The year 2020 saw the largest social movement in response to the police killings of Black people and anti-Black racism in U.S. history. As a result, medical schools and professional societies such as ...the American Medical Association and the Association of American Medical Colleges are reckoning with their role in perpetuating racial inequality and the impact of structural racism on medical training. Whether these efforts will translate into meaningful change has yet to be determined. Success depends on a deep understanding of the fundamental role racism plays in how medical schools function and an acknowledgment that current organizational structures and processes often serve to entrench, not dismantle, racial inequities. Drawing on racialized organizations theory from the field of sociology, this article gives an overview of scholarship on race and racism in medical training to demonstrate how seemingly race-neutral processes and structures within medical education, in conjunction with individuals' biases and interpersonal discrimination, serve to reproduce and sustain racial inequality. From entrance into medical school through the residency application process, organizational factors such as reliance on standardized tests to predict future success, a hostile learning climate, and racially biased performance metrics ultimately stunt the careers of trainees of color, particularly those from backgrounds underrepresented in medicine (URM). These compounding disadvantages contribute to URM trainees' lower matching odds, steering into less competitive and lucrative specialties, and burnout and attrition from academic careers. In their commitment against structural racism in medical training and academic medicine, medical schools and larger organizations like the Association of American Medical Colleges should prioritize interventions targeted at these structural barriers to achieve equity.
Public Health Messaging in an Era of Social Media Merchant, Raina M; South, Eugenia C; Lurie, Nicole
JAMA : the journal of the American Medical Association,
01/2021, Letnik:
325, Številka:
3
Journal Article
Everyday environmental conditions impact human health. One mechanism underlying this relationship is the experience of stress. Through systematic review of published literature, we explore how stress ...has been measured in real-time non-laboratory studies of stress responses to deliberate exposure to outdoor environments. The types of exposures evaluated in this review include: nature viewing, outdoor walks, outdoor exercise and gardening. We characterize study design, modalities of stress measurements, and statistical estimates of effect and significance. Heart rate, blood pressure, and self-report measures provide the most convincing evidence that spending time in outdoor environments, particularly those with green space, may reduce the experience of stress, and ultimately improve health. More work is needed to understand effects of in situ modifications to outdoor environments on residents’ stress response.
•Systematic review of 43 real-time non-laboratory studies of stress responses to outdoor, often natural, environments.•Stress outcome measurements were by anthropometric instruments, saliva, blood, urine, actigraph, self-report and eeg.•Environmental exposures included nature viewing, outdoor walk, outdoor exercise, or gardening.•Heart rate, blood pressure, and self-report results provide the most convincing evidence.
In 2021, The American Association of Medical Colleges released a framework addressing structural racism in academic medicine, following the significant, nationwide Movement for Black Lives. The first ...step of this framework is to “begin self-reflection and educating ourselves.” Indeed, ample evidence shows that medical schools have a long history of racially exclusionary practices. Drawing on racialized organizations theory from the field of sociology, we compile and examine scholarship on the role of race and racism in medical training, focusing on disparities in educational and career outcomes, experiences along racial lines in medical training, and long-term implications. From the entrance into medical school through the residency application process, organizational factors such as reliance on standardized tests to predict future success, a hostile learning climate, and racially biased performance metrics negatively impact the careers of trainees of color, particularly those underrepresented in medicine (URiM). Indeed, in addition to structural biases associated with otherwise “objective” metrics, there are racial disparities across subjective outcomes such as the language used in medical trainees’ performance evaluations, even when adjusting for grades and board exam scores. These disadvantages contribute to URIM trainees’ lower odds of matching, steering into less competitive and lucrative specialties, and burnout and attrition from academic careers. Additionally, hostile racial climates and less diverse medical schools negatively influence White trainees’ interest in practicing in underserved communities, disproportionally racial and ethnic minorities. Trainees’ mental health suffers along the way, as do medical schools’ recruitment, retention, diversity, and inclusion efforts. Evidence shows that seemingly race-neutral processes and structures within medical education, in conjunction with individuals’ biases and interpersonal discrimination, may reproduce and sustain racial inequality among medical trainees. Medical schools whose goals include training a more diverse physician workforce towards addressing racial health disparities require a new playbook.
Structural racism has resulted in long-standing disinvestment and dilapidated environmental conditions in Black neighborhoods. Abandoned houses signal neglect and foster stress and fear for ...residents, weakening social ties and potentially contributing to poor health and safety.
To determine whether abandoned house remediation reduces gun violence and substance-related outcomes and increases perceptions of safety and use of outdoor space.
This cluster randomized trial was conducted from January 2017 to August 2020, with interventions occurring between August 2018 and March 2019. The study included abandoned houses across Philadelphia, Pennsylvania, and surveys completed by participants living nearby preintervention and postintervention. Data analysis was performed from March 2021 to September 2022.
The study consisted of 3 arms: (1) full remediation (installing working windows and doors, cleaning trash, weeding); (2) trash cleanup and weeding only; and (3) a no-intervention control.
