#48: Anti-Racism Series: Foundations with Dr. Ben Danielson

April 13, 2022 | By Sam Masur

Summary

Anti-racism is a lifelong journey. Maybe you’re learning the foundations; maybe you want to re-center yourself to continue dismantling a racist medical system. Listen to our conversation with the one and only Dr. Ben Danielson as we talk about calling out and changing racism in medicine, the power of being present with patients, and the importance of remembering your own power. We promise you’ll leave inspired.

Credits

• Producer, writer, infographic: Angela Y. Zhang MD
• Executive Producer: Max Cruz MD
• Showrunner: Sam Masur MD
• Cover Art: Chris Chiu MD
• Editor:Justin Berk MD; Clair Morgan of nodderly.com
• Guest(s): Ben Danielson MD

Anti-Racism: Foundations Pearls

1. Anti-racism work is everyone’s job, and crucial to work in medicine, a system that often perpetuates racism.
2. Having good conversations about race with patients requires acknowledging your own positionality, making space for their lived experiences, and being present.
3. Interlocking levels of racism affect patient health, especially of those with marginalized identities.

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Anti-Racism, Pt 1 Notes 

Foundation: Terms and Definitions

It is the nature of anti-oppression work for definitions to be dynamic. Thus, these definitions may also evolve over time. Definitions are adapted from Racial Equity Tools and the Swearer Center for Public Service.

Expert opinion: It is very easy for the language of equity and anti-racism to become a tool to perpetuate racism anyways. For instance, plenty of people are brought into brand-new Equity/Diversity officer positions but are not vested with the actual authority or accountability that they can hold leadership to to make changes. The language of equity can be used to subvert equity – it’s much more about what’s in your heart than what’s in your nomenclature.

Race: A socially constructed way of grouping people based on skin color and other apparent physical differences (which has no genetic or scientific basis), in order to give power to some over others and to justify social and economic oppression. As an invented social construct, categorizations of race differ depending on country, and in fact categories have shifted through the decades in the U.S. Census to reflect contemporary geopolitics.

“Race is the child of racism.” – Ta-Nehisi Coates

Racism: A system of oppressive social structures based on the socially constructed concept of race exercised by the dominant racial group (white) over non-dominant racial groups. Racism is different from discrimination, bias, or racial prejudice; it is race discrimination plus power. Racism provides or denies access, safety, resources, and power based on race. Its complexity and structural nature has allowed racism to recreate itself generation after generation, such that systems that perpetuate racial inequity no longer need racist actors or to explicitly promote racial differences in opportunities, outcomes, and consequences to maintain those differences. 

Anti-racism: The active process of identifying and eliminating racism by changing systems, organizational structures, policies and practices and attitudes, so that power is redistributed and  shared equitably. In Ibram Kendi’s words, an anti-racist idea or policy is one that furthers equity. Whatever definition you use, the important thing is that anti-racism is an action, not a passive state – passivity is still racist as inaction supports the status quo, and neutrality is not possible.

Expert opinion: “Anti-racism” is still a responsive term to racism. What you really want is a proactive set of actions that lift up what you’d rather see instead of racism.

There are many evolving frameworks to consider the nuanced impacts of racism. One such framework is Camara Jones’ Levels of Racism, which illustrates succinct examples of institutionalized, personally mediated, and internal racism.

Another framework for considering the role of racism in society is Critical Race Theory (CRT), a legal framework coined in the 1970’s. The framework is lengthy and quite academic, but the core tenets can be summarized as: 

• Race is a social construct and unconnected to biological reality
• Racism is endemic, not aberrational – that is, it is not limited to individuals with malintent, or situations that go horribly awry. It is embedded in our society and serves to uphold the current status quo.
• Lived experiences and stories, especially from individuals from marginalized communities, are crucial to understanding and changing the experience of oppression in America. Expert opinion: Replace some of your outrage with curiosity. Stories are our facts as much as anything else we can understand.
• A commitment to social justice
• Recognizing the importance of interdisciplinary collaboration

Expert practice: Although it is easier to learn about racism in distinct levels, like everything else in the world, there’s more overlapping gradation than that.

