February EDI Corner - Black History Month

During Black History Month, let us be mindful of the centrality of African American history in U.S. history, as well as past and current attempts to erase or alter the teaching of Black history. Because antiracist action requires foundational historical knowledge, we provide a reading list below in an effort to build our capacity as Dental Public Health professionals to engage in antiracism. This list comprises works that highlight Black History and Black authors, and is provided for those wishing to build or deepen their knowledge. 

Additionally, as public health professionals, we need to remember and tell the stories of historical trauma committed against African Americans in medicine and public health, as well as celebrate and recognize past and current Black leaders in public health and related fields. Among many extraordinary Black leaders in Dental Public Health, this month we celebrate Dr. Caswell Evans, an incredible changemaker who has been studying and advocating for racial equity in oral health for decades. Dr. Evans has served in many leadership roles, including as Associate Dean at the University of Illinois Chicago College of Dentistry; Executive Editor and Project Director for the Oral Health in America: A Report of the U.S. Surgeon General; and Past President of the American Public Health Association, the American Board of Dental Public Health, and the American Association of Public Health Dentistry. AAPHD and our discipline has benefited greatly from his leadership.

Black History Month Reading/Watch List

  • The 1619 Project: A New Origin Story by Nikole Hanna-Jones, and accompanying The 1619 Project: Born on the Water children’s book and The 1619 Project on Hulu
  • Caste and The Warmth of Other Suns, both by Isabel Wilkerson, and accompanying film Origin, directed by Ava DuVernay and based on Caste
  • The Color Purple by Alice Walker, and accompanying film adaptation
  • The Fire Next Time by James Baldwin
  • Legacy: A Black Physician Reckons with Racism in Medicine by Uché Blackstock
  • Under the Skin by Linda Villarosa
  • The Immortal Life of Henrietta Lacks by Rebecca Skloot, and accompanying film adaptation
  • Rustin, drama/documentary film directed by George C. Wolfe
  • 13th, documentary film directed by Ava DuVernay
  • When They See Us, limited series based on a true story, executive produced by Ava DuVernay, Oprah, and others
  • The Tuskegee Airmen, film based on a true story, directed by Robert Markowitz
  • Harriet, film based on the story of Harriet Tubman, directed by Kasi Lemmons
  • Selma, historical drama film directed by Ava DuVernay
  • Hidden Figures, biographical drama film directed by Theodore Melfi

 

January EDI Corner - Experiences with Racism in Healthcare Settings

Individual/interpersonal racism occurs between individuals and refers to one’s own racist assumptions, beliefs, or behaviors. It can manifest as implicit bias or overt racial discrimination and is connected to broader socio-economic histories that are supported and reinforced by systemic racism.

The scientific literature is inundated with research demonstrating differences in health outcomes between racial groups.  There is profoundly less scientific evidence linking healthcare differences to the precise mechanisms that produce them, such as racism and discrimination.  As clinicians and dental public health advocates, we need to acknowledge that race is a proxy measure for exposure to experiences of structural and individual racism resulting in a lack of health justice.1

© World Health Organization - Gender, Rights and Equity - Diversity, Equity and Inclusion (GRE)There is a growing call for more national surveys to incorporate items that solicit individuals’ experiences with discrimination that accurately depict the healthcare experiences of marginalized groups. The CareQuest Institute for Oral Health sponsored a national study that examined discrimination and dignity experiences in prior oral health care visits and their relationships with oral health inequities. The results were striking.

  • Nearly 1 in 10 (9%) Black respondents reported having been denied oral care in their lifetime due to discrimination, the highest of any racial/ethnic group. Discrimination experiences in dental settings were associated with poorer oral health status and less probability of planning a future dental visit. 
  • Participantsexperiences of feeling disrespected or not trusting their provider to act in their best interest were associated with odds that were more than three-and-a-half-times as great of reporting not having had an oral health visit in the prior 2 years.2

Another recent landmark national study from the Kaiser Family Foundation examined racial discrimination experiences in healthcare settings broadly.3  Key findings are highlighted below. 

  • A substantial proportion of Black (18%), American Indian/Alaska Native (12%), Hispanic (11%), and Asian (10%) respondents reported being treated unfairly or with disrespect by a healthcare provider because of their race in the past three years.
  • The majority of Black (60%), American Indian/Alaska Native (52%), and Hispanic (51%) adults report preparing for possible insults or feeling they must be very careful about their appearance to be treated fairly during healthcare visits.
  • In open-ended responses describing instances of unfair treatment, individuals describe experiences such as not being taken seriously, not being believed about pain, experiencing rude or harassing behavior, having assumptions being made about them, and being blamed for health conditions or problems they were experiencing.
  • Patient-provider racial/ethnic concordance matters. Black, Hispanic, and Asian Adults who have at least half of their visits with providers who share their racial or ethnic background report having more frequent positive and respectful interactions.

These results serve as a call to action for medical and dental healthcare providers and institutions to support high-quality and anti-racist care. 

Anti Racist actions for individuals in healthcare settings:4
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  • Utilize self-reflection tools, participate in unconscious bias training, watch this video about unconscious bias among healthcare providers. 
  • Foster a culture of belonging for patients through active listening, unconditional respect, and empathy. 
  • Take the 21-day Racial Equity Habit Building Challenge5
    • For 21 days, do one action to further your understanding of power, privilege, supremacy, oppression, and equity.

