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NEW AAPA POLICY: ANTI-RACISM VALUES STATEMENT

Posted 10 days ago by Camille Dyer

Adopted today, November 20, 2020 on the Consent Agenda during AAPA's Virtual House of Delegates!!!!!!  Thank you to ALL of our co-sponsors.

Anti-Racism Values Statement

2020-06-AHPAC       Resolved

 AAPA recognizes that racism, in its systemic, structural, institutional, and interpersonal forms, is an ongoing urgent threat to public health, the advancement of health equity, and excellence in the delivery of medical care.

 

AAPA affirms its commitment to anti-racism values, defined as the intent to change institutional culture, policies, practices, and procedures to remove systemic, structural, institutional and interpersonal racism.

 

AAPA supports the elimination of all forms of racism.

 

Rationale/Justification

 

The resolved is intended to fill a gap in our profession’s values and philosophies, reflect current understanding of the topic, and complement existing AAPA policy.  A search of the AAPA Policy Manual was pursued to identify references to the terms: Race, Racial and Racism.

 

This analysis can be summarized as follows:

  • racism was not mentioned in the policy manual,
  • race was mentioned regarding recruitment and retention of PA students, faculty, and staff,
  • racial minorities were defined,
  • racially-appropriate implementation of clinical preventive services, and
  • respect for values and diversity of all individuals, irrespective of race.

 

Executive summaries of policy papers contain references to nondiscrimination in the provision on policies that discriminate against patient care on the basis of race, and health disparities affiliated with race. AAPA’s policy papers go into additional detail. However, readers are reminded that papers “lose nuance” when content is cherry-picked. The topics covered within the body  include: race-based discrimination in the workplace, education, and healthcare access, coverage, and delivery; acknowledging that American bioethics are based on values that are predominantly white and may differ from those of other races, as well as “dealing with racial conflict in a sensitive manner.” (HX-4600.1.8, HP-3500.3.3, HP-3700.1.4, BA-2300.1.3, HP-3700.1.2, HX-4600.1.7, HP-3200.6.3).

 

Scientists and scholars define racism as encompassing economic, political, social, and cultural structures, actions, and beliefs that systematize and perpetuate an unequal distribution of privileges, resources, and power between white people and people of color.

 

Once the gap was identified - that there was no mention of racism in the AAPA policy manual, the positions taken by other medical associations were explored. An illustrative sample is as follows:

 

  • The American Medical Association (AMA): “The AMA recognizes that racism in its systemic, structural, institutional, and interpersonal forms is an urgent threat to public health, the advancement of health equity, and a barrier to excellence in the delivery of medical care. The AMA opposes all forms of racism. The AMA denounces police brutality and all forms of racially-motivated violence. The AMA will actively work to dismantle racist and discriminatory policies and practices across all of health care.

 

  • The American College of Physicians (ACP): “ACP condemns the injustices and harm that Black and indigenous communities and other people of color experience as a result of pervasive overt and covert systemic institutional racist policies, practices, and discrimination in the United States. ACP commits to being an antiracist organization dedicated to action and policy to confront and eliminate racism. ACP condemns and opposes racist policies and actions that perpetuate injustices and inequities in medicine and throughout all aspects of U.S. society. Urgent actions to remedy historical institutional injustices and inequities include eliminating discrimination, bias, and racism in the U.S. health care delivery system and in medical education. ACP commits to developing new policies and expanding existing ones toward these goals.”

 

  • The American Academy of Family Physicians (AAFP): “As a healthcare organization, the AAFP considers racism a public health crisis. The elimination of health disparities will not be achieved without first acknowledging racism’s contribution to health and social inequalities.”

 

  • The American Nurses Association (ANA): “Racism is a public health crisis that impacts the mental, spiritual, and physical health of all people. The Code of Ethics for Nurses with Interpretive Statements obligates nurses to be allies and to advocate and speak up against racism, discrimination, and injustice.  Consistent with this obligation, ANA has taken positions against racism, discrimination and health care disparities and advocating for human rights.”

 

  • The American Academy of Pediatrics (AAP): “The American Academy of Pediatrics is committed to addressing the factors that affect child and adolescent health with a focus on issues that may leave some children more vulnerable than others. Racism is a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families. Although progress has been made toward racial equality and equity, the evidence to support the continued negative impact of racism on health and well-being through implicit and explicit biases, institutional structures, and interpersonal relationships is clear.”

 

  • The American Psychiatric Association (APA):Supports current and future actions to eliminate racism and racial discrimination by fostering a respectful appreciation of multiculturalism, diversity, and efforts of greater inclusion. Encourages mental health professionals to be mindful of the existence and impact of racism and racial discrimination in the lives of patients and their families, in clinical encounters, and in the development of mental health services. Supports member and public education on impacts of racism and racial discrimination, advocacy for equitable mental health services for all patients, and further research into the impacts of racism and racial discrimination as an important public mental health issue. Recognizes the detrimental effects that racism has on the mental health of people of color and supports policies and laws which would reduce further harm.”

