Pediatric Annals

Editorial Free

Our Responsibility to All of Our Patients and Families

Joseph R. Hageman, MD

Happy New Year, and I hope all of you and your families are safe and well. As we learn more about the coronavirus disease 2019 (COVID-19) from the clinical, virological, and epidemiological data from all over the world, the pandemic and its subsequent outgrowths become more complicated.

Racial health inequities, which are not new in the medical field, have unfortunately been exacerbated during the pandemic. Although I personally provided clinical care to the best of my abilities to everyone during my 30 years of pediatric practice, I recognize that structural racism has played a role in the way many patients of color receive care that is inadequate, biased, and discriminatory.

Research about racial health inequities is prevalent, and some literature has focused on the fact that very low birth-weight infants in the neonatal intensive care unit and their mothers who are from racial and ethnic minority communities receive lower quality of care when compared to White children.1,2

“Structural racism refers to the totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice. These patterns and practices in turn reinforce discriminatory beliefs, values, and distribution of resources. We argue that a focus on structural racism offers a concrete, feasible, and promising approach towards advancing health equity and improving population health.”3

Although many clinicians work hard to provide an equitable quality of care, racial disparities in health care exist and need to be addressed. In the United States, Black newborns die at a rate 3 times greater than White newborns.4 According to Greenwood et al.,4 between 1992 and 2015 1.8 million hospital births in Florida suggested improved mortality in Black infants when there was racial concordance between the newborn and the physician.

As clinicians, we need to be aware of intrinsic biases and make extra efforts with caring for all of our patients and their families, no matter their race or ethnicity.


  1. Profit J, Gould JB, Bennett M, et al. Racial/ethnic disparity in NICU quality of care delivery. Pediatrics. 2017;140(3): e20170918. doi:10.1542/peds.2017-0918 [CrossRef]
  2. Horbar JD, Edwards EM, Greenberg LT, et al. Racial segregation and inequality in the neonatal intensive care unit for very low birth-weight and very preterm infants. JAMA Pediatr. 2019;173(5):455–461. doi:10.1001/jamapediatrics.2019.0241 [CrossRef] PMID:30907924
  3. Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–1463. doi:10.1016/S0140-6736(17)30569-X [CrossRef] PMID:28402827
  4. Greenwood BN, Hardeman RR, Huang L, Soujourner A. Physician-patient racial concordance and disparities in birthing mortality for newborns. Proc Natl Acad Sci USA. 2020;117(35):21194–21200. doi:10.1073/pnas.1913405117 [CrossRef] PMID:32817561
Joseph R. Hageman, MD

Pediatric Annals Editor-in-Chief Joseph R. Hageman, MD, is the Director of Quality Improvement, Section of Neonatology, Comer Children's Hospital; a Senior Clinician Educator, The University of Chicago Pritzker School of Medicine; and an Emeritus Attending Pediatrician, NorthShore University HealthSystem.

Address correspondence to Joseph R. Hageman, MD, via email:

Disclosure: Joseph R. Hageman is a member of the Owlet, Inc advisory board.


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