Confronting Racial Injustice

The SIUE School of Pharmacy is making adjustments to its curriculum. “We’re incorporating the topic of systemic racism and its impact on social determinants of health in a third year required course on population health. In our second year required cultural competency course, we’re going to explore systemic oppression and racism and discuss toxic stress, chronic trauma and the resulting negative health outcomes associated with racial-based trauma,” she said. “I’ve spoken to colleagues who are planning to incorporate similar topics within their existing curriculum. That’s where we need to push our curriculum—finding ways to address the root causes of health disparities. We’ve seen the needle slightly move but I feel we haven’t seen the dramatic change in health disparities that we’ve hoped for because we have not addressed the root cause. That’s when we can break down the true oppressive nature that contributes to health disparities. That’s where we’ll truly see change within healthcare.”

The other essential component, Butler emphasized, is educating faculty members. “We can’t just rely on one individual to teach these types of topics. We have to educate ourselves, especially our pharmacy practice faculty. Are we perpetuating systemic racism by not addressing it? I would say the answer is yes. We all have to go on a personal journey addressing our own implicit biases, educating ourselves especially on the historical context, and actively work toward becoming anti-racist.”

Ensuring diversity among faculty is also part of the responsibility of higher education institutions to expose students to different cultures, she added. “When you have faculty of color or students of color there does tend to be more of a sense of belonging, a more inclusive feeling.” Brianna Henson, director of assessment, University of Kentucky College of Pharmacy, is conducting a national study examining how people of color are shouldering the heavy lifting of diversity work across many organizations.

“The current racial dynamic in pharmacy is unacceptable. It is not reflective of the patient population,” Henson said. “All organizations are struggling with this. One of the approaches for pharmacy and academia—a huge step people miss—is actively recruiting and hiring diversity into your faculty and staff. It starts there from the top down. A lot of times the diversity and inclusion officer at the college will be the only person of color on the leadership team. That’s unacceptable. The statements recently created [in the wake of police shootings] are great, but what does your executive team look like? What does it say to students? We’re showing these students that they don’t belong here even if we don’t say it aloud. Students don’t see themselves represented.” Although Henson cautioned that it can be burdensome to only ask people of color to be the ones to address these issues, she said, “I want to be invited to a welcoming and inclusive table but I want my voice to be heard. Everyone benefits when a variety of identities are present.”

Integrating diversity into the curriculum is the next step. “Diversity and equity initiatives can’t be siloed. They need to be institutional and programmatic, reinforcing the material,” she noted. “If you think about a disease state, it’s introduced in one course and then discussed again and built upon in various other courses. That needs to be the case with any subject, including diversity. We learn by repetition. Include inclusion work in core program outcomes—in the school’s mission. Students need to gain skills to participate in a society that is diverse and may not be like them. It’s not enough to just cover the content; it needs to be thoughtful and intentional. How is it being presented, how is it reflecting the experiences of marginalized groups? The foundations will then become a normal part of the curriculum.”

Resources to Effect Real Change

AACP’s policy statements represented a first step in giving the topic greater visibility and devoting more resources to tackling racial injustice. “This will help show society and other professions who we are and will provide opportunities for us to engage with folks inside and outside of healthcare,” said Dr. Brad Cannon, director of experiential education, assistant professor, College of Pharmacy, Rosalind Franklin University of Medicine & Science. As AACP’s speaker of the house, Cannon convened a policy development task force to make recommendations related to diversity, equity and anti-racism. “Now that the House has passed new policy statements, we will need to take a hard look at where we deploy our resources. In addition to these statements, recommendations were made supporting development of faculty to address issues of racial injustice.”

While individual schools of pharmacy need to look internally at what their institutions are doing, “the great thing about AACP is that people can share what works for them—it comes down to collaborating as best we can across the board,” Cannon noted. “The faculty development issue is going to be central to many because we have to be aware of the things we need to teach and go back and learn some things we didn’t know before.” He emphasized that the Academy has a long history of trying to attract underrepresented minorities to the profession but acknowledged there is much more work to do. “Students want to go where they see themselves. We have to make sure our schools look like a place anybody can go and be successful.”

Cannon added that it is crucial to help students be advocates and find ways to speak out when appropriate. “Some of our students didn’t know how the university would feel about protests but they felt the need to speak out. Part of our job is helping students understand what their role is as an advocate for change and how impactful that can be now and in the future as healthcare practitioners,” he said. “I worry about preparing our students not just for what’s going on now but also for what’s going to be down the road for them. With the dynamics we’re seeing in society, our students have to be prepared to provide all sorts of healing, and some of that will be in different ways than we’ve been focused on in the past. We’re preparing them to be the best healthcare providers they can be.”

