Diversity, Equity & Inclusion

Summer DEI: A Time for Reflection

Volume 12- Summer 2023

I have only been with National Jewish Health since February 2023, and I am continually awed and inspired by the people that work here. The kindness of employees at NJH is only matched by their hunger for and dedication toward Diversity, Equity and Inclusion. Nowhere was this passion more evident than this past June when I had the honor of celebrating Juneteenth and Pride Month with those at National Jewish Heath. Thank you to everyone who participated with us, or in their own way. I can't wait to see how we will continue to grow these celebrations, and as always, DEI is a collaborative effort, so I welcome your feedback here for any upcoming (or past) celebrations.

Perhaps the highlight of Juneteenth was Opal's Freedom Walk on June 19th, during which a group of us donned our Juneteenth apparel, and walked three miles around City Park in solidary with the grandmother of Juneteenth, Opal. We hope those of you who couldn't make it this year will join us next year!

The Pride celebration days followed closely, and I loved meeting every new person who stopped by to pick up a Pride lanyard. Not only that, but the artistry exhibited by employees at National Jewish Health demonstrated how talented and multi-faceted we all are, and it was wonderful to glimpse those moments of inspiration that drive creativity and beauty. Pride week ended with a bang, in a special Grand Rounds with Liz Kvach, MD (from Denver Health), who presented on Gender Affirming Care Considerations for Transgender and Nonbinary Adults. A video recording (and her presentation slides) can be viewed here.

July: The Celebration of Freedom and Reflection

As June transitioned into July, we found ourselves focused on another critical event – Independence Day. July 4th serves as a vital reminder of the nation's birth and the founding principles of freedom, equality, and the pursuit of happiness. However, let's also remember the bittersweet resonance of this day. While we celebrate independence, let's also acknowledge the struggles faced by those who didn't share in the freedom the nation initially promised. The echoes of slavery, discrimination, and inequity are essential reminders of our imperfect past, shaping our resolve to create a more inclusive future.

In celebrating Independence Day, let's remind ourselves that liberty and justice for all isn't an end goal but an ongoing pursuit. This July, let's contemplate our shared past, cherish our present, and envision a future where all citizens can genuinely experience the liberty we commemorate.

August: Women's Equality Day – A Toast to Progress and Promise

As summer reaches its zenith in August, we commemorate an event that marked a turning point in history – Women's Equality Day. Celebrated on August 26th, this day marks the certification of the 19th Amendment, which granted women the right to vote in the United States.

Women's Equality Day pays homage to the brave women who shattered societal norms and fought for their right to political participation. Names like Susan B. Anthony, Patsy Mink, Ellen Ochoa, PhD, Elizabeth Cady Stanton, and Sojourner Truth spring to mind, warriors whose tireless efforts paved the way for generations of women to come.

Yet, it's vital to remember that the fight for women's equality didn't end in 1920. From gender wage gaps to representation in leadership positions, from societal expectations to the fight against harassment, gender equality remains a global challenge. So, as we commemorate Women's Equality Day, let's remember the battles won and the challenges yet to overcome. Let's encourage dialogue about gender equality in our homes, schools, and workplaces, understanding that the fight for equality is a shared responsibility. 

This summer, the message is clear. Each of these events, from Juneteenth and Pride Month to Independence Day to Women's Equality Day, paints a unique picture of diversity, equity and inclusion. They remind us of our shared history, the progress we've made and the path that lies ahead. As we revel in the joys of summer, let's not forget to honor the resilience, the fight and the relentless pursuit of equality these months embody.

This summer, let's commit to fostering an environment of acceptance and respect, a space where everyone can bask in the warmth of inclusivity. Here's to a season filled with reflection, celebration, and unwavering commitment to DEI. May the radiant sun of summer shine brightly on our collective efforts to cherish and promote diversity, equity, and inclusion.

~Tessa O'Connell M.Ed/Ed.S (Director of DEI and Leadership Development) Of course, springtime has many other days and occasions to celebrate, so please visit our complete DEI Celebrations Calendar to see a full list and information on springtime celebrations.  

