AAP Equity Agenda

Introduction

The American Academy of Pediatrics (AAP) believes that all systems of care should seek to promote and achieve health equity for all children. The AAP Equity Agenda guides the Academy’s efforts to achieve health equity and actualize our goals to become an equitable, diverse, and inclusive organization. These efforts include promoting a diverse Academy membership, leadership, and pediatric workforce; applying an equity lens to Academy policy, advocacy, and education; and equipping AAP members with the capacity to foster equity in their practices, institutions, and communities. The AAP Equity Agenda sets forth explicit and intentional action to support the Academy’s commitment to equity, diversity, and inclusion (EDI) and ensures this action permeates all aspects of the Academy’s functioning.

The following principles will guide the AAP Equity Agenda and will serve to advance our goal to eliminate health inequities and disparities and promote equity in child and adolescent health care:

1. All children and adolescents have equitable health care within a medical home that includes primary care, subspecialty services, emergency medical services, and hospital care.

2. Child and adolescent health care professionals shall address the social, behavioral, and environmental factors that affect children’s health, development, and achievement.

3. Child and adolescent health care professionals deliver care in a culturally and linguistically effective manner that addresses the unique needs of each child and family.

4. Child and adolescent health care professionals deliver care based on the best available evidence.

5. Child health care professionals advocate for identification and elimination of racist policies and the inequities that contribute to racial disparities and impede equity.

6. Child and adolescent health care is delivered using language that the patient and family prefer.

7. Child and adolescent health care delivery settings are welcoming and reflect the diversity of their patients.

8. Child health professionals receive training on delivering culturally and linguistically effective care.

9. The child health care workforce is diverse and reflective of the child population.

10. Child and adolescent health care services are evaluated using data stratified by insurance status, race and ethnicity, language, socioeconomic status, gender, gender identity, religion, disability, and sexual orientation.

The AAP Equity Agenda was built on the recommendations of the Task Forces on Diversity and Inclusion and Addressing Bias and Discrimination. It is composed of the following domains:

• Internal Processes
• Education
• Leadership
• Clinical Practice
• Policy & Advocacy

The AAP Equity Agenda falls within the jurisdiction of the AAP Board Committee on Equity (BCOE), which is responsible for implementation. The BCOE will foster accountability by monitoring implementation and regularly reporting to the full AAP Board of Directors.

The following workplan delineates objectives and activities for year one of the AAP Equity Agenda. While the Equity Agenda is broad, the AAP Board of Directors has articulated the goal of advancing racial equity with an emphasis on addressing anti-Black racism in year one. To that end, proposed action items were informed, in large part, by the AAP policy statements The Impact of Racism on Child and Adolescent Health and Truth, Reconciliation, and Transformation: Continuing on the Path to Equity. It is important to note, however, that this document does not represent the sum of all the work that needs to be done to achieve this goal. Rather, the workplan prioritizes activities that are feasible and will be impactful over the next 12 months.

There is a need for urgent action. However, this action must lead to sustained, transformative change.

The following members of the Task Force on Diversity and Inclusion and Task Force on Addressing Bias and Discrimination, as well as the authors of The Impact of Racism on Child and Adolescent Health policy statement, are acknowledged for their contributions to this work:

Task Force on Diversity and Inclusion (2015-2017) 

Danielle Laraque-Arena, MD, FAAP, Co-Chair
DeWayne Pursley, MD, MPH, FAAP, Co-Chair
Shaquita Bell, MD, FAAP
Carol Berkowitz, MD, FAAP, FACEP
Marilyn Bull, MD, FAAP
Uriel Castaneda, MD, FAAP
Tina Cheng, MD, MPH, FAAP
Jacqueline Dougé, MD, MPH, FAAP
Maheswari Ekambaram, MD, FAAP
Olanrewaju (Lanre) Falusi, MD, FAAP
Elena Fuentes-Afflick, MD, MPH, FAAP
Christopher Harris, MD, FAAP
Nathaniel Jones, MD
Yvonne Maldonado, MD, FAAP

