Article #1. COVID-19 Pandemic, Unemployment, and Civil Unrest
Article #2. Diagnosing and Treating Systemic Racism
Article #3. TedTalk by Dr. Camara Jones, MD, PhD, engaging storyteller, national thought leader, and expert on the effects of racism and social inequalities on personal health. Dr. Jones serves on the faculty at Emory, and previously served on the faculty at Harvard and Morehouse. She is a valued lecturer at the NIH National Institute on Minority Health and Health Disparities.
"The Gardener's Tale" is a simple, elegant, and powerful example of privilege and systemic (institutionalized), personally mediated, and internalized racism.
Article #4. Dr. Jones defines institutional=structural racism as "differential access to the goods, services, and opportunities of society by race. Institutionalized racism is normative, sometimes legalized, and often manifests as inherited disadvantage. It is structural, having been codified in our institutions of custom, practice, and law, so there need not be an identifiable perpetrator."
Please reflect on the impact of persistent Structural Racism in Indigenous communities, where plumbing poverty (40% of Navajo households lack running water) is ubiquitous.
Article #5. David R. Williams is the Florence Sprague Norman and Laura Smart Norman Professor of Public Health and chair of the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health.
Article #6. Podcast with our own Founding Dean of UCSD Public Health School, Dr. Cheryl Anderson on "How Redlining Contributed to Health Disparities"
Article #7. Recognizing and Reacting to Microaggressions in Medicine and Surgery. This article addresses microassaults, microinvalidations, environmental microaggressions, and how to respond to microaggressions.
Article #8. Justice in June app, offers daily antiracism training in 10, 25, or 45 minute increments (similar to mindfulness training).
Article # 9. AHA, Editors, and Cardiologists Ask: How did 'Racist' paper make it to print?
Article #10. Majority Taxes Black physicians pay "minority taxes" performing extra duties to help organizations achieve diversity. Perhaps White physicians should pay "majority taxes" by...
Article #11. Please take the time to hear the concerns of Black, Latinx, Native American student leaders. Please listen with a compassionate and empathetic ear/heart to these poignant stories, which we might not otherwise have the privilege to hear.
Article #12. This article by Dr. Kevin Gutierrez forced me to question the utility of disseminating antiracist articles/videos on Friday afternoons, particularly during a difficult week when yet another unarmed Black man, Jacob Blake, was shot in the back by police in front of his three young sons, while a 17 year old shot and killed two protestors opposing Blake's shooting and pervasive police brutality. Our Black students are undone, feeling defeated, frustrated, and hopeless.
Article #13. One of our Orientation Week sessions for our newest cohort of 134 medical students included an introduction to our new Health Equity Thread, Cultural Humility, and Structural Competence.
We would have liked to show them diverse neighborhoods of San Diego in person, but resorted to a virtual tour instead. Barrio Logan was a residential neighborhood until zoning laws allowed industry, naval shipyards and a labyrinth of freeways to weave through and above its quiet streets and ports.
Article #16. Citing the ongoing pandemics of COVID-19 and racism on the health of the nation, the AAMC (Association of American Medical Colleges) released a framework on Oct. 6 that is designed to guide and inspire the academic medicine community to begin addressing decades of structural racism within medicine.
Article #17. COVID-19 case-fatality rates (case-to-death ratios) in San Diego, Los Angeles, and California are highest among Asian-Americans, but these observations have not informed funding/intervention priorities. This article discusses structural racism in Asian-American communities.
Article #18. Dr. Kimberly Manning (Emory University) gave a very engaging Medicine Grand Rounds Lecture last week on "I May be Biased: What Can I Do About It?. Her strategies to recognize and manage our own biases, especially in a clinical setting, offer practical and feasible solutions. (Thank you to Drs. DJ Gaines and Simerjot Jassal for inviting Dr. Manning.)
Article #19. MS4 Betial Asmerom, 2019 AAMC Herbert Nickens Awardee for Health Equity Leadership, was interviewed in the Washington Post for student-led anti-racism learning and advocacy initiatives.
Article #20. The AMA has taken action to explicitly recognize racism as a public health threat and detailed a plan to mitigate its effects.
Article #21. "Trauma has profound implications for mental and physical health. Historical trauma, as we explore in this article, can create health inequities centuries later.
These include “the first documented case of bioterrorism by the colonial government” in the form of the distribution of blankets that contained smallpox to American Indians, the “Indian removal act” of 1830 that forcibly relocated Cherokee populations and killed thousands in the process, the scalping bounties that made the practice legal and rewarded the killing of American Indians during the Dakota War of 1830–1862, and more.
This trauma is “held personally and transmitted over generations. Thus, even family members who have not directly experienced the trauma can feel the effects of the event generations later.”
Article 22-1. Injustice in health care treatment persists, including among Black physicians who advocate (plead) for appropriate care, as chronicled by Dr. Susan Moore , who died of COVID-19 complications.
Article 22-2. Representatives from all UC medical schools are organizing a 5 part Race-Conscious Seminar Series, where we plan to discuss if and how race should be presented in medical education, and if and how race/ethnicity should be defined and applied in clinical practice. The following article by UCSF faculty leading the Race-Conscious seminar (K. Bibbins-Domingo, E Burchard) offers provocative insight to this timely conversation.
