Transcription:
The Impact of Racism on Health

Bill Klaproth: (Host) As our country comes to grips with racial injustice, we want to talk about children and how racism affects a child's health, right from the very beginning. With us to talk about this important topic is Dr. Cynthia Cross, Division Chief of the Pediatric Hospitalist program at Le Bonheur Children's Hospital and the Medical Director for the Le Bonheur Mobile Medical Unit. This is the Peds Pod by Le Bonheur Children's Hospital. I'm Bill Klaproth. Dr. Cross, thank you so much for your time. We really appreciate it. And it is great to talk with you. So first off, how does being a victim of racism and living in a culture of racism affect the health of a child?  

Dr. Cynthia Cross: (Guest) Thanks for having me. This is a complex issue and requires looking at it from different periods in a child's life dating back to probably before they're conceived, looking at maternal health, and this may lead to problems that continue throughout the life of the child, or at least in those early years of development. And there are myriad issues that come up related to, racism and, reflective of poverty.

Host: So you're saying even the health of the mother during pregnancy affects that child right from the outset, from the beginning.   So in your clinical experience, then how have you seen this manifested?

Dr. Cross: So there are conditions in pregnancy that can be treated and not affect the fetus without adequate prenatal care. Some of these kids will present early in infancy from untreated maternal conditions and require a hospital stay. One, the issue can be an untreated sexually transmitted infection in the mother that crosses the placenta and affects the unborn child. So the problem can start fairly early on.

Host: Wow. Okay. So you called it an untreated maternal medical conditions. So you just gave us an example of that. Are there any other conditions that you see that arise?

Dr. Cross: So, counseling that occurs during prenatal care, for instance, anti-smoking counseling can help one to perhaps quit smoking and not have a baby with low birth weight who may end up in the neonatal intensive care unit. A mother who has untreated mental illness, a mother with a seizure disorder who may need her medication changed during pregnancy, and then have that adjusted once she delivers. Even someone with a thyroid condition who is pregnant will need a change in medication during those first few months of the pregnancy and even before conception. However, if one does not get that care, then those things don't happen and those effects are passed on to the fetus. Even maternal stress has been shown to affect the unborn.

Host: Well, that is really interesting Dr. Cross. So then taking this one step further. How does race affect access to health care or quality care for children?

Dr. Cross: That's a good question. And again, somewhat of a complex issue and some of the issues are related directly to poverty and generational issues with the medical profession, as a group. So this may make one resistant to want to come for care. And so folks will wait until they're sicker to come in. Sometimes that leads to long-term problems. Sometimes that can result in death. Getting to the doctor can be a problem because there are many families that don't have their own cars, so they need to wait for transportation. maybe there's one car and that family member works late. And they show up at the ER at two in the morning because the doctor's office is closed and the car just made it home. And so that's when the child seeks care. And then you take that one step further, if that kid only comes to the emergency department, then they don't get vaccines. They don't get what we call anticipatory guidance, where we can talk to families about issues such as diet and exercise and mental health and school performance, because that typically doesn't happen in any emergency department. It's a problem-oriented, care delivery system.

Host: Well, I think we all recognize these health care issues that may arise out of racism need to change. So what are the first steps we need to take as a community to help change this?

Dr. Cross: That's another great question. I think it is incumbent on all of us to try and make a difference for folks who don't have a voice. Children don't vote. And they need advocates. Their parents can advocate them, but they also need their community, to advocate for them to see beyond the immediate picture that needs the eye to try and look and see what are the barriers to care. So if one has a patient who did not take the medication prescribed and now, they returned and they're sicker. Stopping to ask what happened with getting that prescription. And sometimes the answer is, I went to the pharmacy, it required prior authorization, and I just didn't go back to. pick it up. So one thing we've done is to try and send prescriptions to our pharmacy that's on-site, that way we know if there's going to be a problem for the family, obtaining their medication, assisting families with transportation. Just stopping to talk to folks about what's going on and asking how we can help, because there are certainly things that we can do, with engaging families and meeting them where they are.

Host: So you just said some great points there that we, as a community need to advocate for them. How about on an individual basis for someone listening to this? Is there something individuals can do on their own to help enact change in this area?

Dr. Cross: So not to be cliché, but if you see something say something. So if you see, Unfair attitudes, speaking up to say, Hey, let's give that person the benefit of the doubt. Let's not assume that there was negative intent or that they just don't care. So I think first adjusting our own attitudes toward people who were different than we are, and trying to figure out how things happen and what we can do to help. I think when we are in tune with our own attitudes, it can help us be more open and put us in a better position to help the folks who cross our paths every day. That are in need of hope and need of just a little bit of assistance rather than, the natural tendency to blame people for their circumstances. So I think it starts within our hearts and our minds and it goes from there.

Host: Those are really wonderful points you made Dr. Cross about people needing hope and how we as individuals can bring that hope to each other and treat each other with compassion and kindness and understanding which we all need. And this whole world needs right now. So I'm just kind of curious to ask you, how do you see your role as a provider in providing equal health care to children of all races and backgrounds?

Dr. Cross: Absolutely and something that I think about most days, if not every day, I was born in Memphis and an inner-city neighborhood. I have had asthma most, if not all of my life. And I can still remember what it feels like to be sick and to not be able to breathe and I take that and I allow those experiences to fuel me every day. To try and be the best doctor I can be for each and every patient whose path I cross, whether they are, African American, Hispanic, Caucasian, Asian, Muslim, it doesn't matter. I want to meet them where they are and see what I can do to help. I see myself as a person who can provide hope, who can help with healing. One who can advocate for my patients. Whatever the forum is. I have done advocacy at the national level, at the state level, and at Le Bonheur advocating for patients to get what they need. I feel that's my role here also for girls and particularly girls of color, I am a living example of what can be achieved.

Host: I love that answer, Dr. Cross, and just, one more personal question if you'll allow me, I'm just curious, why is all of this so important to you?

Dr. Cross: That's a good question. And I've been asked that before. It's important to me because I care. I take what I do very seriously as not only my, profession, for me, it's, a ministry if you will. It is my chance to treat people the way God would have us treat them no matter what their circumstances are. And I keep this on my heart every day.

Host: That is so good. That's so good. Dr. Cross thank you for your time. We really appreciate this. Thank you again.

Dr. Cross: You are certainly welcome. It was my pleasure.

Host: That's Dr. Cynthia Cross. And to learn more, please visit lebonheur.org/podcast. And be sure to subscribe to the Peds Pod on Apple Podcasts, Google Play, or wherever you listen to your podcasts, you can also check out Le Bonheur.org/podcast to view our full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children's Hospital. Thanks for listening.