 

  • The American Public Health Association (APHA): “Racism is a longstanding systemic structure in this country that must be dismantled, through brutally honest conversations, policy changes and practices. Racism attacks people’s physical and mental health. And racism is an ongoing public health crisis that needs our attention now! We see discrimination every day in all aspects of life, including housing, education, the criminal justice system and employment. And it is amplified during this pandemic as communities of color face inequities in everything from a greater burden of COVID-19 cases to less access to testing, treatment, and care.

 

  • The American College of Obstetrics and Gynecology: “We condemn racism and discrimination in any form, including in systems such as law enforcement and health care. As the nation's leading organization of physicians dedicated to women's health, we know that words are not enough. With respect to our specialty, the unacceptable racial inequity in the delivery of health care led us this past fall to launch our Commitment to Changing the Culture of Medicine and Eliminating Racial Disparities in Women's Health Outcomes. Our work spans clinical, advocacy, and policy contexts and, importantly, requires self-reflection and examination of our own biases and prejudices so that we can then address them.”

 

  • The American College of Cardiology: “We cannot fully achieve our mission without also tackling underlying factors that literally discriminate against those providing or receiving care.”

 

References:

  1. American Medical Association. (2020). AMA Board of Trustees pledges action against racism, police brutality. Retrieved from https://www.ama-assn.org/about/board-trustees/ama-board-trustees-pledges-action-against-racism-and-police-brutality
  2. American College of Physicians. (2020)  Racism and health in the United States: a policy statement from the American College of Physicians. Retrieved from https://www.acpjournals.org/doi/full/10.7326/M20-4195?journalCode=aim
  3. American Academy of Family Physicians. (2020). AAFP condemns all forms of racism. Retrieved from https://www.aafp.org/news/media-center/statements/aafp-condemns-all-forms-of-racism.html
  4. American Nurses Association. (2020). ANA’s Membership Assembly Adopts Resolution on Racial Justice for Communities of Color. Retrieved from https://www.nursingworld.org/news/news-releases/2020/ana-calls-for-racial-justice-for-communities-of-color/#:~:text=ANA's%20Membership%20Assembly%20Adopts%20Resolution%20on%20Racial%20Justice%20for%20Communities%20of%20Color,-Jun%2020th%202020&te
  5. American Academy of Pediatrics. (2019). The impact of racism on child and adolescent health. Retrieved from https://pediatrics.aappublications.org/content/144/2/e20191765
  6. American Psychiatric Association. (2018). Position statement on resolution against racism and racial discrimination and their impacts on mental health. https://www.psychiatry.org/newsroom/news-releases/apa-condemns-racism-in-all-forms-calls-for-end-to-racial-inequalities-in-u-s
  7. American Public Health Association. (2020). Racism is an ongoing public health crisis that needs our attention now. Retrieved from https://www.apha.org/news-and-media/news-releases/apha-news-releases/2020/racism-is-a-public-health-crisis
  8. American Public Health Association. (2020). Declaration of Racism as a Public Health Issue. Retrieved from https://www.apha.org/topics-and-issues/health-equity/racism-and-health/racism-declarations
  9. American Public Health Association. (2020). Racism and Health. Retrieved from https://www.apha.org/topics-and-issues/health-equity/racism-and-health
  10. Eschner, K. (2020). Racism is undeniably a public health issue. Retrieved from https://www.popsci.com/story/health/racism-public-health/
  11. Gantzer, H. (2020). Internists “Gravely Concerned” About Discrimination and Violence by Public Authorities and Others. Retrieved from  https://www.acponline.org/acp-newsroom/internists-gravely-concerned-about-discrimination-and-violence-by-public-authorities-and-others
  12. Jee-Lyn García, J., & Sharif, M. Z. (2015). Black Lives Matter: A Commentary on Racism and Public Health. American journal of public health, 105(8), e27–e30. https://doi.org/10.2105/AJPH.2015.302706
  13. Hilliard, A. (1992). Racism: Its origins and how it works. Paper presented at the meeting of the Midwest Association for the Education of Young Children, Madison, WI.

 

 

Related AAPA Policy

HX-4100.1.3

AAPA opposes all forms of sexual harassment and gender discrimination.

 

HX-4100.1.4

AAPA supports equal rights for all persons and supports policy guaranteeing such rights.

