Between rules and resistance: moving public health emergency responses beyond fear, racism and greed.

In times of a public health emergency, lawyers and ethicists play a key role in ensuring that government responses, such as travel restrictions, are both legally and ethically justified. However, when travel bans were imposed in a broadly discriminatory manner against southern African countries in response to the Omicron SARS-CoV-2 variant in late 2021, considerations of law, ethics or science did not appear to guide politicians' decisions. Rather, these bans appeared to be driven by fear of contagion and electoral blowback, economic motivations and inherently racist assumptions about low-income and middle-income countries (LMICs). With a new pandemic treaty and amendments to the WHO's International Health Regulations (IHR) on the near-term horizon, ethics and international law are at a key inflection point in global health governance. Drawing on examples of bordering practices to contain contagion in the current pandemic and in the distant past, we argue that the current IHR is not adequately constructed for a just and equitable international response to pandemics. Countries impose travel restrictions irrespective of their need or of the health and economic impact of such measures on LMICs. While the strengthening and reform of international laws and norms are worthy pursuits, we remain apprehensive about the transformative potential of such initiatives in the absence of collective political will, and suggest that in the interim, LMICs are justified in seeking strategic opportunities to play the same stark self-interested hardball as powerful states.

Educators Countering the Impact of Structural Racism on Health Equity.

Health equity endorses that all persons are respected equally, and society must exert intentional efforts to eradicate inequities. Race, frequently taught as an impartial risk factor for disease, is a facilitator of structural inequities stemming from racist policies. Nursing educators must help students understand the impact of structural racism on patient populations, communities, and society at large. This article illustrates the face of structural racism, highlights how structural racism impacts health care outcomes, and provides meaningful ways for educators to unmute racism and facilitate race-related discourse in the classroom to counter the impact of structural racism on health equity.

EQUIP emergency: can interventions to reduce racism, discrimination and stigma in EDs improve outcomes?

BACKGROUND: Despite a publicly funded system, health care in Canada has been shown to be deeply inequitable, particularly toward Indigenous people. Based on research identifying key dimensions of equity-oriented health care as being cultural safety, harm reduction and trauma- and violence-informed care, an intervention to promote equity at the organizational level was tested in primary health care, refined and adapted, and tested in Emergency Departments (EDs). METHODS: In partnership with clinical, community and Indigenous leaders in three diverse EDs in one Canadian province, we supported direct care staff to tailor and implement the intervention. Intervention activities varied in type and intensity at each site. Survey data were collected pre- and post-intervention from every consecutive patient over age 18 presenting to the EDs (n = 4771) with 3315 completing post-visit questions in 4 waves at two sites and 3 waves (due to pandemic constraints) at the third. Administrative data were collected for 12 months pre- and 12 months post-intervention. RESULTS: Throughout the study period, the participating EDs were dealing with a worsening epidemic of overdoses and deaths related to a toxic drug supply, and the COVID 19 pandemic curtailed both intervention activities and data collection. Despite these constraints, staff at two of the EDs mounted equity-oriented intervention strategies; the other site was experiencing continued, significant staff shortages and leadership changeover. Longitudinal analysis using multiple regression showed non-significant but encouraging trends in patient perceptions of quality of care and patient experiences of discrimination in the ED. Subgroup analysis showed that specific groups of patients experienced care in significantly different ways at each site. An interrupted time series of administrative data showed no significant change in staff sick time, but showed a significant decrease in the percentage of patients who left without care being completed at the site with the most robust intervention activities. CONCLUSIONS: The trends in patient perceptions and the significant decrease in the percentage of patients who left without care being completed suggest potential for impact. Realization of this potential will depend on readiness, commitment and resources at the organizational and systems levels. TRIAL REGISTRATION: Clinical Trials.gov #NCT03369678 (registration date November 18, 2017).

The role of grassroots community organizations in transforming healthcare systems to achieve health equity.