Clinical Applications

We can use the clinical case on precocious puberty in Black girls to illustrate how these different types of racism influence each other:

Interpersonal: Blake and Epstein found that Black girls tend to be viewed as more mature and older than their age. This “adultification” of Black girls can lead to less interpersonal empathy and other negative consequences.

Environmental/Structural: Studies show that chemicals found in personal use products, or as a byproduct of industrial waste, can lead to precocious puberty (in addition to other health outcomes, e.g. malignancies). 

Systemic: The “weathering” hypothesis, which posits that repeated exposures to a racist society leads to health inequities along racial lines not attributable to genetics, may lead to earlier epidemiological puberty among Black youth (and more so for those assigned female at birth given the intersectional impacts of sexism and racism). To code precocious puberty as “normal” in Black youth such as in this case study moves the onus off of systemic change and instead characterizes the individual as “atypical”. Expert opinion: When we normalize something that is abnormal, we are accepting the abnormal as the new normal. In this case, by normalizing Black trauma and oppression, we are accepting that this is the new normal.

Talking to Patients about Racism

Be mindful of your own positionality (set of interlocking identities, e.g. race, gender, sexuality, ability status, socioeconomic status (SES) when considering conversations about racism with patients. Note that our expert’s practice may not apply to you if you identify differently than they do, given different lived experiences. That being said, our guest offers some advice for these sometimes difficult conversations:

• Reclaim your listening skills and really be present with your patients. Without time (which systematically, providers lack), you can’t build relationships and be present with patients on their terms
• See your patients beyond just their immediate problems. There will always be an endless supply of those to keep us busy and distracted from seeing the beauty and brilliance in patients and each other, and from changing medicine more broadly.
• Uncenter yourself and your feelings – the practice of medicine is often confused with the practice of saviorship. Instead of responding with, “That patient experience was really hard for me”, ask yourself how you can be supportive to your patient while considering your own positionality. Healthcare is a team sport – who else should be in the room, maybe with a more connected lived experience?
• Validate their experiences. Consider what it took for your patient to bring up their lived experience in a room of providers who might not look like them. Don’t make your patients “prove” their experience of racism.
• You, as the provider, are also a learner in this situation.

Dismantling Racism in Medicine

Medicine and healthcare are active players in perpetuating racism and thus, as healthcare workers we have a responsibility to commit to the never-ending journey of living in an anti-racist manner. As Dr. Danielson says, one of the consequences of an incredibly hierarchical profession like medicine is that everyone ends up feeling relatively powerless to make changes. But don’t shortchange yourself – know your power and boldly reach beyond what you think is possible.

Make a conscious effort to pause and ask yourself where assumptions in healthcare are coming from. Although naming the effects of racism in medicine is important to combat health inequity, the constraints of the healthcare system result in using quick proxies as stand-ins for social determinants of health (e.g. using race instead of naming racism). Along with the systemically passed down examples of eugenicist and racist medicine (e.g. the false notion that Black people have inferior lungs, or the invention of the IQ test as justification against racial intermixing), guidelines have created ‘quick bridges’ to explain health inequities that attribute them to false biological differences instead of systemic racism. By questioning this, we can start to uncenter standards that have been built around whiteness, some of which are so deeply structured that we may not at this moment understand how to unpack and unlearn them.

So what can you do to start dismantling an entrenched and racist system? Some ideas to get you started:

• Find the community of people at your institution doing this work – this work is uplifting when it brings people together.
• Utilize horizontal mentorship and learn from trainees. Many trainees have different expectations and show up as their whole, unapologetic selves.
• For those with minoritized identities: Break out of the expectation that you have to suffer to get to where you want to go. Demand for things to be better and to change.
• Don’t let others define your power.

Goal

Listeners will explain the different levels of racism, how medicine perpetuates each type, how to acknowledge patients’ lived experiences, and the importance of anti-racist work.

Learning objectives

After listening to this episode listeners will…  

1. Explain the different levels of racism, and how they interact.
2. Recognize key concepts when discussing race and racism with patients.
3. Describe why it is essential to enact anti-racist change in medicine.

Disclosures

Dr Danielson reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures.

Citation

Zhang A, Danielson B, Cruz M, Masur S, Chiu C, Berk J. #48: Anti-Racism Series: Foundations with Dr. Ben Danielson. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ April 13, 2022.