Difference-in-differences mixed-effects regression models were used to estimate the effect of the interventions on multiple primary outcomes: gun violence (weapons violations, gun assaults, and shootings), illegal substance trafficking and use, public drunkenness, and perceptions of safety and time outside for nearby residents.
A master list of 3265 abandoned houses was randomly sorted. From the top of this randomly sorted list, a total of 63 clusters containing 258 abandoned houses were formed and then randomly allocated to 3 study arms. Of the 301 participants interviewed during the preintervention period, 172 (57.1%) were interviewed during the postintervention period and were included in this analysis; participants were predominantly Black, and most were employed. Study neighborhoods were predominantly Black with high percentages of low-income households. Gun violence outcomes increased in all study arms, but increased the least in the full remediation arm. The full housing remediation arm, compared with the control condition, showed reduced weapons violations by -8.43% (95% CI, -14.68% to -1.19%), reduced gun assaults by -13.12% (95% CI, -21.32% to -3.01%), and reduced shootings by a nonsignificant -6.96% (95% CI, -15.32% to 3.03%). The trash cleanup arm was not associated with a significant differential change in any gun violence outcome. Instances of illegal substance trafficking and use and public drunkenness outcomes were not significantly affected by the housing remediation or trash cleanup treatment. Perceptions of neighborhood safety and time spent outside were unaffected by the intervention. The study arms did differ in a baseline characteristic and some preintervention trends, which raises questions regarding other potential nonmeasured differences between study arms that could have influenced estimates. No evidence of displacement of gun violence outcomes was found.
In this cluster randomized controlled trial among low-income, predominantly Black neighborhoods, inexpensive, straightforward abandoned housing remediation was directly linked to significant relative reductions in weapons violations and gun assaults, and suggestive reductions in shootings.
isrctn.org Identifier: ISRCTN14973997.
The root causes of violent crime in Black urban neighborhoods are structural, including residential racial segregation and concentrated poverty. Previous work suggests that simple and scalable ...place-based environmental interventions can overcome the legacies of neighborhood disinvestment and have implications for health broadly and crime specifically.
To assess whether structural repairs to the homes of low-income owners are associated with a reduction in nearby crime.
This cross-sectional study using difference-in-differences analysis included data from the City of Philadelphia Basic Systems Repair Program (BSRP) from January 1, 2006, through April 30, 2013. The unit of analysis was block faces (single street segments between 2 consecutive intersecting streets) with or without homes that received the BSRP intervention. The blocks of homes that received BSRP services were compared with the blocks of eligible homes that were still on the waiting list. Data were analyzed from December 1, 2019, to February 28, 2021.
The BSRP intervention includes a grant of up to $20 000 provided to low-income owners for structural repairs to electrical, plumbing, heating, and roofing damage. Eligible homeowners must meet income guidelines, which are set by the US Department of Housing and Urban Development and vary yearly.
The main outcome was police-reported crime across 7 major categories of violent and nonviolent crimes (homicide, assault, burglary, theft, robbery, disorderly conduct, and public drunkenness).
A total of 13 632 houses on 6732 block faces received the BSRP intervention. Owners of these homes had a mean (range) age of 56.5 (18-98) years, were predominantly Black (10 952 78.6%) or Latino (1658 11.9%) individuals, and had a mean monthly income of $993. These census tracts compared with those without BSRP intervention had a substantially larger Black population (49.5% vs 12.2%; |D| = 0.406) and higher unemployment rate (17.3% vs 9.3%; |D| = 0.357). The main regression analysis demonstrated that the addition to a block face of a property that received a BSRP intervention was associated with a 21.9% decrease in the expected count of total crime (incidence rate ratio IRR, 0.78; 95% CI, 0.76-0.80; P < .001), 19.0% decrease in assault (IRR, 0.81; 95% CI, 0.79-0.84; P < .001), 22.6% decrease in robbery (IRR, 0.77; 95% CI, 0.75-0.80; P < .001), and 21.9% decrease in homicide (IRR, 0.78; 95% CI, 0.71-0.86; P < .001). When restricting the analysis to blocks with properties that had ever received a BSRP intervention, a total crime reduction of 25.4% was observed for each additional property (IRR, 0.75; 95% CI, 0.73-0.77; P < .001). A significant dose-dependent decrease in total crime was found such that the magnitude of association increased with higher numbers of homes participating in the BSRP on a block.
This study found that the BSRP intervention was associated with a modest but significant reduction in crime. These findings suggest that intentional and targeted financial investment in structural, scalable, and sustainable place-based interventions in neighborhoods that are still experiencing the lasting consequences of structural racism and segregation is a vital step toward achieving health equity.
We measured dynamic stress responses using ambulatory heart rate monitoring as participants in Philadelphia, Pennsylvania walked past vacant lots before and after a greening remediation treatment of ...randomly selected lots. Being in view of a greened vacant lot decreased heart rate significantly more than did being in view of a nongreened vacant lot or not in view of any vacant lot. Remediating neighborhood blight may reduce stress and improve health.
PDF
