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Disclosure

• Neither I nor any member of my immediate family has a financial relationship or interest with any proprietary entity producing health care goods or services related to the content of this CME activity.

• My content will not include discussion/ reference of any commercial products or services

• I do not intend to discuss an unapproved/ investigative use of commercial products/ devices

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F. Bruder Stapleton, MDPresident, American Pediatric Society

Professor and Chair, Department of PediatricsUniversity of Washington School of Medicine

Mind the Gap

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Mind the Gap: A loud message in London

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What is the “Gap” in Pediatrics

Race and Ethnicity

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“Mind the Diversity Gap”

“Mind”: a verb I chose for two meanings:

1. “To pay attention to”

(recognize the gap)

2. “To care about, to object to”

(in this case to take action in response to)

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• Ethnicity • Race • Socioeconomics • Age• Sexual orientation• Experiences • Physical abilities• Gender • Lifestyle • Spirituality • Political views• Context: school, work, social

set, community, organization, geography, family

• Religion

Diversity and Inclusiveness

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Our patients

http://www.census.gov/hhes/socdemo/children/data/sipp/well2009/tables.html

55.7%

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Our patients: Now and Future

http://www.census.gov/hhes/socdemo/children/data/sipp/well2009/tables.html

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Profile of our teenagers

http://www.census.gov/hhes/socdemo/children/data/sipp/well2009/tables.html

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Elementary school years

http://www.census.gov/hhes/socdemo/children/data/sipp/well2009/tables.html

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The growing diversity

http://www.census.gov/hhes/socdemo/children/data/sipp/well2009/tables.html

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U.S. Children 12-17 years

http://www.census.gov/hhes/socdemo/children/data/sipp/well2009/tables.html

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U.S. Children 6-11 years

http://www.census.gov/hhes/socdemo/children/data/sipp/well2009/tables.html

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U.S. Children Under 6 years

http://www.census.gov/hhes/socdemo/children/data/sipp/well2009/tables.html

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States with majority of “minority” children

Arizona Mississippi

California New Mexico

Florida Nevada

Georgia Texas

Hawaii Washington, DC

Maryland

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The Pediatric Workforce

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The Pediatric Gap

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Finding a “place” for Under-Represented-in-Medicine Pediatricians to help shape the care of all children

“A place is not a place until

people have been born in it,

have grown up in it, lived in it,

known it, died in it – have

both experienced and shaped it.”

- Wallace Stegner. A Sense of Place

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The Pediatrics Diversity Gap

Why is it important to address the gap?

1. Diseases and conditions vary with populations

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Increase in Pre-HTN & HTN in US Children (8-17y) 1988-2002

Din-Dzietham et al, Circulation, 2007

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Disparity in Premature Births

%

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Disparity in the Obesity Epidemic

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What happens to these obese children?

• 1 in 3 children born in US will develop Diabetes Mellitus in their lifetime

• 1 in 2 MINORITY 1 in 2 MINORITY children will develop Diabetes Mellitus in their lifetime

Narayan KM et al. JAMA. 2003 Oct 8;290(14):1884-90.Mokdad AH et al. JAMA. 2004 Mar 10;291(10):1238-45.

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Excellent health for “all” children is not yet a reality

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Why isn’t there more researchfocused on these issues

1. Inclusion of minority communities in clinical trials.

2. Number of investigators from diverse communities.

3. Funding of awards from under-represented minority applicants by NIH appears to be lower.

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NIH Success for black scientists

• Black R01 applicants 10% less likely to be funded than white scientists by NIH.

• Minority R01 applicants: 16% Asian, 3.2% Hispanic, 1.4% Black and 0.05% AI/AN.

• Odds of receiving R01 was improved for all applicants if having received training grant.

Ginther D. Science 2011

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The Pediatrics Diversity Gap

Why is this important?

1. Diseases and conditions vary with populations

2. There is an economic impact

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Costs in dollars and cents

• Eliminating health disparities for minorities would have reduced direct medical care expenditures by $229.4 billion for the years 2003-2006.

• Between 2003 and 2006, 30.6% of direct medical care expenditures for African Americans, Asians, and Hispanics were excess costs due to health inequalities.