Task Force on Addressing Bias and Discrimination (2017-2019)

Joseph Wright, MD, MPH, FAAP, Chair
Benard Dreyer, MD, FAAP
Steven Federico, MD, FAAP
Monika Goyal, MD, FAAP
Andrea Green, MD, FAAP
Amy Houtrow, MD, PhD, MPH, FAAP
Tiffani Johnson, MD, FAAP
Joyce Mauk, MD, FAAP
Fernando Mendoza, MD, MPH, FAAP
Kelly Moore, MD, FAAP
Hugo Scornik, MD, FAAP
Maria Trent MD, MPH, FAAP, FSAHM
Ashaunta Anderson, MD, FAAP
Evan Weiner, MD, FAAP
Flavia Mercado, MD, FAAP
Lynn Smitherman, MD, FAAP

Impact of Racism on Child and Adolescent Health

Maria Trent MD, MPH, FAAP, FSAHM
Jacqueline Dougé, MD, MPH, FAAP
Danielle Dooley, MD, MPhil, FAAP

I. Internal Process

Goal 1

Implement organizational change necessary to eliminate racism and promote equity, diversity, and inclusion.

Objective 1.1

Foster an organizational culture that strives to eliminate racism and promotes equity, diversity, and inclusion.

Year 1 Action Items:

1. Revise human resources procedures to prioritize recruitment, retention, and promotion of underrepresented staff of color and seek consultation on human resources policies that overcome gaps in diversity across the AAP management and staff.
2. Update staff orientation processes and other internal staff communication and training to reflect the commitment to creating a welcoming and inclusive work environment.
3. Engage an equity, diversity, and inclusion (EDI) consultant to assess staff readiness and include anti-racism education and training as part of ongoing staff development; address racial equity and AAP culture and climate and build staff capacity to embed racial equity and inclusion into the work of the Academy.
4. Create internal structures, such as employee resource groups, to meet the diverse needs of the AAP staff.

Objective 1.2

Establish governance, operationalize equity, and ensure accountability in all AAP programs and initiatives.

Year 1 Action Items:

1. The Board Committee on Equity (BCOE) will monitor implementation of the Workplan, seek expert advice, advise and report to the Board, ensure adequate resource allocation and alignment of AAP operations, and provide training for the Board on anti-racism.
2. Amend the AAP bylaws to include anti-discrimination by a referendum of the membership.
3. Establish staff workgroups to support implementation of the Equity Agenda.
4. Conduct survey to assess EDI initiatives across all AAP departments.
5. Incorporate goals to eliminate racism and promote equity, diversity, and inclusion in the AAP Strategic Plan.
6. Create staffing structure necessary to elevate and sustain AAP equity efforts.
7. Increase contracting with Black and other minority-owned businesses and vendors.

Objective 1.3

Identify, measure, and monitor impact.

Year 1 Action Items:

1. Improve data collection on AAP members regarding race, ethnicity, primary language, country of origin, medical school type (IMG/USMG), gender, gender identity, sexual orientation, age, and disability status.
2. Develop baseline data on the diversity of AAP membership and leadership.
3. Incorporate questions about EDI initiatives/needs in committee, council, section, and chapter annual reports.
4. Collect and report demographics on elected, selected, and appointed AAP representatives, including course faculty and editorial boards.
5. Develop a dashboard to track and monitor metrics related to EDI initiatives, including staff recruitment and retention.
6. Solicit and understand perspectives of Black and other pediatricians underrepresented in medicine who are not members of the AAP.

Objective 1.4

Develop and promote content and messaging on racism and equity, diversity, and inclusion across all AAP media and communications platforms.

Year 1 Action Items:

1. Standardize inclusive language to be used across all publications and communications.
2. Develop and deliver content for Healthychildren.org, Healthychildren.org en Español, and patient education materials for parents of children across the age continuum.
3. Disseminate key EDI messages through AAP leaders and spokespersons to media, in collaboration with chapters, committees, councils, and sections.
4. Adapt messaging and communications strategies and diversify spokespersons to be responsive to local differences and inclusive of diverse communities.
5. Elevate the role of diverse youth and family voices in AAP communications.
   
