and Adolescent Health
Maria Trent, Danielle G. Dooley, Jacqueline Dougé, SECTION ON ADOLESCENT
HEALTH, COUNCIL ON COMMUNITY PEDIATRICS and COMMITTEE ON
ADOLESCENCE
Pediatrics 2019;144;
DOI: 10.1542/peds.2019-1765 originally published online July 29, 2019;

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/144/2/e20191765

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