An Entrustable Professional Activity Addressing Racism and Pediatric Health Inequities

Racism and discrimination are the root of many pediatric health inequities and are well described in the literature. Despite the pervasiveness of pediatric health inequities, we have failed to adequately educate and prepare general pediatricians and pediatric subspecialists to address them. Deficiencies within education across the entire continuum and in our health care systems as a whole contribute to health inequities in unacceptable ways. To address these deficiencies, the field of pediatrics, along with other specialties, has been on a journey toward a more competency-based approach to education and assessment, and the framework created for the future is built on entrustable professional activities (EPAs). Competency-based medical education is one approach to addressing the deficiencies within graduate medical education and across the continuum by allowing educators to focus on the desired equitable patient outcomes and then develop an approach to teaching and assessing the tasks, knowledge, skills, and attitudes needed to achieve the goal of optimal, equitable patient care. To that end, we describe the development and content of a revised EPA entitled: Use of Population Health Strategies and Quality Improvement Methods to Promote Health and Address Racism, Discrimination, and Other Contributors to Inequities Among Pediatric Populations. We also highlight the ways in which this EPA can be used to inform curricula, assessments, professional development, organizational systems, and culture change.

A tridimensional view of the Hispanic Health Paradox: Its relationship with faith, the enclave theory, and familism

This paper examines the "Hispanic (American) Health Paradox," the juxtaposition of Hispanics’ longer lifespan than the average American amid numerous inequities regarding social determinants of health. Hispanic Americans endure multiple health disparities with a higher incidence and prevalence of chronic conditions. They also experience multiple psychosocial and physical health challenges, including higher rates of food insecurity, poverty, segregation, discrimination, and limited or no access to medical care. Nevertheless, Hispanics enjoy better physical well-being and lower mortality rates when compared to non-Hispanics in the United States (Ruiz et al., 2021). This project aims to analyze the sources of this group’s biosocial advantages and resilience, allowing them to have a longer lifespan amidst their lower health status and increased risk for chronic conditions. It explores the political and social justice implications of these inequities. It also examines the strategies to close the gap on Latinos' current health care disparities via public policy aspects of federal and state legislature. A narrative review method was utilized to examine the existing literature on this paradoxical effect. Keywords based on Medical Subject Headings (MeSH) used to search resources for relevant studies included: Hispanic health paradox (health paradox, immigrant paradox), ethnic minorities (Latinos, LatinX), health disparities (disproportionate health, health inequities), social justice (healthcare stakeholders, health inequities solutions, inequities recommendations), mental health, physical health, and co-morbidities. A quality assessment of full-text peer-reviewed articles yielded 80 articles to compile this narrative review. The research revealed that, despite glaring disparities in social determinants of health, Hispanic Americans have overall experienced better health outcomes through a culture that emphasizes spirituality, community support, and strong family ties.