Story at a glance
- A new study published in JAMA Pediatrics found that race was “frequently” used in U.S. pediatric clinical guidelines in ways that could negatively affect health care inequities.
- Researchers in Washington state and Wisconsin looked through more than 400 pediatric clinical guidelines to find instances where race or ethnicity was used.
- Only 30 percent of the guidelines used race or ethnicity at all.
A new study published this week found that race was used “frequently” in medical guidelines for U.S. pediatricians in a way that could negatively affect health care inequities.
As part of the study, published this week in JAMA Pediatrics, a team of Washington and Wisconsin-based physicians parsed through 414 English-language medical guidelines for patients younger than 19 years old and found that only 126, or 30 percent, used race or ethnicity.
Out of those guidelines that did use race, study crafters found 87 instances where the use of race had a “potential negative effect” and 50 instances where its use had a “potential positive effect.”
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One example of an inappropriate use of race researchers found was in the 2017 Infections Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea.
According to the study, the guideline states “higher risk groups in the United States include young African American and Asian children, especially during winter months…the higher rates among African American children had been attributable to cross-contamination within the home during preparation of chitterlings, a seasonal dish prepared from pig intestines…”
Study crafters determined the use of race in the context to be inappropriate because it conflated race with a negative stereotype.
But most of the guidelines reviewed, 70 percent, made no mention of race or ethnicity at all.
“I think it actually shows a missed opportunity for us as medical organizations to be proactive in talking about healthcare inequities and systemic racism in our field,” said one of the study’s lead authors, Courtney Gilliam, pediatric hospital medicine fellow at Seattle Children’s Hospital, about the sizable portion of guidelines that made no reference to race or ethnicity.
Physicians have long known that medicine has a history of looking at race as a “risk factor” for certain illnesses or conditions, Gilliam said, which inspired her and her colleagues to think about how race and language about race is used in medical guidelines.
The study’s creation coincided with a number of medical organizations’ recognition of their role in perpetuating health inequities and public commitments to address them.
In 2019, the American Academy of Pediatrics released a statement acknowledging the role of racism in child and adolescent health. Last year, the U.S. Centers for Disease Control and Prevention declared racism a threat to public health and in May, 20 obstetrics and gynecology organizations called for collective action to address racism in their practices.
“What we have learned is whenever we use race as an issue, we should be saying we understand that race is a social construct not a biological construct and it’s likely that these risk factors or increased risk are due to social determinants of health and not biological differences,” said Benard Dreyer, professor at the department of pediatrics at New York University’s Langone Health.
Associate Professor of Pediatrics and director of equity and justice in curricular affairs at Columbia University Hetty Cunningham, who did not take part in the study, called the study a “critical contribution” toward health equity in the United States.
“Laying out all this data in all these clinical guidelines…it’s going to be useful for everybody at all levels of healthcare,” Cunningham said.
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