Race: A Core Determinant of a Child’s Health

Mar 11, 2022
5 min read

By: Marie Jo Abdul-Hay

Many factors influence a child’s health. An obvious factor would be genetics, but other demographics like socio-economic status, parental education level and race also have an immense impact on a child’s medical outcome. Race has particularly been shown to influence patient outcome at all ages and even before birth, and that is not due to physiological differences, unfortunately, rather it is due to internalized racism which results in adverse consequences. This paper will discuss how racism reflects inequalities in child healthcare before birth up until adolescence.

Before Birth

Racism starts affecting children of color even before birth. Racial discrimination has been shown to be one of the causes of maternal stress, which, when chronic, is known to cause physiological stress (1). This subsequent physiological stress can impact the development of the fetus and its epigenetics, resulting in a lower birth weight for example, which is associated with many complications. Besides, women who experience racial discrimination have been shown to be more likely to have preterm births: 14.1% of Black infants and 9.7% of Hispanic infants were born preterm in 2018 in the United stated compared to 9.1% white infants (2). Preterm birth is a risk factor for some chronic diseases later in the infant’s life, validating the impact of racism on the infant way before its birth (3). Another piece of evidence that validates the presence of racism in the healthcare system is seen in the neonatal intensive care unit (NICU): the survival of a black neonates in the NICU if more than twice less likely, compared to white neonates, which indicates a lower quality of care administered (2). Besides, antenatal steroids, which are drugs provided to pregnant women anticipating a preterm birth, were more likely to be administered to a white mother compared to a Hispanic mother (2).

After Birth

Racism continues to affect children once they are born. Racial discrimination could be associated with physiological and psychological changes, impacting the child’s physical and mental health (3). Young children can start understanding racism as early as 3 to 4 years of age, and are capable of identifying with negative racial stereotypes at that age. This is extremely influenced by their entourage’s attitude and experiences regarding racial discrimination, impacting their own attitude toward groups in their society and even negatively impact their perception of their own group. Their awareness of racism towards their own group can increase self-consciousness as well as depression and anxiety symptoms, therefore already affecting their mental health in their early childhood (3). As racialized children become more conscious, around the ages of 10-12, the encounter of racist events further causes feelings of discouragement and helplessness (3), further promoting mental illness and even impacting their physical health.

Adolescence

As children of color enter adolescence, they become more aware of their minority status and their affiliation to a devalued community, which can increase anger levels drastically (3). Drug use has been also shown to be tightly linked to racism, especially in youth of color under 18 that are unable to regulate their emotions in response to stressors, like racism, anxiety and depression (3).

On the physical health level, research has shown a negative association between social stress and immune function: racism has been shown to increase viral infection susceptibility as the stress and increased aggressiveness experienced causes a release in cortisol, which dampens the immune system, as well as causes a release in inflammatory molecules, causing inflammation (3).

On the other hand, racism can drastically affect an individual’s mental health: Black and Latino male youth are most likely to report having been accused of stealing by shopkeepers, and other adverse events with adults in the educational system and the police (3). And although overall incarceration rates have been decreasing (3), youth from African American, Hispanic, and American Indigenous origin are still excessively represented (1). Incarceration can expose these youth to abusive and adverse experiences, which can compromise their socio-emotional development, therefore affecting their mental health1.

Some Indirect Effects of Racism

Furthermore, racism does not only affect its victims, but its bystanders as well. Youth bystanders of racism have also been shown to experience deep physiological effect and psychological effects when asked to recall the memory of a past adverse event, expanding the impact of racism to not only its victims, but its passive witnesses as well (1).

Racism has also been shown to negatively affect education level, which is positively associated with detrimental long term health outcomes in children. Adults with a college degree are expected to have a longer lifespan and less rates of chronic diseases; however, children of color are more likely to show chronic absenteeism and lower graduation rates from high school, decreasing their chance of receiving the full benefits of educational achievements (1), and therefore explaining some of the health outcome discrepancies seen in people of color later in life. Unfortunately, one of the obvious causes for these discrepancies is the internalized racism in schools: Non-African American teachers are more likely to doubt an African American student’s ability to graduate, while an African American student is more likely to achieve graduation if they were exposed to a teacher of their race during elementary school (1).

Some Reasonable Solutions

It is no surprise that improving the effects of racism on children and adolescents is not an easy solution and should be addressed on many levels and in many aspects of an individual’s life, like in schools, in medical centers, and even in workplaces. Currently, there is a crucial need to move from describing inequalities and investigating their cause to acting towards lowering them, like implementing protocols to prevent their incidence (2). Pediatricians should heavily contribute to this change, first by investigating their own bias and constantly advocating for community and governmental initiatives. Pediatrics staff must also work to improve communication between families and healthcare workers by educating medical staff about racial disparities in the healthcare system, emphasize equity and provide interpreter services to non-English speaking families. It is essential for pediatric healthcare workers to create an inclusive environment and clearly state that all patients and families are welcome. They must also treat everyone with respect and high quality care, regardless of their background and demographics, and then by potentially establishing new policies and tools to ensure equitable care to all patients. Healthcare workers should also “follow through” with their patients and fulfill their duties outside the hospital walls to ensure the long-term health and well-being of their patients and their families (2). A bigger step towards establishing health equity would be to eliminate all barriers like discrimination, poverty, and promote access to education, housing and health care, but it is clear that there is still a long way to go before achieving any of those.