• Eliminating health inequalities for minorities would have reduced indirect costs associated with illness and premature death by more than one trillion dollars between 2003 and 2006.

The economic burden of health inequalities in the United States. Joint Center for Political and economic studies. Washington DC, 2009.

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The Pediatrics Diversity Gap

Why is this important?

1. Diseases and conditions vary with populations

2. There is an economic impact

3. Quality of care is less in minority populations

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Safety and Quality of Care

Spanish-speaking patients had a two-fold risk of a severe adverse event compared to English-speaking patients.

Interpreters did not alter the risk.

Cohen A et al. Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics 2005; 116:575.

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2009 NHDRDistribution of changes over time in racial, ethnic, and socioeconomic disparities for selected core quality measures, 2000-2002 to 2005-2007

A Quality Gap

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The Pediatrics Diversity Gap

Why is this important?

1. Diseases and conditions vary with populations

2. There is an economic impact

3. Quality of care is less in minority populations

4. Trust in providers is a challenge

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A healthy “place” for all children

“Neither the country or society…can be healthy until we…acquire the sense, not of ownership, but belonging.”

- Wallace Stegner

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Challenges of Trust

1. First year medical students found to have implicit preference for white patients.

JAMA 2011

2. Pediatricians were also found to have implicit preference for adult European-Americans compared to adult African- Americans. This preference was associated with perceived compliance. Med Care 2008

3. African-American parents perceived greater partnership if treated in a community health center compared to a hospital or private practice. J Pediatr 2011.

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Mind the Gap: A call for action

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The Pediatrics Diversity Gap

What is APS doing?

Task Force on Diversity and Inclusiveness

June 2011- November 2011

Elena Fuentes-Afflick, MD, MPHTask Force Chair

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Task Force Members

• Jose Cordero, MD, MPH• Phyllis Dennery, MD• Danielle Laraque, MD, MPH• Fernando Mendoza, MD• Leslie Walker, MD• Ex officio:

Judy Aschner, MD

Bruder Stapleton, MD

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New APS Mission Statement

The mission of APS is to advance academic pediatrics.

APS will accomplish this mission by promoting pediatric research and scholarship, serving as a strong and effective advocate for academic pediatrics, recognizing and honoring achievement, and cultivating excellence, diversity, and equity in the field of pediatrics through advocacy, scholarship, education, and leadership development.

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A New APS Value has been added to our Value Statement

We believe that:

• Advancing academic pediatrics improves child health by preventing disease and eliminating health disparities

• Diversity, equity, and inclusion are essential values for academic pediatrics, pediatricians in training, and the practice of pediatrics

• Advancing pediatric research improves health across the lifespan, from infancy through adulthood

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What we as leaders can do

1. Carry the message of “Mind the diversity gap” in all our leadership venues.

2. Study how to create an inclusive culture.

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What we as leaders can do locally

University of Washington Department of Pediatrics mission statement:

Through excellence, innovation, and collaboration, we will improve the health of all children and adolescents and reduce inequities by educating the pediatric and physician leaders of the future, advancing research, advocating for children and providing the nation's best primary and specialty pediatric clinical care. In partnership with our health care and academic institutions, we are committed to a diverse and inclusive faculty who can reach their personal and professional goals in a collegial environment. 2012 revision

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What we as leaders can do

1. Carry the message of “mind the gap” in all our leadership venues.

2. Study how to create an inclusive culture.

3. Get involved with the increasing number of diverse minority medical students and introduce them to pediatric careers.

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Although some improvement, a long way to go to close the gap

First-Year Enrollees to U.S. Medical Schools

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What we as leaders can do

1. Carry the message of mind the gap in all our leadership venues.

2. Study how to create an inclusive culture.

3. Get involved with the increasingly diverse minority medical students to encourage pediatric careers.

4. Make diversity a priority during searches, when appointing committees locally and nationally, and listening to our minority patients and colleagues for advice to improve our culture.

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As leaders in Pediatrics, let’s make eliminating the diversity gap a priority

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My partner, friend and advisor

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My support system

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My “grand” super heroes