Two events converged in early 2020 to expose vast disparities and inequities that have been harming many racialized and marginalized people for decades and shake up healthcare systems around the world. The COVID-19 pandemic and the brutal killing by police of George Floyd, an unarmed Black man, created a groundswell of emotions that erupted in protests and calls for social justice. Governments, corporations, and businesses made statements against racism, primarily anti-Black racism, instituted Diversity, Equity, and Inclusion (DEI) policies, and appointed DEI managers to show they were taking action to tackle racism and uphold social justice. However, grassroots community organizations had the most impact in mobilizing populations and effecting change to contain and reduce the spread of the deadly COVID-19 virus, as well as challenging leaders to do more than just talk about dismantling systemic, structural, and institutional racism.

The importance of addressing racial microaggression in nursing education.

The Pandemic laid bare how embedded racism is within our structures, institutions and societal systems. We are bearing witness to long standing issues now manifesting as deep inequities that have been overlooked. In both academic and clinical instruction and settings there is a need for a culture shift to empower recipients of racialized aggression and enable allies, active bystanders and leaders to respond in ways that promote values that extend our shared humanity. Using research, experience and observations the authors provide best practices for responding to and dismantling microaggressions. In addition, they discuss the impact of microaggression within nursing education and clinical settings. These include recommendations for student recipients, applicable to classroom and clinical settings, and intervention proposals for allies, active bystanders and leaders.

Structural Racism and Cancer: Calls to Action for Cancer Researchers to Address Racial/Ethnic Cancer Inequity in the United States.

As leaders with the American Society of Preventive Oncology (ASPO) Cancer Health Disparities Special Interest Group, we describe the role of structural racism in perpetuating cancer health inequity historically, and potential implications of COVID-19 in exacerbating the effects of structural racism on patients with cancer seeking screening, diagnostic care, treatment, and survivorship support. As a strategy to reduce cancer inequities in the United States, we provide the following calls to action for cancer researchers to help alleviate the burden of structural racism: (i) identify and name structural racism while describing its operation within all aspects of scientific research; (ii) comprehensively integrate discussions on structural racism into teaching, mentoring, and service activities; and (iii) understand and support community actions to address structural racism.

The #StopAsianHate Movement on Twitter: A Qualitative Descriptive Study.

Evidence-based intervention and policy strategies to address the recent surge of race-motivated hate crimes and other forms of racism against Asian Americans are essential; however, such efforts have been impeded by a lack of empirical knowledge, e.g., about racism, specifically aimed at the Asian American population. Our qualitative descriptive study sought to fill this gap by using a data-mining approach to examine the contents of tweets having the hashtag #StopAsianHate. We collected tweets during a two-week time frame starting on 20 May 2021, when President Joe Biden signed the COVID-19 Hate Crimes Act. Screening of the 31,665 tweets collected revealed that a total of 904 tweets were eligible for thematic analysis. Our analysis revealed five themes: "Asian hate is not new", "Address the harm of racism", "Get involved in #StopAsianHate", "Appreciate the Asian American and Pacific Islander (AAPI) community's culture, history, and contributions" and "Increase the visibility of the AAPI community." Lessons learned from our findings can serve as a foundation for evidence-based strategies to address racism against Asian Americans both locally and globally.

Antiracism, Black Lives Matter, and Critical Race Theory: The ABCs of Promoting Racial Equity in Pediatric Practice.

Police shootings of unarmed Black men, women, and children at the intersection of disparities in the setting of the coronavirus disease 2019 pandemic have resulted in a long overdue national awakening regarding race and racism in society. This article defines some of the key terms, providing a foundation to help promote equity in pediatric practice. Although no single article can result in full competency regarding such complex issues, it is meant to provide a foundation for pediatricians on a journey to deepen their knowledge and understanding toward a path to action. [Pediatr Ann. 2022;51(3):e95-e106.].

Beyond Research, Taking Action Against Racism.

One large Massachusetts health system has ambitious plans for how it can become an antiracist institution.