Truth, Reconciliation, and Transformation: Continuing on the Path to Equity

Abstract

One year ago, the American Academy of Pediatrics (AAP) published a landmark policy statement identifying racism as a core social determinant of health and a driver of health inequities.1 Seventy-five years ago, the AAP admitted its first Black members, Drs Alonzo deGrate Smith and Roland Boyd Scott. As the AAP continues to evolve its equity agenda, it is essential that the tortuous experiences of Drs deGrate Smith and Scott on their pathway to AAP membership be truthfully acknowledged and reckoned with.At the time of their initially rejected applications in 1939, both Drs deGrate Smith and Scott were busy clinicians and well-established leaders in the pediatric academic community as faculty at the Howard University College of Medicine in Washington, DC. Dr deGrate Smith, through the practice pathway, and Dr Scott, via examination, were among the earliest pediatricians to achieve certification under the Advisory Board of Medical Specialties (ABMS) when the American Board of Pediatrics (ABP) was established in 1933. However, the ABMS required American Medical Association (AMA) membership to honor certification, and the local AMA chapter, the Medical Society of the District of Columbia, was segregated.2 According to the oral history interview of Dr Melvin E. Jenkins Jr, advocacy on the part of the inaugural ABP president, Dr Borden Veeder, was necessary to permanently eliminate this exclusionary barrier and to make certification possible for all eligible candidates regardless of race or ethnicity.3 Drs deGrate Smith and Scott faced other systemic barriers, including the inability to gain admitting privileges to care for even their own patients at local hospitals in the District of Columbia. This was a hurdle that Dr Scott was not able to overcome until 1955, fully 6 years after he had already been appointed Chair of Pediatrics at Howard University.4Although AAP bylaws did not explicitly prohibit physicians of color from membership, and Drs deGrate Smith and Scott were finally admitted in 1945, it is clear that the AAP Executive Board struggled with unbiased consideration of their applications. The characterizations related to Drs deGrate Smith and Scott in the following passages excerpted directly from meeting transcripts of AAP Executive Board meetings in November 1939, November 1944, and June 1945 are elucidating, instructive, and painful to read. The verbatim dialogue and proceedings highlight the racist attitudes and beliefs from which early AAP leaders were clearly not immune.In the United States there is a tendency to be ahistorical when it comes to race. The lack of acknowledgment, or worse, the intentional whitewashing of history and the longitudinal relationship of 400 years of oppression on the present-day expression of racism is not uncommon. As the AAP turns the corner toward the 2030 centennial anniversary of its founding, we cannot do so without authentically acknowledging, owning, and reconciling past discriminatory transgressions like the shameful gauntlet to membership experienced by Drs Alonzo deGrate Smith and Roland Boyd Scott.In honoring the memory of these two trailblazers and their contributions to pediatrics and the AAP,7 be it resolved that, we, the Board of Directors of the AAP:The AAP as an organization is on a firm pathway to broadly establishing an equity agenda through meaningful diversity and inclusion and a societal commitment to combating bias and discrimination in all its forms, including structural and systemic anti-Black racism (Fig 1). This country is already majority represented by children of color when it comes to the pediatric population.Embracing racial and ethnic socialization is critical for all children and families as well as for the pediatricians who care for them. Healing starts at home with truth, reckoning, and honest reconciliation.The AAP is proud to transparently acknowledge, proud to publicly reconcile, and proud to continue to lead on behalf of the best interests of children, adolescents, and young adults and the people who care for them.Sara H. Goza, MD, FAAPLee Savio Beers, MD, FAAPKyle E. Yasuda, MD, FAAPWarren M. Seigel, MD, FAAPMark Del Monte, JDWendy S. Davis, MD, FAAPWarren M. Seigel, MD, FAAPMargaret C. Fisher, MD, FAAPMichelle D. Fiscus, MD, FAAPRichard H. Tuck, MD, FAAPDennis M. Cooley, MD, FAAPGary W. Floyd, MD, FAAPMartha C. Middlemist, MD, FAAPYasuko Fukuda, MD, FAAPLisa A. Cosgrove, MD, FAAPCharles G. Macias, MD, FAAPConstance S. Houck, MD, FAAPJoseph L. Wright, MD, FAAP