To begin understanding systemic racism and its impact on social determinants of health, researchers said pharmacists must first look inward and examine their own biases and socializations.
With an evolving understanding of systemic racism as a public health issue, leaders in the pharmacy field have begun exploring ways in which pharmacists can impact these issues in their communities. To begin having this wider impact, experts say pharmacists must first recognize racism and its links to social determinants of health.
The authors of a recent perspective published in the American Journal of Pharmaceutical Education (AJPE) said systemic racism is not only a root cause of social determinants of health but is also a public health emergency. Factors such as education, job opportunities, and living situations affect a wide range of health and quality of life, including access to health care, according to the authors. Despite some research on these social determinants, the authors said effective policies and sustainable programs have been challenging to implement and maintain.
“What is missing is the explicit recognition of the relationship among social determinants of health and system racism,” the authors wrote.
They added that systemic racism is “reflected in the policies, laws, rules, norms, and customs enacted by organizations and societal institutions that advantage whites as a group over groups of color,” and added that a deeper understanding is essential to address health disparities.
Pharmacists and other health care professionals have not traditionally been trained to understand and address social determinants of health or systemic racism as a root cause, despite some research and programs that have been designed to improve understanding of these issues. The County Health Rankings Model has identified clinical care as just 20% of the health factors impacting health outcomes, whereas physical environment accounts for 10% and social and economic factors account for 40%. Because of these findings, the perspective authors said interventions focused on socioeconomic factors can have an increased impact at the population level, as opposed to individual patient-focused clinical interventions.
“I think racism is a very significant issue for people to access the resources that they need for everything and anything that relates to health,” said Sandra Leal, PharmD, MPH, FAPhA, CDE, president of the American Pharmacists Association (APhA), in an interview with Pharmacy Times.
Leal has focused much of her work on how pharmacists can serve patients in marginalized and minority communities, especially along the US-Mexico border.
“What we’re seeing is a public health crisis, and how do we address that?” Leal said. “How we have to address that is head-on.”
In order to mitigate these issues, experts say pharmacists must first look inward and address their own implicit biases while educating themselves about the issues. Diversity and cultural competency trainings are often included in pharmacy curriculum, according to the AJPE perspective authors. Without context, however, they said this has resulted in students and health professionals linking cultural diversity to negative outcomes and experiences without addressing the root cause of systemic racism.
“In education, this is the time to have honest conversations with students, faculty, staff, and alumni to identify ways in which we can understand how our own socializations and biases perpetuate systemic racism,” the authors wrote.
In the academic setting, the authors said increased resources to improve student and faculty recruitment of people of color is a step in the right direction. According to their article, the American Association of Colleges of Pharmacy created a task force that took a holistic look at this issue. The task force members recommended both increasing resources and improving the climate for learning and success for people of color in pharmacy schools.
After graduation, the authors added that pharmacists should consider how systemic racism impacts their fellow pharmacists and technicians. Many pharmacists who identify as Black or indigenous persons of color (BIPOC) are typically forced to carry the workload of leading diversity initiatives at their organizations. The authors said that what is needed is for non-BIPOC individuals to engage in this work.
Furthermore, the authors said many BIPOC pharmacists face racial discrimination in their work environments, including having their work minimized by colleagues or facing discrimination from patients. Support for BIPOC pharmacists must be an intentional effort through organizational policies and processes, including providing support to speak up when they are facing discrimination or have concerns about these issues.
Leal said organizations such as APhA have also tried to address systemic racism and its related problems directly. Over the past year, she said APhA has launched a task force that, during their recent House of Delegates meeting, introduced intentional and specific language around racism.
“We’re actually looking internally—looking at our policies and procedures, looking at things like diversity, inclusion of diverse groups—even as early on as [during] pharmacy [school] admissions, so that we can have populations that represent the community,” Leal said.
She added that she hopes these conversations continue into the future because creating meaningful changes will take time.
“We’re all talking about [racism] now, [but] I hope [the discussion] doesn’t go away. This has to be a conversation that continues. This has been a problem for hundreds of years and we’re not going to fix it overnight. What we have to do is start really dealing with the rhetoric out there, dealing with and confronting the fact that there is racism at every level.”
Arya V, Butler L, Leal S, Maine L, et al. Systemic Racism: Pharmacists’ Role and Responsibility. American Journal of Pharmaceutical Education; November 1, 2020. https://www.ajpe.org/content/84/11/8418. Accessed March 25, 2021.