A new mother who had just worked nine hours as a retail associate entered a medical clinic to seek care for her four-month old son who has been coughing over the past three days. Her google search yielded a clinic in the economic upper echelon of the southwest suburbs, between her place of employment and her condominium, which she recently purchased to give her infant son a chance at a better life, far from the violent community of Austin on the westside of Chicago. After a two-hour wait, a pediatrician finally examined her son and quickly diagnosed her baby with bronchiolitis. The Pediatrician prescribed the child a nebulizer and Abuterol, a medication to help with the infant’s symptoms. Instead of explaining the prognosis of the child’s condition to the mom, along with the side effects of the medication, and possible causes that may have led up to the child’s illness, the Pediatrician instructed her to do a search on You-tube for instructions on how to use the bulky apparatus. As the Pediatrician prepared to leave the room, the mother asked if the Pediatrician could examine the baby one more time because the infant rolled off the bed last month. The Pediatrician nodded and left the room for a few moments and returned with a confrontational tone and a clipboard to interrogate the new mom about the fall. He ordered a test to make sure that the baby’s skull was not fractured from the fall that occurred a month prior. A series of the tests came back negative, that is, “normal”. Later that night, at 2 am, her doorbell rang. It was an Investigator with the Department of Children and Family Service (DCFS). The new mother was traumatized.
The Aspen Institute (AI) defines structural racism as a system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity. The AI roundtable explains that structural racism, or structural violence, is not something that a few people or institutions choose to practice. Instead, it is a social norm, or predominant characteristic, of the social, economic, and political systems and culture in which we all exist. Healthcare Providers are mandated reporters, which means that they are legally compelled to report all signs of suspected abuse. The issue at hand is the role of one’s biases when making these reports. There were multiple positive reviews on the internet about the clinic from privileged patients, citing exceptional service, friendly staff, and knowledgeable pediatricians. Need one wonder what the biases were that precipitated the unfounded and spontaneous leap to suspicion in the events that left a new mother feeling traumatized and destined to a future of distrusting the health care system?
Numerous studies have revealed that trauma undermines efforts to promote health, safety, and well-being. After the experience the new mother suffered a prolonged dread of ever having to take her child to another doctor and, even more, a fear of going outside of her immediate community for any medical visits, for fear that this type of structural racism may threaten her once again. Many populations are experiencing this type of trauma or structural violence. Despite the recognition of the widespread nature of trauma as a public health epidemic at the population level, the predominant focus for addressing trauma continues to be addressed at the individual level. Although trauma-informed care is becoming the standard of care, there is not an existing framework that addresses the structural violence that certain populations continue to experience on a daily basis. Discriminatory policies and practices have led to the present-day microaggressions that have traumatized communities of color and impoverished populations.
The health of a population is shaped by social, biological, physical, and behavioral factors. These factors determine the way a population will respond to diseases and illnesses. These social determinants that affect a population’s health are conditions in the places where people live, learn, work, and play. Everyone deserves to live a safe and healthy life, and the whole fabric of our society is enriched when everyone can live free of structural abuses, suspicions and barriers. Structural racism is currently traumatizing marginalized populations and preventing those populations from living a healthy life.
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