Article 23. Today, January 15, would have been Reverend Martin Luther King's 92nd birthday. While addressing the Medical Committee for Human Rights 55 years ago, Dr. King's words: "Of all the forms of inequality, INJUSTICE in Health is the most shocking and the most inhuman" remains relevant today.
The following article by Dr. Mary Bassett and colleagues (Director of the FBX Center for Health and Human Rights at Harvard) addresses racist policies (Redlining and Racialized Residential Segregation, Police Violence and the Carceral State, and Unequal Health Care) as some of the root causes of US Racial Health Inequities. The article also addresses our role in dismantling structural racism.
Article 24. National Youth Poet Laureate, 22 year old, recent Harvard graduate (Sociology), author and activist, Amanda Gorman, shared her poignant words on Unity and Hope.
Article 25. COVID-19 prevalence in San Diego remains highest among Native Hawaiians/Pacific Islanders, followed by Latinx and Black communities.
EISB COVID-19 Daily Update (sandiegocounty.gov)
UCSD Health (including many student, staff, and faculty volunteers) and San Diego County have worked tirelessly at the Petco Park super station, and in establishing the new RIMAC site and other venues (in development).
COVID vaccination rates are highest among Native Hawaiians/Pacific Islanders (9.1%), followed by Whites (8.9%), Asians (8.1%) and American Indians/Alaskan Natives (7.4%), but lag behind among Latinx (3.4%) and Black (3.3%) communities.
Is this due to access? or Acceptability? Most importantly, what can we do (and how do we engage our medical, pharmacy, and public health students) to increase access and acceptability in impacted communities?
Article 26. In the wake of the COVID-19 pandemic, Asian Americans have been widely scapegoated for the COVID-19 pandemic, including microaggressions and egregious comments directed at our students and hospital personnel. Many of the abuses were verbal, but have turned violent in recent weeks, particularly among elderly Asian Americans in the San Francisco Bay Area and New York City.
One-third of our learners are Asian American, and while some have mumbled privately about shocking racist comments, and fears that an elderly parent/grandparent might be attacked, private and public outrage have been temperate.
Article 27. Anti-Asian violence continues, including a recent, unprovoked attack on an 83 year old Filipina woman who was punched in the head while riding the San Diego trolley.
The fear of these unprovoked attacks weigh heavily on our Asian American students (~35% of our student body) who have articulated their own fear, frustration at the seeming lack of support for Asian American students and faculty, and the lack of Asian American representation in anti-racism initiatives, curriculum content, and leadership.
Video: Tritons Tackling Xenophobia: Battling Racism in the Era of COVID-19Article 28. "Pulse oximetry tests received scrutiny recently when the U.S. Food and Drug Administration (FDA) cautioned that the devices were limited in utility, particularly among persons of color. For individuals with a darker skin tone, however, the device may not accurately read the wavelength of light through the more deeply pigmented skin."Other articles: Are Lung capacity Tests Exacerbating COVID-19 Article 29: Police killings and effects on mental health in Black Americans. Please watch this 13 minute episode of 60 Minutes, with Dr. David Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health and Chair of the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health. Article 30: People of Color Are Exposed to More Pollution. Article 31: Decoupling Crisis Response from Policing- A Step Toward Equitable Psychiatric Emergency Services. Article 32: Celebrating Asian and Pacific Islander Heritage month offers an opportunity to learn about the history of our 50th state, and the role of colonialism, indentured servitude in the sugar industry, ethnic hierarchies, and marginalization of migrants from former/current US colonies (Marshall Islands, Micronesia, the Philippines, Puerto Rico, Guam, Samoa). Article 33: UC Medical Schools recently concluded a 5 part series on Racism and Race: The Use of Race in Medicine and Implications for Health Equity Event Series | UCSF School of Medicine. Please view these informative and thought provoking conversations at your leisure.
The conversation about the definition and use of race in Medical Education continues in this insightful NEJM article (w/co-author, Dorothy Roberts JD, keynote speaker in the above series, and acclaimed scholar of race, gender, and the law).
Article 34: Scientists, administrators, staff and leaders from the National Institutes of Health have published a commentary in Cell which outlines a framework for how NIH’s recently launched UNITE initiative will work to end structural racism in the biomedical research enterprise. The authors acknowledge that the current NIH diversity and inclusion efforts have been valuable, but not sufficient. The article details current and future actions being undertaken at NIH to create a more equitable ecosystem across biomedical science. Article 35: Medical Students' Perceptions of Faculty Role Modeling of Respect for Diversity.
Survey included 28,778 graduating medical students: Among Black/African American students, 36.8% reported perceiving a lack of faculty respect for diversity compared with White students (14.4%). American Indian/Alaska Native/Native Hawaiian/Pacific Islander, Asian or Hispanic/Latinx students also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds compared with male students and students who identified as LGB had greater odds compared with heterosexual students.
