By JOANN BUONOMANO and MARIE-E. RAMAS
The board of directors of the New Hampshire Academy of Family Physicians openly denounces institutionalized racism, which results in the unwarranted deaths and disparate health outcomes of Black Americans.
As physicians, we see firsthand the undeniably deleterious impact that racism has on patient health, and we are not alone in this observation. The American Academy of Family Physicians, the American Medical Association, the American Public Health Association, and leaders from both the Harvard T.H. Chan School of Public Health and the Johns Hopkins Bloomberg School of Public Health, as well as many health system leaders, recognize that racism is a public health crisis needing our immediate attention, as it affects us all both directly and indirectly.
Now, as a nation, we condemn the violation of human rights and abuse of power resulting in the deaths of unarmed Black men and women. We mourn with our fellow Americans over the deaths of George Floyd, Breonna Taylor, Ahmaud Arbery, Tony McDade, Sandra Bland, Eric Garner, Trayvon Martin, Philando Castile, Freddie Gray, and the tragically long list of Black lives disproportionately taken too soon.
Although the infamous words “I can’t breathe” are months behind us, we must not forget.
New Hampshire is one of the least racially diverse states in the country, yet we are not immune to the manifestations of racism and unconscious preferences that lead to unequal health, social and economic opportunities and outcomes. Our physician members cannot forget the stories of our patients whose children have been taunted, belittled, wrongfully disciplined, or disregarded because of their family background. We cannot unhear or unsee our patients’ anxiety, fear, or missed opportunities caused by biased policies and practices within our schools and workplaces.
Furthermore, as physician scientists, we rely on best evidence to provide the highest quality care for our patients – we now understand the biology of how chronic stress and trauma exacts a toll on the physical health of people of color in the United States.
As family physicians, we always have been, and always will be, here for difficult conversations. It is part of our calling to bring about the betterment of public health and engage in responsible public advocacy for our patients and communities. There is no equivocating on this: Racism is a public health crisis. The practice of discriminatory policies coupled with the abuse of power result in devastating effects on our Black and brown communities.
We are troubled and saddened by the staggering maternal and infant mortality rates for Black mothers and babies, where pregnant Black women are over three times more likely than white women to die during childbirth, and Black babies die over twice as much as white babies. We see how the impact of racism on our toddlers, children, teens, and adults result in poor physical and mental health.
While there is increasing collective awareness of implicit bias and recognition of the vitality of cultural competency and workforce diversity, more needs to be done in creating a culture that celebrates and uplifts the richness of those who work and live in this state. We are deeply distressed by the overwhelming disproportionate impacts of the coronavirus pandemic, which is unmasking longstanding disparities in access to quality health care and safe and secure housing, as well as the economic security that results from good jobs with meaningful benefits. These disparities are the result of years of existing policy and systems-level action, and inaction, by our institutions and societal structures.
Under the charge of Gov. Sununu, the N.H. COVID-19 Equity Response Team released its initial report on July 12, outlining disparities in cases and outcomes throughout the state. There, we recognize the continued divide between communities of color and white patients in the state. The report notes: “As cases of COVID-19 increased in New Hampshire, quantitative public health data, along with anecdotal evidence, began to tell the story we expected to hear: People of Color were more likely to contract COVID-19; more likely to work in essential industries and positions that placed them in hazardous situations; more likely to not be able to easily access testing; less likely to be able to socially/physically distance and less likely to be able to recover from the economic and social impact of the pandemic. This pandemic, like all others before, was quickly amplifying and widening the divide.”
Our board of directors released a call to action to our fellow physician colleagues to actively engage in efforts to address inequities and structural racism in our respective spheres of influence. Today, we invite our community members to join us in our commitment to making our communities well by the following:
- Educate: Increase education on equity, implicit bias, and their effects within the state.
- Policy: Ask your leaders to dedicate policy to ensure all community members have the opportunity to grow professionally, civically, and physically by creating policies that cultivate a culture of equity.
- Collaborate: Collaborate with different groups, organizations, or people to understand and implement both individual and collective changes that can break down barriers.
- The New Hampshire Academy of Family Physicians recognizes that in the context of American history, if Black lives do not matter then all lives cannot matter.
(Dr. Joann Buonomano is president and Dr. Marie-E. Ramas is vice president of the New Hampshire Academy of Family Physicians board of directors.)