Health advocacy for all children is proudly at the core of pediatric care providers’ identity. This makes the findings in the report by Parikh et al1 in this issue of Pediatrics particularly disturbing. The study describes how rates of key safety outcomes for hospitalized children vary by race, ethnicity, and payer in a way that disadvantages minoritized populations. Our highest calling as pediatricians is to keep all children safe, particularly in our care. The idea that we implicitly or explicitly permit, or even are party to, activities that put specific populations of children at greater risk of harm challenges our professional values and puts us at a crossroads. Will we tolerate inferior outcomes for certain children, or will we fulfill our identity as child health champions for all?
Historic parallels to patient safety improvement work provide lessons. A few decades ago, almost no one believed patient safety was a problem, much less did they collect, examine, or share safety data. Then early landmark studies and commentaries2,3 began to expose unacceptable rates of safety events. In pediatrics and elsewhere, critics circled around methodologic imperfections, debated nuances of operational definitions, and looked askance at hospitals other than their own, imagining that high rates of safety events must be the problem of other children’s hospitals. At some point, organizations such as the Children’s Hospitals’ Solutions for Patient Safety, Vermont Oxford Network, and the Children’s Hospital Association conceded that safety outcomes were unacceptable and shared, discussed, and actively sought to improve rates of hospital-acquired harm.4,–6 Only then was there improvement. Acknowledging the problem in spite of imperfect data was a critical first step in progress such that now the focus of resources has moved past questions about whether a system might be unsafe to exploring innovations to continuously improve.
Undoubtedly, we need to reckon with the etiology of safety outcome disparities and address imperfect methodology, but these critical tasks cannot distract us from the acknowledgment that we provide disparate care. Nor are they problems we are obligated to fully address before we get to the work of improvement. The report by Parikh et al reinforces other research7,8 that shows us that children of certain races and ethnicities are not receiving safe and effective health care to the same degree as their peers. Despite proudly identifying ourselves as child health advocates, we are letting them down. As we did several years ago when confronted with the realities of unsafe care, we must shift our attention from the question of whether disparities exist to how to eliminate them. Research must focus on the investigation and transparent demonstration of where critical care processes are different for various categories of children and how we can provide all children, regardless of their race or ethnicity, language, socioeconomic status, ability, or insurance provider, with the care they need. Advocacy of children is what drove so many of us into the field of pediatrics. Our passion is genuine. We must mobilize around this issue, and we will. For if we don’t, we will fail not just our patients but ourselves.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2023-063714.
CONFLICT OF INTEREST DISCLOSURES: The author indicated she has no conflicts of interest to disclose.