   

II. Education

 Goal 2: Equip members with knowledge and skills to address equity, diversity, and inclusion.

Objective 2.1: Identify or develop new and existing educational content on anti-racism and structural racism.

Year 1 Action Items:

1. Provide education and maintenance of certification (MOC) offerings to address unconscious bias and other forms of interpersonal racism, race and ethnicity as social constructs, and the framework of intersectionality.
2. Develop/identify and disseminate a curriculum to address racism and promote racial equity in practices and communities.
3. Support learning communities and provide simulation opportunities and other interactive learning opportunities to ensure pediatricians are competent to deliver culturally effective care.
4. Make equity-focused content from the 2020 National Conference & Exhibition available as enduring continuing medical education (CME) and prioritize content on racism and EDI at the 2021 National Conference & Exhibition.
5. Build a shared understanding of systemic racism across pediatric medicine, including the awareness and understanding of a structural competency approach to addressing racism.

Objective 2.2: Ensure educational activities integrate content on bias, heath inequities, structural racism, and health disparities.

Year 1 Action Items:

1. Evaluate existing CME/MOC offerings for inclusion of content on bias, heath inequities, structural racism, and health disparities.
2. Work to eliminate race-based medicine and other forms of bias in all CME/MOC activities.
3. Develop necessary training or resources and incorporate guidance into faculty instructions and course development.

Objective 2.3: Collaborate with relevant partners in medical education and certification to incorporate content on bias, racism, and inequities that are essential to medical training and practice.

Year 1 Action Items:

1. Conduct an environmental scan of current EDI-related initiatives, identifying opportunities for collaboration/engagement.
2. Convene stakeholders to evaluate current and future training and certification needs.
3. Advocate for additional training based on identified gaps in graduate medical education and CME.
   
   

III. Workforce & Leadership

Goal 3: Strengthen and diversify the pipeline to pediatrics and AAP leadership.

Objective 3.1: Identify and implement strategies to strengthen and diversify the pediatric pipeline.

Year 1 Action Items:

1. Conduct a literature review and/or environmental scan to identify best practices and effective strategies for pipeline program development.
2. Develop and/or disseminate tools and resources to support evidence-based section, council, and chapter pipeline programs.
3. Foster and enhance relationships with underrepresented in medicine (URiM) medical student members and national student affinity organizations to provide meaningful opportunities for exposure to pediatrics.
4. Seek opportunities to partner with other pediatric societies and groups across organized medicine to diversify the pediatric workforce.
5. Invest in new, or expand existing, pediatric pipeline initiatives (eg, Pediatric Pipeline Innovation Program).

Objective 3.2: Increase the percentage of members underrepresented in medicine serving in AAP leadership.

Year 1 Action Items:

1. Require consideration by the Board of racial and ethnic diversity in appointing committee members and selecting nominees for other leadership positions, including editorial boards.
2. Support the efforts of the National Nominating Committee to prioritize racial and ethnic diversity in nomination of national leaders.
3. Increase diversity of nomination and selection committees of councils and sections.
4. Establish procedures to mitigate implicit bias and increase transparency during nomination and selection processes.

Objective 3.3: Foster equity, diversity, and inclusion among AAP leaders.

Year 1 Action Items:

1. Provide training for AAP leaders on EDI-related topics, such as inclusive leadership; incorporating EDI into leadership practices; creating a culture of compassion, empathy, and authentic inclusion within executive committees; and interrupting racism through leadership.
2. Develop resources to support strategies for recruiting a diverse pool of AAP leadership.
3. Ensure all selection/nomination committee members, including the Board, complete implicit bias training.
4. Create actionable resources to foster EDI initiatives across AAP constituencies.

Objective 3.4: Provide leadership development opportunities for trainees and early- to mid-career underrepresented in medicine (URiM) members.