 

Race, Ethnicity and Pulmonary Function Testing

Dear National Jewish Health Community,

Thank you for the opportunity to bring you an update from our PSCCM DEI Committee. I have the honor to work with my colleague Matt Griffith, and an incredible DEI committee representing the Division of Pulmonary Sciences and Critical Care Medicine at the University of Colorado (PSCCM Diversity, Equity, and Inclusion Committee link here). This committee is comprised of members from the pulmonary division across four sites (CU Anschutz, National Jewish Health, VA Medical Center, and Denver Health) and in this space I will share with you highlights from the past month. One of the most significant events that has happened in pulmonary medicine this year is the publication of the American Thoracic Society (ATS) position statement on use or race-based algorithms for evaluation in lung function (see the press release here.

Spirometry is the most used breathing test that we use in at National Jewish Health and in the field of pulmonary medicine. It measures how rapidly a person can inhale and exhale, and is abnormal in diseases that affect the airways like COPD, pulmonary fibrosis, cystic fibrosis and other diseases. When we measure lung function, we compare a patient’s values to a set of normal values, so that we can state how normal or abnormal their function is. Since the early days of the spirometer, it was used to demonstrate differences between enslaved people and enslavers, with the false conclusion that decreased lung function in enslaved people was due to race (rather than the actual consequences of living in an environment of torture and illness). Due to these assumptions rooted in slavery and white supremacy, race-based “corrections” for lung function have been built into the software of the actual machines that measure lung function. In our field, with these racial norms being part of the software of the machines, we have continued to use race-based normal values in our interpretations of lung function, with many people not even realizing that the interpretations were different based on race. This is a huge example of systemic racism in the field of pulmonary medicine. For more on the history of spirometry, I recommend the book by Lundy Braun PhD, Breathing Race into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics.

Over the years, and especially since the murder of George Floyd raised the collective consciousness about systemic racism and injustice, people have questioned many race-based “norms” in medicine. While lung function varies based on biologic variables such as age, sex, and height, use of a superficial assumption such as self-identified race has been challenged, especially since that assumption may cause harm. Using a race-specific adjustment that assumes lower lung function is “normal” means that people may have had the severity of lung diseases underappreciated, potentially leading to inadequate diagnosis and treatment. Over the past few years many papers in peer-reviewed journals have challenged these assumptions, and at the same time the ATS responded by organizing a workshop and putting out their statement recommending race neutral approach in interpretation of lung function. For a summary you can read the ATS press release here. We, the division of pulmonary sciences and critical care in medicine at the University of Colorado, welcome this statement as an overdue change, and hope that it will help us move toward justice in medicine.

On June 22, we hosted a panel of discussants from the ATS statement, with co-chair and lead author Nirav Bhakta MD/PhD historian and co-author, Lundy Braun PhD, and Noemi Hall PhD from NIOSH. It was a really great discussion about the process that went into creating this significant statement and next steps as we move forward. I invite you to watch the Journal Club on Race Race and Ethnicity in PFT Interpretation here. Also, please find a link to the study here.

Additionally, our PSCCM DEI Committee put out several statements for Juneteenth, Pride Month, and a response to the recent Supreme Court decisions that affect our ability to create a diverse and inclusive workspace. To read those, please click here.

The PFT statement and our work continue to teach us that our work in DEI is far from done, and it is a pleasure to work with a group dedicated to diversity, equity, inclusion and justice in the PSCCM Division and at National Jewish Health.

 Sincerely, Patricia George MD 

 

Upcoming DEI Events

The Department of Diversity, Equity, and Inclusion welcomes  Naftali Kaminski, MD, FERS, ATSF  Concludes his three-part lecture series with  Gender Equity: The Role of Men  Friday, October 20th in Heitler Hall (also available on Zoom) Time: TBD

 

In Case You Missed it...

This lecture (and corresponding resource) has been uploaded and is available to watch here  As mentioned by Dr. George, watch the Journal Club on Race Race and Ethnicity in PFT Interpretation here.