"Faculty may be unaware that they are modeling negative behaviors and may regard themselves as nonbiased; however, they may demonstrate negative unconscious attitudes and biases, such as aversive racism and gender blindness, toward marginalized groups during patient encounters. Students may also feel unsupported in situations in which patients demonstrate racism, sexism, or discrimination toward LGB trainees and faculty do not speak out against this behavior."
"These behaviors can lead to the perception of decreased learning opportunities and a lack of support and mentorship, which serve as barriers to academic success and may undermine institutional recruitment and retention efforts."
Article 36: Disparities in Cardiovascular Medicine.
The articles are authored by some of our recent guest lecturers, including Dr. Michelle Albert (UCSF, President-elect of the American Heart Association),
and initiatives similar to the Fade Hypertension elective initiated by UCSD SOM MS4 students (Manny Keiler, Kevin Gilbert, and Edgar Vega)
as well as other informative articles on heart failure, cerebrovascular disease mortality, hypertension treatment, and diversifying the cardiology pipeline.
Article 37: The NIH National Institute on Minority Health and Health Disparities (NIMHD) issued a call for scientists to address the topic of structural racism and its effects on health in the current issue of Ethnicity and Disease.
Among the opinion pieces, commentaries, and original research articles in this issue, this article might be relevant (as we reflect on the communities who grow our food, tend our gardens, and build our homes).
"The wage theft experienced by Latino Day Laborers perpetuates factors rooted in structural racism.... These experiences are indicative of a risk environment rooted in structural racism, where Latino Day Laborers are forced to endure exploitative conditions not acceptable to most Americans.
Article 38: We are grateful to the MarDestinee Perez, Marnie Brookolo and Dr. Shaun Travers of the Office for Equity, Diversity, and Inclusion (ucsd.edu) for insightful, facilitated conversations on myriad social justice issues, including a meaningfully reflective dialogue yesterday on "Power and Privilege".
Thoughtfully selected reading assignments include this article by Dr. Max Romano, who catalogued some of the ways he accrued unearned privilege as a White male physician:
• When I walk into an exam room with a person of color, patients invariably assume I am the doctor in charge, even if the person of color is my attending.
• If I respond to a call for medical assistance on an airplane, people will assume I am really a physician because of my race.
• Even if I forget my identification badge, I can walk into the hospital and know that security guards will probably not stop me because of the color of my skin.
• When I travel to and from the hospital late at night as required by my job, I do not fear that I will be stopped, delayed, unjustly detained, inappropriately touched, injured, or killed by the police because of my race.
• I can name racism in my professional workspace and not be accused of being angry, potentially violent, or excessively emotional.
• Throughout my education, I could succeed academically without people questioning whether my accomplishments were attributable to affirmative action or my own abilities.
• I am reminded daily that my medical knowledge is based on the discoveries made by people who looked like me without being reminded that some of the most painful discoveries were made through inhumane and nonconsensual experimentation on people of color.
• Every American hospital I have ever entered contained portraits of department chairs and hospital presidents who are physicians of my race, reminding me of my race’s importance since the founding of these institutions.
• I know that I can leave the impoverished area where I work without being accused of abandoning my community.
• I can pretend that health disparities don’t affect me or my family without acknowledging that we accrue benefits from a system that systematically favors our skin color.
"Although systems of racial oppression take generations to dismantle, we must begin with an awareness of the problem. White physicians have an opportunity to acknowledge the unearned racial privilege that benefited their careers and actively work to dismantle the systems that propagate racism in medicine. I challenge other white physicians to speak out against the racism we have all benefited from and to work towards racial justice in our medical system for our colleagues and our patients."
(Thank you again, Mar, Marnie, and Shaun, for invaluable learning and reflection).
Where do you hold power and privilege?
How do/will you use/exert your power and privilege?
How do/will you share your power and privilege?
As our neighbors in Oregon are escaping wildfires and a heat dome approaches the western half of the US, recent UCSD research highlights climate inequities locally and globally:
Dr. Susanne Benz, UCSD School of Global Policy and Strategy showed that "low-income neighborhoods and communities with higher Black, Hispanic and Asian populations experience significantly more urban heat than wealthier and predominantly white neighborhoods. Extreme heat has been linked to a range of consequences for humans, from premature births, to lower test scores, decreases in productivity and increased risk of heat stroke among children and the elderly."
"The U.S. is responsible for about 25% of all planet-warming emissions currently in the atmosphere atmosphere, while Guatemala, for example, has contributed roughly 0.0002%. But more than 75% of the heat-related deaths can be linked to climate change. About 35% of the U.S.’s heat-related deaths could be attributed to the climate change that has already occurred; in many cities, older people of color are twice as likely to die during extreme heat.
Worldwide, the effects are unequal. Within the U.S., the effects are unequal. At the county, at the city, in the neighborhood—the effects are unequal,” says Benmarhnia.
Article 40. Although health disparities persist with regards to COVID vaccination rates, there's good news that Native Americans have the highest COVID vaccination rate in the U.S. | NOVA | PBS Article 41. The August 17, 2021 issue of JAMA focuses on Racial and Ethnic Disparities and Inequities in Medicine and Health Care and includes original research, editorials, and viewpoints:
and valuable editorials and viewpoints: