Q&A: Researchers address impact of systemic racism on childhood asthma

Key takeaways:

• Community members, social scientists and policymakers should be incorporated into health care research.
• Community health workers are necessary in bridging gaps in care.

Several tactics, such as community engagement and increased funding, can address systemic racism and the impact it has on childhood asthma outcomes, according to a workshop report in Annals of the American Thoracic Society.

The workshop report resulted from the collaboration of a panel of experts at the 2022 American Thoracic Society International Conference that aimed to identify gaps that could address systemic racism in childhood asthma research.

Healio spoke with Stephanie Lovinsky-Desir, MD, MS, a volunteer medical spokesperson for the American Lung Association, about the workshop and its results.

Healio: Why are efforts to understand the underlying causes of Black and Latino children with asthma needing more ED visits and hospitalizations important, especially for achieving equity in asthma care?

Lovinsky-Desir: Many of the disparities in outcomes that we see across groups of children stem from structural inequities in the systems, policies and environments where children live, go to school and play. This is not just for diseases such as asthma, but asthma is a great model to illustrate the impact of disparate exposures and outcomes because of the high health care utilization, including ED visits. Thus, if we want to level the playing field so that children are not suffering more than their peers, we need to understand and address how these structural and systemic factors contribute to disease burden.

Healio: How does systemic racism affect the issue?

Lovinsky-Desir: Paula Braveman, MD, MPH, defines systemic racism as the relegation of people of color to inferior status and treatment based on unfounded beliefs about innate inferiority. This leads to unjust treatment and oppression of people of color and influences factors such as access to quality health care, locations and conditions where people live and work, opportunities for economic stability and other social determinants of health. Thus, systemic racism influences the structural and social environment and conditions and has a direct impact on health outcomes including for children with asthma.

Healio: What do you think heath care professionals as well as others in our society misunderstand about the issue?

Lovinsky-Desir: One of my favorite quotes is from the physician Paul Farmer, MD, PhD, who said, “There is an enormous difference between seeing people as the victims of innate shortcomings and seeing them as the victims of structural violence. Indeed, it is likely that the struggle for rights is undermined whenever the history of unequal chances, and of oppression, is erased or distorted.” I think this quote speaks to the fact that we often blame the victims of oppression instead of taking time to understand how systems create inequity and oppression. This is certainly true for health care professionals.

Healio: Why is it important to understand how historically racist policies that further marginalize already disenfranchised groups still have modern day health impacts?

Lovinsky-Desir: It is easy to forget or not understand policies that were created by our ancestors in generations past. And that naiveté creates space for victim blaming and shaming. However, when we take the time to understand how and why policies were created to uphold caste systems in the United States, it offers an opportunity to address the upstream factors that contribute to health inequity. I also believe that understanding and acknowledging the history offers space for empathy, compassion and opportunities to build trust.

Healio: How should the results of this panel affect public health policy?

Lovinsky-Desir: Our workshop report is meant to serve as an opportunity to call out structural racist factors that contribute to childhood asthma disparities and a framework for researchers to continue to assess and address these impacts. We offer concrete strategies and opportunities for researchers, funding agencies and institutions to consider as they determine where to invest in future research and policy. My hope is that we can continue to build the evidence for interventions and solutions that can address some of the upstream contributors to childhood asthma disparities.

Healio: What are the current gaps in health care that you think need to be emphasized in terms of systemic racism affecting child health?

Lovinsky-Desir: I think a big gap in health care is the silos within which we practice medicine and the lack of appreciation for the added benefit of incorporating nontraditional health care providers within the medical model. Community health workers are a great example of people who can help bridge the gap between the clinical space and social communities and networks where families live and spend the majority of their time. Building up this workforce is one example of what we can do to meet people where they are and better understand their immediate and long-term needs. We also need diverse representation in health care administration, people who can understand the lived experiences of individuals and who can help reduce barriers to accessing quality health care.

Healio: What future research should be done on this topic?

Lovinsky-Desir: I think we make a strong case in this report for using implementation science frameworks in future research of childhood asthma. This includes ensuring that research incorporates many different disciplines including social scientists, policymakers, community members, patients and families, among others. There are so many people that have a unique set of expertise and that view the issues that we are all concerned about from a unique lens. Thus, it is important to have many different skillsets and viewpoints together to help solve these problems that are rooted in generational inequity and oppression.

Healio: How can doctors take this information and incorporate it into their practice?

Lovinsky-Desir: It is important for doctors to learn about resources within their communities that can address some of the barriers and struggles that their patients and families are facing. For example, it is not enough to identify that allergen exposure in the home is contributing to frequent exacerbations for your patient. We need to help families identify potential solutions to this problem. This might be by connecting them to a social worker or community health worker that has access to social support networks, or connecting a family directly to programs that assist with environmental remediation. Our patients need us to listen to their immediate concerns, care about what they are telling us and help them access the tools and resources that they need to improve their health.

Reference:

• Lovinsky-Desir S, et al. Ann Am Thorac Soc. 2024;doi:10.1513/AnnalsATS.202407-767ST.
• Braveman PA, et al. Health Aff (Millwood). 2022;doi:10.1377/hlthaff.2021.01394.

For more information:

Stephanie Lovinsky-Desir, MD, MS, can be reached at sl3230@cumc.columbia.edu.