APIC Research Agenda Includes Race and HAIs
Are people of color at greater risk of infections?
With the SARS-CoV-2 pandemic exposing widespread inequities and deep-set systemic racism in healthcare, the Association for Professionals in Infection Control and Epidemiology (APIC) is planning research to address some of these critical issues. For example, one research proposal is to design a study to determine if patients of color or non-white ethnicity are at greater risk of acquiring healthcare-associated infections (HAIs).
“One of our goals is to really move forward with diversity, equity, and inclusion on every level,” says Ann Marie Pettis, RN, BSN, CIC, immediate past president of APIC. “[This] includes our staff, our board, looking at our membership, and importantly, our research agenda. We want to focus on people of color in terms of equity. Is there an equity issue? How does it affect them in terms of HAIs? If you look, there’s really a paucity of literature on that across the board.”
APIC plans to hire in-house infection prevention researchers to conduct some of this work, which will include updating workforce demand and staffing ratios for infection prevention.
”We want to make sure that our members are up to speed in terms of their ability to conduct research, evaluate research, and write grants,” Pettis says.
Given the social upheaval and the political divide in the last few years, it is not surprising there has been some pushback on research into systemic racism in healthcare. For example, a white supremacist group held a protest at a hospital in Boston that was conducting research on equity and systemic racism.
“It’s such a flashpoint topic, but we know it’s the right thing to do,” Pettis says. “We need to answer these questions, and then it needs to be dealt with. It needs to be addressed.”
‘We Will Not Tolerate Genocide’
The Jan. 22, 2021, protest incident included about 20 white nationalists standing in front of Brigham and Women’s Hospital holding a long, makeshift sign that said, “B and W Hospital Kills Whites.”1 Uniformly clad in brown khakis and black coats with their faces covered, they passed out flyers with photographs of two of the principal physician researchers. The flyers accused the researchers of “anti-white policies,” and warned that “we will not tolerate the genocide of the people who founded this city.”
Those targeted were Michelle Morse, MD, chief medical officer for the New York City Health Department, and Bram Wispelwey, MD, a physician at Brigham and Women’s. They are working on research to create more equity in healthcare delivery and treatment.
Again, the pandemic exposed major fault lines in the level of care for people of color compared to whites. Both Morse and Wispelwey declined to comment for this report.
Joane Moceri, PhD, MN, RN, racism researcher and associate dean of the University of Portland school of nursing, gave her opinion on the incident with the caveat that she did not know the full details.2
“It sounds like the protesters were confusing equity with equality because of their racist lens,” she said. “If Black and brown people need additional care to ensure health equity, they should receive it, even if it appears to be more than a white counterpart, who may actually need less care.
“White power, privilege, and supremacy are at the heart of racism. Racism could not exist without it.”
Recently, Trust for America’s Health released a sweeping pandemic analysis that called for “addressing the systemic inequities that led to COVID-19’s disproportionate health and economic impacts, particularly in communities of color and low-income communities.”
They traced some of this to policymakers ignoring decades of calls to properly fund and sustain public health, rather than responding to emergencies and reverting to the meager status quo.
“Underfunding contributed to understaffed and overworked health departments using out-of-date technologies,” the trust reported.3 “In addition, lack of support and outright threats against public health officials contributed to hundreds of senior-level state and local public health officials leaving the profession.”
Put simply, the nation’s public health and acute and long-term care systems were woefully inadequate to deal with disease on the level of a pandemic, and the almost 1 million people dead two years later serve as a bitter testament.
“Communities of color were disproportionately affected in large part due to the ways in which structural racism and classism impacts where people are born, grow, live, work, and age,” the report stated. As a result, American Indians and Alaska Natives died of COVID-19 at a rate that was 2.2 times higher than whites. The mortality rate of Hispanic/Latino Americans was 2.1 times higher than whites, and for Blacks it was 1.9 times higher.
Cultural Humility, Privilege Awareness
“What is missing is cultural humility and the recognition that patients bring their histories and cultures with them,” Moceri says.
“For optimal healing to occur, these must be addressed as part of care. A powerful aspect of structural racism is the privilege of not having to see racism, because white providers and people in general don’t have to confront it in the way BIPOC [Black, indigenous, and people of color] members of our society do,” she adds.
The rise of white supremacy groups is meant in part to keep it that way, with efforts to balance healthcare equity seen as “anti-white.”
“Can meaningful change be made in healthcare with 400-plus years of racism at its back?” Moceri says. “I want to believe it can happen, but unfortunately, it will not happen overnight. Yet, that is not a reason to give up. For healthcare to change, I suggest we all first take a good look at our codes of ethics. At least in the ANA [American Nurses Association] Code of Ethics for Nurses, it is clearly spelled out that racism is unethical.”
White nurses and providers need to realize and reflect on their privilege, and more providers of color are essential, she added.
“The structures that prevent people of color from entering the health professions need to be dismantled,” Moceri emphasized.
REFERENCES
- Moceri JT. Overview and summary: Racism and nursing: Diverse perspectives. OJIN: The Online Journal of Issues in Nursing 2022;27. doi: 10.3912/OJIN.Vol27No01ManOS. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-27-2022/No1-Jan-2022/Racism-and-Nursing-Diverse-Perspectives.html
- Martin P. Neo-Nazis target anti-racist doctors at Brigham and Women’s Hospital, calling them ‘anti-white.’ GBH News. Published Feb. 2, 2022. https://www.wgbh.org/news/local-news/2022/02/02/neo-nazis-target-anti-racist-doctors-at-brigham-and-womens-hospital-calling-them-anti-white
- Trust for America’s Health. Ready or not: Protecting the public’s health from diseases, disasters and bioterrorism. Published March 2022. https://www.tfah.org/wp-content/uploads/2022/03/2022_ReadyOrNot_Fnl.pdf
With the SARS-CoV-2 pandemic exposing widespread inequities and deep-set systemic racism in healthcare, the Association for Professionals in Infection Control and Epidemiology is planning research to address some of these critical issues, including one proposal to design a study to determine if patients of color or non-white ethnicity are at greater risk of acquiring healthcare-associated infections.
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