Year 1 Action Items:

1. Collaborate with the Section on Pediatric Trainees; Section on Early Career Physicians; Section on Minority Health, Equity, and Inclusion; and others to provide professional development.
2. Establish or enhance existing mentorship and sponsorship programs to prepare Underrepresented in medicine members for AAP and other leadership opportunities.
3. Incorporate EDI-related training into existing (eg, Young Physicians Leadership Alliance) and new leadership development programs.
4. Develop and launch a program to build capacity of trainees and/or early to mid-career members to address equity through education, practice, and advocacy.
5. Establish and/or support existing career development and award programs (eg, New Century Scholars, Billie Wright Adams Scholars) to recognize the professional and scholarly accomplishments of trainees and early- to mid-career Underrepresented in medicine pediatricians.

Objective 3.5: Expand EDI efforts of the District EDI Champion network.

Year 1 Action Items:

1. Revise and expand the scope of District EDI Champions.
2. Provide training and ongoing support for District Champions.
3. Disseminate and implement actionable resources to further support chapter EDI efforts. (See objective 3.3)
   
   

IV. Clinical Practice

Goal 4: Equip members with the knowledge, skills, and capacity to advance health equity and combat racism through clinical practice.

Objective 4.1: Develop and disseminate resources and tools to assist pediatricians, pediatric medical subspecialists, and pediatric surgical specialists to provide linguistically and culturally effective care, specifically addressing bias and discrimination.

Year 1 Action Items:

1. Develop and disseminate resources to help pediatricians create a linguistically and culturally safe and effective medical home that includes family and youth involvement.
2. Explore opportunities for the Maternal and Child Health Bureau to incorporate guidance for screening children, adolescents, and families about racism and other forms of bias and discrimination into Bright Futures.
3. Disseminate tools to help pediatricians develop and implement an action plan to advance racial equity through clinical practice.

Objective 4.2: Provide clinicians with educational tools for families on how to support positive child and youth development and to mitigate the negative physical and emotional outcomes resulting from bias and discrimination.

Year 1 Action Items:

1. Expand and disseminate resources for pediatricians to support positive child and youth racial identity development.
2. Provide materials on effective practice strategies to prevent and/or mitigate bias and discrimination.
3. Develop practice-based resources for families with civil rights concerns, including medical-legal partnership models and referrals to appropriate agencies.
   
   

V. Policy & Advocacy

Goal 5: Advance the AAP Equity Agenda through advocacy and policy development.

Objective 5.1: Prioritize EDI in AAP policy development.

Year 1 Action Items:

1. Review existing AAP policy and catalog existing recommendations related to equity, diversity, and inclusion for dissemination.
2. Implement new policy intent form that requires authors to address health equity considerations in policy statement development.
3. Use available stratified child and adolescent health data to identify and address equity gaps when developing policy statements, educational programs, and quality improvement activities.

Objective 5.2: Develop new policies necessary to address the systemic racism and health disparities that harm diverse groups of children and youth.

Year 1 Action Items:

1. Use the gap analysis conducted by the Task Force on Addressing Bias and Discrimination, the BCOE, and Board Committee on Policy (BCOP) to prioritize and delegate the development of new policy statements, clinical reports, technical reports, and clinical practice guidelines.

Objective 5.3: Advocate for policies and programs that advance child health equity and diversify the pediatric workforce.

Year 1 Action Items:

1. Use the Academy’s advocacy resources to promote federal, state, and community-level advocacy that addresses health inequities, advances racial equity, and promotes social justice.

2. Advocate with other pediatric and medical education organizations (eg, Association of American Medical Colleges, American Board of Medical Specialties, American Board of Pediatrics) to promote diversity and inclusion throughout the field of pediatrics.

3. Establish and enhance interdisciplinary partnerships with other organizations that have developed campaigns against racism.

4. Partner with organizations and groups that advocate to remediate the effects of structural and systemic racism on child health outcomes.

5. Coordinate and align advocacy effort with state chapters to advance the AAP Equity Agenda.