Guidance on Conversations About Race and Racism in Pediatric Clinical Settings.

OBJECTIVE: To develop guidance for pediatric clinicians on how to discuss race and racism in pediatric clinical settings. METHODS: We conducted a modified Delphi study from 2021 to 2022 with a panel of pediatric clinicians, psychologists, parents, and adolescents with expertise in racism and child health through scholarship or lived experience. Panelists responded to an initial survey with open-ended questions about how to talk to youth about race and racism. We coded the responses using qualitative methods and presented them back to the panelists. In iterative surveys, panelists reached a consensus on which themes were most important for the conversation. RESULTS: A total of 29 of 33 panelists completed the surveys and a consensus was reached about the concepts pediatric clinicians should consider before, during, and after conversations about race and racism and impediments clinicians may face while having these discussions. Panelists agreed that it was within the pediatric clinician's role to have these conversations. An overarching theme was the importance of having background knowledge about the systemic nature of racism. Panelists agreed that being active listeners, learning from patients, and addressing intersectionality were important for pediatric clinicians during conversations. Panelists also agreed that short- and long-term benefits may result from these conversations; however, harm could be done if pediatric clinicians do not have adequate training to conduct the conversations. CONCLUSIONS: These principles can help guide conversations about race and racism in the pediatric clinical setting, equipping clinicians with tools to offer care that acknowledges and addresses the racism many of their patients face.

Policy solutions to eliminate racial and ethnic child health disparities in the USA.

Societal systems act individually and in combination to create and perpetuate structural racism through both policies and practices at the local, state, and federal levels, which, in turn, generate racial and ethnic health disparities. Both current and historical policy approaches across multiple sectors-including housing, employment, health insurance, immigration, and criminal legal-have the potential to affect child health equity. Such policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. Policy efforts that do not directly address structural racism will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism. In Paper 2 of this Series, we build on Paper 1's summary of existing disparities in health-care delivery and highlight policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improve the health of racially and ethnically minoritised children.

Can Capitalism Drive Health Equity? Considering The Benefits And Risks Of Social Drivers Of Health Bonds.

Capitalism and health are not synonymous. Numerous health care advances and innovations have stemmed from the financial incentives that a capitalistic society fosters, but individuals and communities achieving optimal health is not always tied to a financial gain. The impact of capitalism-derived financial tools such as social bonds to address social drivers of health (SDH) therefore needs to be carefully scrutinized, not only for the potential benefits but also for the potential unintended consequences. Ensuring that as much of the social investment as possible is directed by communities experiencing gaps in health and opportunity will be crucial. Ultimately, failure to find ways to share both the health and financial benefits of SDH bonds or other market-derived interventions risks perpetuating underlying wealth inequities between communities and deepening the structural issues that cause SDH disparities in the first place.

Structuring Equity Into Minnesota's COVID-19 Response: Lessons Learned and Future Investments.

BACKGROUND: The Minnesota Department of Health (MDH) integrated 3 intentional teams into their novel coronavirus 2019 (COVID-19) response to ensure equity was not lost in the speed of response. IMPLEMENTATION: These teams-the Cultural, Faith, and Disability Communities Branch, Tribal COVID-19 Healthcare Team, and Vaccine Equity Branch were able to reach communities through trusted partners, elevate the voices of communities most impacted, respect tribal sovereignty, establish equity leadership, and set equity goals and metrics. LESSONS LEARNED: The top-down nature of incident command, combined with pre-COVID-19 systems and structures that impede equity, led to both barriers and opportunities for centering equity in response efforts. Inclusion of staff and community voice in decisions and guidance leads to better results; each community's unique needs have to be considered. Equity metrics and goals help direct resources to the most disadvantaged. State, local, and tribal public health infrastructure was built quickly and needs ongoing resources to be sustained. FUTURE INVESTMENTS: MDH is leveraging new funding to embed successful response structures into the organization. These structures are intended to build state, local, and tribal capacity and address systemic challenges at MDH. CONCLUSION: While equity can be incorporated into pandemic response and incident command structures, ongoing investment to support public health infrastructure is vital to sustaining equity.

Drug-dispensing limits within Medicaid during the COVID-19 pandemic.

SUMMARY The 1-month drug-dispensing limit is a common drug utilization tool used by state Medicaid agencies to control spending. Since the beginning of the COVID-19 pandemic, many states relaxed the 1-month dispensing limit restriction in order to align with social distancing recommendations. Yet, some states have not relaxed this limit and have differed substantially regarding the policies that have been implemented. Among states that relaxed the 1-month supply limit, determining which chronic disease drugs qualified for this extension can be challenging for patients and clinicians. As more commercial and Medicare insurance beneficiaries are offered 90-day drug supplies, the 30-day drug supply limit with Medicaid has become a health equity issue, since many individuals insured by Medicaid have already experienced a disproportionate impact from and remain at high risk for severe COVID-19 disease. Thus, we propose policy solutions to ensure that Medicaid beneficiaries have safe and uninterrupted access to chronic disease medications during and beyond the COVID-19 pandemic. DISCLOSURES: No funding was received for this work. Alpern has received funding from Arnold Ventures for research related to the use and spending of off-patent drugs, unrelated to this work, and is a member of the Pharmacy and Therapeutics Committee at Regions Hospital, St. Paul, MN. DeSilva has received CDC support for work on Vaccine Safety Datalink, VISION network, and Center of Excellence for Newcomer Health, unrelated to this work. Chomilo is Medicaid Medical Director for the State of Minnesota's Department of Human Services.