 

BA-2200.1

The AAPA’s definition for racial and ethnic minorities shall be persons who are Black or African American, Hispanic or Latino, Asian, Native Hawaiian or other Pacific Islander, American Indian or Alaska Native, or two or more races.                                           

 

HP-3200.6.1

In order to ensure the age, gender, racial, cultural and economic diversity of the profession; AAPA strongly endorses the efforts of PA educational programs to develop partnerships aimed at broadening diversity among qualified applicants for PA program admission. Furthermore, the Academy supports ongoing, systematic and focused efforts to attract and retain students, faculty, staff,  and others from demographically diverse backgrounds.

 

HP-3300.1.3

“...PAs should routinely implement recommended clinical preventive services appropriate to the patient’s age, gender, race, family history and individual risk profile. Preventive services offered to patients should be evidence-based and demonstrate clinical efficacy. PAs should be familiar with the most current authoritative clinical preventive service guidelines and recommendations.

 

HX-4100.1.10

AAPA is committed to respecting the values and diversity of all individuals irrespective of race, ethnicity, culture, faith, sex, gender identity or expression and sexual orientation. When differences between people are respected everyone benefits. Embracing diversity celebrates the rich heritage of all communities and promotes understanding and respect for the differences among all people.

 

Policy paper: Promoting the Access, Coverage and Delivery of Health Care Services

Cited at HX-4600.1.8 – paper on page 95

“...AAPA opposes policies that discriminate against patients on the basis of pre-existing conditions, health status, race, sex, age, socio-economic status or other discriminatory demographic or geographic factors…”

“...AAPA’s guiding principles promote policies that protect patients from discrimination based on pre-existing conditions, health status, race, sex, socio-economic or other discriminatory demographic or health-related factors…”

“...AAPA opposes policies that discriminate against patients on the basis of pre-existing conditions, health status, race, sex, age, socio-economic status or other discriminatory demographic or geographic factors…”
                                                                       

Policy paper: Guidelines for Updating Medical Staff Bylaws: Credentialing and Privileging PAs

Cited at HP-3500.3.3 – paper on page 107

”Discrimination

The fundamental criteria for medical staff membership or clinical privileges should be directly related to the delivery of quality medical care, professional ability and judgment, and community need. Medical staff membership or particular clinical privileges should not be denied on the basis of color, creed, race, religion, age, ethnic or national origin, political beliefs, disability, socioeconomic status, sex, sexual orientation, or gender identity.”

 

Policy paper: End-of-Life Decision Making

Cited at HP-3700.1.4 – paper on page 167

“...The major premises of American bioethics are based on values that are predominately western, white, and middle class. The values and beliefs of other races and cultures may differ significantly. For example, the perception and expression of pain is significantly influenced by cultural and racial factors.

 

Policy paper: Guidelines for Ethical Conduct for the PA Profession

Cited at BA-2300.1.3, and HP-3700.1.2 – paper on page 188

...Nondiscrimination of Patients and Families
 PAs should not discriminate against classes or categories of patients in the delivery of needed health care. Such classes and categories include gender, color, creed, race, religion, age, ethnic or national origin, political beliefs, nature of illness, disability, socioeconomic status, physical stature, body size, gender identity, marital status, or sexual orientation.
                                                                                                                       

Nondiscrimination in the Workplace and Classroom

It is unethical for PAs to engage in or condone any form of discrimination. Discrimination is defined as any behavior, action, or policy that adversely affects an individual or group of individuals due to disparate treatment, disparate impact, or the creation of a hostile, inequitable or intimidating work or learning environment. This includes, but is not limited to, discrimination based on sex, color, creed, race, religion, age, ethnic or national origin, political beliefs, nature of illness, disability, socioeconomic status, physical stature, body size, gender identity, marital status, or sexual orientation.                                          

See also, the sections on Nondiscrimination of Patients and Families, and Sexual Harassment

 

Policy Paper: Improving Children’s Access to Health Care 

Cited at HX-4600.1.7 – paper on page 219

“...Like other professional medical associations, AAPA has endorsed the goals of the Healthy People 2010 project, which is “firmly dedicated to the principle that “regardless of age, gender, race or ethnicity, income, education, geographic location, disability, and sexual orientation-every person in every community across the nation deserves equal access to comprehensive, culturally competent, community- based health care systems...” (Healthy People 2010, 2000)...”