 

Dealing with Patient Microaggressions  

Microaggressions are those everyday brief and subtle (usually unintentional) exchanges that act as insults or send denigrating messages to marginalized groups. The term was coined after the Civil Rights era by Professor Chester M. Pierce and revived in recent years by Psychologist Derald Wing Su. Microaggressions are usually a direct result of our implicit (or unconscious) biases. The best way to prevent microaggressions is to become aware of one's implicit biases, and then actively practice working against those biases in day-to-day interactions. Watch video.

The toll that overt racism and covert microaggressions take on minoritized groups is cumulative. Often, especially with microaggressions because they are so insidious, addressing them with the aggressor can feel like an “overreaction.” Even more challenging, marginalized groups who experience microaggressions and racism are placed in a tough position to speak out about a seemingly small incident that can be viewed as insignificant, that many people worry about being perceived as aggressive, angry, or as playing the race or gender card. Some might respond by saying, “Why are you being so sensitive? I didn’t mean anything by it,” and so often, these slights go unaddressed, but their impact has still been felt.

It is important to recognize that the impact of words and actions matters more than intent, however, for marginalized groups, it's the unpacking of that intent that's been the most difficult part of processing the internal effects of microaggressions. Microaggressions can be consumed in insidious ways in our everyday interactions, so much so that we often don't know its full effects. The problems with microaggressions are that they are hidden behind coded language. This coded language affixes itself into the crevices of culture and creates a safe way to discriminate. Examples of that coded language include words like intimidating, loud, spicy, angry, emotional, volatile, unprofessional, aggressive, and private, which then translates to loaded language and feedback. These types of coded language are examples of how feedback can be aligned with stereotype threats that are generally based on your race, gender, or other differences that illicit false narratives that show up in patient practice and interaction. Coded language does not make room for you as a full individual with lived experiences.

The impact of these microaggressions is that people who experience them often feel powerless and afraid to speak out, particularly in situations when the assault comes from a patient. However, it is important to remember that even though microaggressions might seem harmless, they reinforce discrimination and prejudice. These have a big impact on your physical health, mental health, and psychological well-being, so much so that psychologists and educators have shown that stereotype threats can cause an achievement gap for marginalized groups. When a negative stereotype is associated with a certain group that a person is naturally assigned membership of because of their skin color, gender, or race, it's been shown to have an impact not only on the person's performance, but also shows how a stereotype threat can create feelings of anxiety that have negative impacts on mental health. It's the persistence of exclusion, alienation, and discrimination over time that can affect life experience. Additionally, it can lead to provider burnout in a field that is sorely in need of greater diversification. 

Generally, there are three ways to deal with microaggression, but the theme for all encounters is to call the person "in" and not "out." Calling the offender "in" creates an atmosphere where the patient can learn, instead of becoming defensive. You can do this in one of three ways:

  • Ask them for more information- This technique disarms defensiveness and allows thinking about the impact of words. Some sentence starters for this are:
    • “Could you say more about what you mean by that”?
    • “How have you come to think that?”
  • Ask probing questions that allow them to separate intent from impact and offer an alternative. A sentence starter for this is:
    • “I know you didn’t realize this, but when you ___________________ (comment/behavior), it was hurtful/offensive because __________________ (reason). Instead, you could have_________________ (different language or behavior.)”
  • Finally, you can challenge the stereotype. Some sentence starters for this are:  
    • “Actually, in my experience ________________________."
    • “That sounds like a stereotype. Is that what you mean?”
    • “Another way to look at it is________________________.”


Recognizing that patient interactions can be a little more nuanced that traditional microaggression scenarios, here are some resources that show how other providers have dealt with racist patients and microaggressions in the past. 

