New Study Series Addresses Racial Inequities in Pediatric Care, Need for Policy Reform

Recent research published in The Lancet Child & Adolescent Health revealed pervasive racial inequities in pediatric care across the US, as a dual-paper series identified structural racism embedded in various sectors of society, impacting the health care received by non-White children.^1,2 The findings indicate an urgent need for policy reform.

“We must fundamentally rethink and redesign systems and policies, not only in health care but across the societal spectrum, to promote equitable, excellent health for all children,” lead researcher Natalie Slopen, ScD, of Harvard University, stated.

The impact of low socioeconomic status on a child’s health is falling on minority families as racial income gaps persist and anti-poverty programs aren’t yet rid of racist approaches.

Wide-Ranging Inequities in Pediatric Care

“There are deeply entrenched racial disparities that span broad sectors of US society and transcend generations,” series author Monique Jindal, MD, MPH, University of Illinois Chicago School of Medicine, said in a statement. “These lead to, among other disadvantages, stark inequities in health care for children from minoritized racial and ethnic groups.”

The research exhibited extensive disparities in pediatric specialties, including neonatal care, emergency medicine, surgery, developmental disabilities, mental health care, and palliative care. Regardless of health insurance status, racial and ethnic minority children consistently receive lower-quality health care compared with their White peers.

“It is abundantly clear that to ensure every child in the USA receives the best possible health care, there is a critical need for far-reaching policy changes that directly address deep-rooted structural racism at its core,” Jindal stated.

The researchers refined the review to control for health insurance status and found that these inequities were not the result of lacking access to health services.

“From the very earliest moments of life, there are pervasive inequities in the quality of health care received by children in the USA. Racism profoundly impacts not only children’s health but also people’s health on into adulthood, emphasizing the vital importance of tackling disparities in the care received by children,” Slopen stated.

Key findings include the following:

• Neonatal care: Infants from minority racial and ethnic groups, especially Black and Hispanic children, consistently receive lower-quality neonatal care than White infants.
• Primary care: Poor quality communication between health care providers and children from non-White racial and ethnic groups contributed to persistent inequalities in primary care.
• Emergency medicine: Disparities existed in wait times, triage assessment, suspected child abuse evaluation, and pain management. Children from minority groups are less likely to receive painkillers for various medical conditions.
• Surgery: Inequities exist in the diagnosis of developmental disabilities, with Black and Asian children less likely to receive diagnoses before preschool or kindergarten compared with White children.
• Mental health care: Lower rates of adequate care for major depressive disorder and attention-deficit/hyperactivity disorder are seen among Black, Hispanic, and other children from minority groups compared with White children.

Structural and Systemic Obstacles

Researchers reported that existing policies and practices at the local, state, and federal levels contribute to structural racism, hindering pediatric health equity. Housing, economic, employment, criminal justice, and immigration policies all play a role in perpetuating these disparities, according to the studies.

Areas that need to be addressed for equitable pediatric care include:

• Housing and neighborhood policies: A child’s health outcome is significantly influenced by housing instability, poor quality, unaffordability, and characteristics of the neighborhood they live in. Racial and economic disparities in housing continue, and the researchers argue it’s time for a comprehensive strategy to improve these conditions.
• Economic and employment policies: The impact of low socioeconomic status on a child’s health is falling on minority families as racial income gaps persist and antipoverty programs aren’t yet rid of racist approaches. Researchers call for Medicaid and Children’s Health Insurance Program (CHIP) expansion to work toward equity.
• Criminal justice policies: Black individuals are disproportionately affected by the criminal justice system, which has been linked to negative health effects among this community. Preventing young people from going to prison and mitigating the effects on children with parents in prison is paramount, according to the researchers.
• Immigration policies: Access to public health benefits is limited due to immigration policies, which have a significant impact on children’s health. It was stated that these policies should enhance eligibility for better health outcomes.

“We now have more evidence than ever that pediatric care in the USA is not only disparate but inequitable for a large group of children. Policies that advance health justice and reach across institutions, communities, and populations are urgently needed,” series lead Nia Heard-Garris, MD, MBA, MSc, of Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University, stated.

Implications and Future Research

The research suggests implications for health care practice and policy, urging hospital systems to address structural racism within existing policies. Additionally, the need to end racial segregation in pediatric care and enhance the diversity of the medical workforce is highlighted. The researchers call for further investigation to understand the experiences of specific demographic groups, emphasizing the intersectionality of race and ethnicity with other sociodemographic features.

According to the studies, the findings demonstrate the critical need for immediate policy reforms to tackle structural racism and promote equitable pediatric care in the US. The disparities identified demand a comprehensive and collaborative effort across sectors to ensure every child receives the best possible health care, irrespective of their racial or ethnic background.

References:

1. Slopen N, Chang A, Johnson T, et al. Racism and child health in the USA 1. Racial and ethnic inequities in the quality of paediatric care in the USA: a review of quantitative evidence. Lancet Child Adolesc Health. 2024;8:147-158. https://www.thelancet.com/series/racism-child-health-USA

2. Jindal M, Barnert E, Chomilo N, et al. Racism and child health in the USA 2. Policy solutions to eliminate racial and ethnic child health disparities in the USA. Lancet Child Adolesc Health. 2024;8:159-174. https://www.thelancet.com/series/racism-child-health-USA