                                               

Policy paper: Affirmative Action in PA Education

Cited at HP-3200.6.3 – paper on page 227

“...The court found that the undergraduate admissions policy, which awarded points to underrepresented minority applicants solely because of race, was insufficiently “narrowly tailored to achieve the interest in educational diversity that respondents claim justifies their program.” Justice O’Connor explained that race can be considered a “plus” factor in admissions if that factor is considered in the context of a “highly individualized, holistic review of each applicant’s file, giving serious consideration to all the ways an applicant might contribute to a diverse educational environment…”

“...The challenge remains for all institutions to determine the type of plan that will consider race in such a way as to achieve that critical mass but does not utilize a point or quota system…”              

“... A more diverse health care force may also improve both access to health care as well as the health status of minority populations. Research has shown that minority physicians are more likely to practice in medically underserved areas. Patients also express strong preference for racial/ethnic concordance with their health care provider. One study of the effect of race and gender on the physician-patient partnership showed that patients who saw physicians of their own race rated the decision making style of the provider as more participatory and involved…”

“...The majority of students agreed with published reports of many investigators that the medical profession should represent the country’s racial and ethnic composition to a larger degree. (5)

In January 2004, the Institute of Medicine released a report entitled In the Nation’s Compelling Interest: Ensuring Diversity in the Healthcare Workforce. The report reinforces the importance of increasing racial and ethnic diversity among health professionals. Greater diversity among health care professionals is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, better patient-provider communication, and better educational experiences for all students while in training.”                             

“...Recruitment and retention of diverse student populations allows individuals to educate each other about cultural differences in health beliefs and experience of illness, to confront prejudice and prior assumptions, and to experience dealing with racial conflict in a sensitive manner. PAs must strive to develop cultural competence as one aspect of professional competence…”

 

Possible Negative Implications

None.

 

Financial Impact

None.

 

Attestation

I attest that this resolution was reviewed by the submitting organization’s Board and/or officers and approved as submitted

 

Signature

Camille Dyer, MS, PA-C, AACC, DFAAPA

President, African Heritage PA Caucus

camidyer@yahoo.com

 

(Cosponsoring COs listed in attached Appendix)

 

Contacts for Resolution

Folusho Ogunfiditimi, DM, MPH, PA

Chief Delegate, African Heritage PA Caucus

folu@yahoo.com


Christina Wojnarwsky, PA-C, ATC

Chief Delegate, LBGT PA Caucus

info@lbgtpa.org

 

Appendix

American Academy of Nephrology PAs, Nguyen Park, PA-C, Chief Delegate

American Association of Surgical PAs, Erin Sherer, EdD, MPAS, PA-C, RD, President

Arizona State Association of PAs, Jacob Gubler, MMS, PA-C, President

Connecticut Academy of PAs, Mark Turczak, MHS, PA-C, President

Colorado Academy of PAs, Alysia Wiley, MMS, PA-C, Chief Delegate

Florida Academy of PAs, Gregory L. Burns DHSc, MMS, PA-C, DFAAPA, President

Geriatric Medicine PAs, Kris Pyles-Sweet, MS, PA-C, Chief Delegate

Illinois Academy of PAs, Katie Sweitzer, PA-C, President

Indiana Academy of PAs, Thomas Meehan, PhD, PA-C, Chief Delegate

Iowa PA Society, Natalie Weber, PA-C, President

LBGT PA Caucus, Cameron Nicholson, PA-C, President

Maryland Academy of PAs, Jennifer Grover, DHSc, MMS, PA-C, President

Massachusetts Association of PAs, Jason Parenete, PA-C, President

Michigan Academy of PAs, Ryan Desgrange, PA-C & Michelle Petropoulos, DMSc, PA-C, DFAAPA, Co-Chief Delegates

Minnesota Academy of PAs, Elise Haupt, MPH, PA-C, President

Mississippi Academy of PAs, Murl D. Dotson, PA-C, Emeritus, Chief Delegate 

Nevada Academy of Physician Assistants, Brian S. Lauf, DMSc, MPAS, PA-C, DFAAPA, President

New Jersey State Society of PAs, Amanda DiPiazza, PA-C, Chief Delegate

New York State Society of PAs, Brian Glick, PA-C, Chief Delegate

North Carolina Academy of PAs, Alisha DeTroye, MMS, PA-C, DFAAPA, President

Ohio Association of PAs, Josanne Pagel, MPAS, PA-C, DFAAPA, Chief Delegate

Oregon Society of PAs, Alysia I. Privrat, DMSc, MPAS, PA-C, Chief Delegate

PA Academy of Vermont, Sarah Bushweller, PA-C, President

PAs in Asian Health, Dimmie Dang, PA-C, President  

PAs for Global Health, Lyndsey Milcarek, PA-C, MPH, President

PAs in Hospice and Palliative Medicine, Nadya Dimitrov, DPM, PA-C, Chief Delegate

PAs for Latino Health, Robert S. Smith, DHSc, PA-C, DFAAPA, Chief Delegate

PAs for Rural Health, Ed Friedmann, PA, Chief Delegate 

PAs in Virtual Medicine and Telemedicine, Amanda Shelley, MPAS, PA-C, President

Student Academy of AAPA, Delilah Dominguez, LCSW, PA-S3, Chief Delegate

Texas Academy of PAs, Monica Foote-Ward, MPAS, PA-C, ATC, Chief Delegate

Washington Academy of PAs, Gabrielle Zecha, PA-C, MHA, DFAAPA, President