Mighty Blog

Dr. Marc Gorelick speaks on racism’s impact on health care

By: Marc Gorelick, MD, Children’s president and CEO

If you have any interest in the health of children, the new policy from the American Academy of Pediatrics entitled The Impact of Racism on Child and Adolescent Health is worth reading.  The statement reviews evidence for the effect of racism on children’s health and on health disparities, and makes recommendations on how health professionals can address and ameliorate the adverse health impacts of racism.

One “aha” for me is the notion that racism is, in fact, a social determinant of health.  While I had always considered that disparities in health can arise from disparities in housing, education, etc., and that many of these are mediated by racism, I hadn’t made the connection that racism itself is a social determinant. Not only does racism drive the kind of disparities in these other social determinants, but the internalized experience of racism creates a toxic stress response with adverse health effects as well.

As noted in the AAP Policy Statement, racism is a “system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call ‘race’) that unfairly disadvantages some individuals and communities, [and] unfairly advantages other individuals and communities.”  It further goes on to state that racism can operate through different mechanisms: institutionalized (or structural), and personally mediated.  The latter includes not only the kind of overt, willful, and ugly race hatred of the Bull Connor variety that involves violent threats and racial epithets, but also the subtler, unconscious forms of implicit bias we all carry.  As the National Association of Educators of Young Children puts it, “racism is a system of oppression that results from a combination of prejudice and power.”

Now, the topic of racism has been much in the news recently.  The term itself is seen as partisan and divisive.  Part of the problem is that the term “racism” refers to a concept that is multidimensional and complex, hardly amenable to Twitter-based discourse.  And this, I think, is where much of the rancor comes from.  For many people, “racism” connotes solely the personally-mediated variety, and more specifically, the willful, angry variety.  For them it is only about the prejudice, and not about the power.  Thus they feel that calling out racism equates to questioning their integrity and character, and that of the majority of the population.  Moreover, the fact is that there is fortunately less of that kind of viciously-expressed race hatred than there once was (if still a disturbing amount).  It is thus tempting to think of racism as a thing of the past, rather than an ongoing legacy of centuries.

So how do we get past the sticking point we seem to be at, where the urgency seems clear to some, and the problem seems non-existent to others?  It won’t happen via Twitter, where the complexity of a seemingly simple 6 letter word cannot be explored.  Antiracists must understand that the opposite of antiracism isn’t necessarily pro-racism.  We need to recognize that many people have a narrower view of the same word, and when they hear an attack on racism they hear an attack on them personally.  We need to educate ourselves and each other on the many forms of racism – both prejudice and power – and how racism “saps the strength of the whole society through the waste of human resources.”  Especially our children.


Interested in more information on child and adolescent health, visit Children’s to see what services are available. 

Marc Gorelick, MD, president and CEO
Kaitlyn Kamleiter