    • Plan includes suggestions for readings, podcasts, videos, observations and ways to form and deepen community connections

Anti Racist actions for healthcare institutions:6

  • Provide ongoing training for staff at all levels that include concepts related to racism and unconscious bias.
  • Institute patient/staff reporting mechanisms for discrimination and follow up on them.

References:

  1. Lett E, Asabor E, Beltrán S, Cannon AM, Arah OA. Conceptualizing, Contextualizing, and Operationalizing Race in Quantitative Health Sciences Research. Ann Fam Med. 2022 Mar-Apr;20(2):157-163.
  2. Raskin, S.E., Thakkar-Samtani, M., Santoro, M. et al. Discrimination and Dignity Experiences in Prior Oral Care Visits Predict Racialized Oral Health Inequities Among Nationally Representative US Adults. J. Racial and Ethnic Health Disparities (2023)
  3. Artiga S, Hamel L,  Gonzalez-Barrera A, Montero A, Hill L, Presiado M, Kirzinger A, and LopesL. Survey on Racism, Discrimination and Health: Experiences and Impacts Across Racial and Ethnic Groups. Kaiser Family Foundation. Published: Dec 05, 2023 Survey on Racism, Discrimination and Health: Experiences and Impacts Across Racial and Ethnic Groups | KFF  
  4. Hassen N, Lofters A, Michael S, Mall A, Pinto AD, Rackal J. Implementing Anti-Racism Interventions in Healthcare Settings: A Scoping Review. Int J Environ Res Public Health. 2021 Mar 15;18(6):2993.
  5. https://www.americaandmoore.com/21-day-re-challenges
  6. Hassen N, Lofters A, Michael S, Mall A, Pinto AD, Rackal J. Implementing Anti-Racism Interventions in Healthcare Settings: A Scoping Review. Int J Environ Res Public Health. 2021 Mar 15;18(6):2993. 

Resources:  

Anti-racism Resources | AAMC


 

December EDI Corner - Disrupting Unconscious Bias

Unconscious bias (also called implicit bias) is a negative attitude or social stereotype about a social group that we are not consciously aware of.1,2 If left unchecked, unconscious biases we all carry from past experiences (e.g., culture, environment, caregivers, media) can negatively influence our decision-making, our interactions with others, and our ability to create a welcoming environment, even when we have the best intentions. Actively disrupting unconscious biases by building awareness and taking action can help align our behaviors with our values to create a more equitable, diverse, and inclusive environment for everyone.

There are evidence-based approaches to reduce unconscious bias. Project Implicit offers resources to become aware of biases and the Kirwan Institute at The Ohio State University provides a self-guided training program. The Perception Institute has compiled strategies to reduce implicit bias in education and healthcare, and some of these are described below:

  • Improve decision-making conditions: When making important decisions, slow down thinking or pause to prevent implicit biases from determining behaviors.
  • Counter-stereotypic imaging: Broaden the definition of a successful other beyond traditional stereotypes and expectations, e.g., Latine astronaut.
  • Stereotype replacement: Recognize when a thought is based on stereotypes, label the thought as stereotypic, and reflect on why the thought occurred. Then, replace the stereotypical thought with a non-stereotypical one.  
  • Perspective taking: Seeing oneself as part of a stereotyped group can lead to a greater sense of connection to that group.
  • Increasing opportunities for contact: More frequent interactions among people from different backgrounds increase feelings of connection and reduces prejudices, e.g., expand inner circles.
  • Individuation: Obtaining specific information about each member to avoid making generalizations about a group.
  • Doubt objectivity: Learning about non-conscious thought processes leads to skepticism of objectivity and better guarding against biased evaluations.
  • Count: Use data to identify patterns leading to unequal outcomes (e.g., racial disparities) and consider if bias plays a role.
  1. American Psychological Association. November 2022. Implicit Bias. https://www.apa.org/topics/implicit-bias 
  2. University of San Francisco Office of Diversity and Outreach. n.d. Unconscious Bias Training. https://diversity.ucsf.edu/programs-resources/training/unconscious-bias-training

 

November EDI Corner - Inclusive Communication

Words matter! Improving equity is within the DNA of Dental Public Health, and we often talk about “underserved” or “vulnerable” populations as the targets of research, interventions, or initiatives. However, using those terms is problematic because they victimize and otherize people, and they aren’t specific about the ways in which particular populations face barriers to health or health care. 
For guidance on how to use more inclusive, person-centered language, the CDC recently released Principles for Inclusive Communication, and these two articles (Sotto-Santiago 2019 and Black, Cerdeña, and Spearman-McCarthy 2023) elucidate why we need to avoid using the term “minorities” when referring to people or groups who are racially minoritized. 
Here are some key inclusive communication tips from these resources as a start:

  • Instead of “underserved populations”, try “people who face financial/transportation/etc. barriers to care”
  • Instead of “low-SES populations”, try “people with lower income” or “people experiencing poverty”
  • Instead of “Medicaid patients”, try “people with Medicaid”
  • Instead of “disabled people”, try “people with an intellectual or developmental disability”
    • Note that some populations prefer identity-first terminology, such as Autistic people
  • Instead of using racial identity as a noun (e.g., Blacks, Latinos, Whites), use it as an adjective (e.g., Black/Latino/White people/adults/children)

Regardless of our stage of life or career, we’re all on a journey toward communicating in ways that are more inclusive and empowering. Let’s keep working toward this goal together!