Another way AACP will bring focus to these issues is through the Equity, Diversity and Inclusion Institute it is cohosting (virtually) with The University of Mississippi in January 2021. “Our hope is to improve how schools are addressing topics of diversity, equity, patient care,” explained Dr. Katie McClendon, clinical associate professor, department of pharmacy practice, University of Mississippi School of Pharmacy, who is involved in planning the event. “We want schools to have dedicated time to learn about these issues to assess where they are and then develop a plan that works for that institution to better address these topics at their institution. We hope there will be community built so we can learn from each other and give teams dedicated time to work on their plans to improve.”

She said that while some schools have long track records working to become more inclusive, others have just started making inclusivity a priority due to recent events. “Wherever we are in the process, it’s about taking some time to reflect on our biases, implicit and explicit, and reflect on how we’ve acted in the past or maybe didn’t act, and developing a plan to be better educators and clinicians,” McClendon said. “I hope this is an opportunity for schools to look at curricula and see how fully they develop their students in the area of racial injustice. There are ways to have it as separate material or a separate course but also great ways to integrate it to make it part of the everyday experience for our students. There are lots of small ways to address historical and current injustice. Schools can take time to reflect and think about where those opportunities are.” As an example, she noted that she teaches a women’s health course and will discuss the historical context of “Mississippi appendectomies” (forced sterilizations).

McClendon does believe that the current circumstances in the United States will change the way social determinants of health are discussed in pharmacy schools. “I think the story of what we’re learning about with COVID and health disparities and who’s more likely to get it, it’s an excellent real-time example for schools to talk about. A lot of schools are looking at their curricula to figure out where conversations about COVID best fit.”

Preparing future pharmacists to address inequities in patient care “is the forefront of what we as educators and as pharmacy schools are trying to do: make students become practitioners who take care of all of our patients,” she continued. “I was looking at AACP’s mission and it is to partner with the schools to improve societal health. Everything we do has that in mind. If we’re not more self-aware and taking action to improve in this area, we’re not going to accomplish our goals.”

Breaking Down Stereotypes and Broadening Representation

Kentucky’s Henson wants to see pharmacy schools design curricula that are more thoughtful about discussions around social determinants of health. “When designing the curriculum it might be helpful to have people who have an education background, not just a pharmacy background. Diversity and inclusion offices also have resources for you,” she suggested. “It’s important to look at the classroom environment. Are you valuing students’ opinions? Assessing diversity is going to take creative approaches. Professors should think about sometimes being more of a facilitator rather than the formal instructor. Students might be more comfortable talking with each other. It’s important to talk about health disparities, provide context as to why these disparities exist, as well as share positive things about marginalized populations.”

Understanding history and our own socialization is key to preparing future pharmacists to address inequities in patient care, said NPhA’s Butler. “Often students have no idea why there are differences in chronic disease states among minorities,” she pointed out. “That further perpetuates biases. The messages we’ve been taught continue to shape how we think and how we stereotype certain individuals. If we have these biases that were generated years ago, we have to be able to recognize that, disrupt them and educate ourselves.”

Butler added that expanding the diverse representation of students and faculty is key to enhancing the educational experience of student pharmacists, but it also provides representation out in the field when interfacing with patients. Moving forward, Butler said the Academy must embrace strategies that show a commitment to broader representation. “The Academy may make recommendations for curricular changes or increase in faculty and student minority representation, but is this truly a value of the Academy, and how does that manifest in actions?” she asked. “Is the representation of the leadership diverse? The opening keynote speaker for the AACP conference [Dayna Bowen Matthew] was excellent. She addressed the timely topic of racial inequities, and that was a tangible action showing that the Academy feels like this is a priority. We need to be looking for additional ways to make this value truly manifest in action.”

Henson would also like to see proactive approaches. “A lot of institutions have been pretty straightforward about their goals with diversity and inclusion but it’s important to put the money behind that,” she emphasized. “Encourage your faculty to publish in education or diversity and inclusion journals—other things beyond pharmacy. Creating a task force is a good first step. It would be more helpful to sit down with students, faculty and staff to create a philosophy around this looking 20 years down the road. Some institutions have focus groups for students from marginalized groups, but don’t leave out faculty and staff. Develop a philosophy looking at 20 years down the road. It’s about creating more equitable leadership models, including diverse students, and giving everyone a voice.”

Jane E. Rooney is managing editor of Academic Pharmacy Now.