  • Addressing Microaggressions and Macroaggressions in the Clinical Encounter (video)(Opens in a new window)
  • AMA Presents: Courageous Conversations: Addressing Microaggressions(Opens in a new window) (panel discussion)
  • Dealing with Racism as a Healthcare Professional (Article with many links)(Opens in a new window)
  • Addressing Patient Bias and Discrimination Against Clinicians of Diverse Backgrounds (journal)(Opens in a new window)
    • I really liked this one because it provides a framework for providers to use when experiencing racism from patients
  • Slaves by Dr. Renuka Gupta, MD(Opens in a new window) (journal and audio reading)
    • Dr. Gupta’s experience with patient racism
  • Video: Navigating Microagressions in Everyday Life with Professor Kevin Nadal


Finally, know you are not alone, and that you are not being sensitive or over-reacting. Microaggressions are known as "death by a thousand cuts" for a reason, and unless we can address them in the moment, they will most likely continue. Recognizing that sometimes we just need to be heard and affirmed, the department of DEI offers "Healing Circles" as way to try and unload some of the lasting impacts of microaggressions. This is a safe space to talk and listen to others who have similar experiences. If you are interested in scheduling a healing circle, fill out a form here.

~Tessa O'Connell M. Ed/Ed.S

 

DEI Articles, News and Resources

 AAMC Deeply Disappointed by SCOTUS Decision on Race-Conscious Admissions(Opens in a new window)

  • Read more about the AAMC's position on the Supreme Court of the United States (SCOTUS) in Students for Fair Admissions v University of North Carolina and Students for Fair Admissions v Harvard(Opens in a new window)
  • Also, check out AAMC's Center for Health Justice and they amazing resources here(Opens in a new window)
    • Sample articels include "Beyond Binary: Expanding LGBTQ+ Clinical Data"(Opens in a new window) and "Mather Earth: Climate and Maternal Health Justice"(Opens in a new window)

LGBTQ+ Health Updates(Opens in a new window)

  • This is a wonderful resource to learn more about gender affirming care, stay up to date on the most recent news and research surrounding LGBTQ+ persons, and learn more on inclusive care and practices. 

Creating a Trans Inclusive Workplace (pdf)

  • Learn how to create a more inclusive and welcoming environment for all employees, regardless of their identity. 

The Economics of Thiness (pdf)

  • Women may have broken the glass ceiling, but other forms of discrimination begin to arise as a way to continue the marginalization of women in the professional world.

21-Day Racial Equity Habit Building Challenge(Opens in a new window)

  • This 21-Day Challenge concept was conceived several years ago by diversity expert Eddie Moore, Jr.(Opens in a new window) to advance deeper understandings of the intersections of race, power, privilege, supremacy and oppression. The goal of the Challenge is to assist each of us to become more aware, compassionate, constructive, engaged people in the quest for racial equity. The Challenge invites participants to complete a syllabus of 21 short assignments (typically taking 15-30 minutes), over 21 consecutive days, that include readings, videos or podcasts. It has been intentionally crafted to focus on the Black American experience. The assignments seek to expose participants to perspectives on elements of Black history, identity and culture, and to the Black community’s experience of racism in America. 

What Are Pronouns? And Why Do They Matter?(Opens in a new window)

  • In English, whether we realize it or not, people frequently refer to us using pronouns when speaking about us. Often, when speaking of a singular human in the third person, these pronouns have a gender implied -- such as “he” to refer to a man/boy or “she” to refer to a woman/girl. These associations are not always accurate or helpful.

Trans Tips for Allies (PDF graphic)(Opens in a new window)

 

Submit a Diversity, Equity, and Inclusion Form

 DEI Issue, Suggestion, or Question

  • Submit feedback here(Opens in a new window)

Request for DEI training

  • 1-on-1 coaching, book clubs, DEI interventions, or group workshop
  • Submit a request here(Opens in a new window)

Statement of Diversity

In the DEI, we acknowledge that: 

  • No one has all the answers (especially us)
  • In difference, there is strength
  • DEI work is never done
  • DEI is ever-evolving and changing, and as a result, so is our relationship with it
  • We are all learners in DEI and must learn from one another

 

We constantly strive towards positive DEI change and never intend to harm or insult purposefully. Therefore, it is vital for us to know when we do accidentally engage in macro or microaggressions. So, please email DiversityandInclusion@NJHealth.org (or fill out our anonymous feedback form here!) to let us know if our unconscious biases get in the way of this good work, or even if you have any other ideas, suggestions, questions, or issues. 

Thank you!  Tessa O’Connell Director of DEI and Leadership Development