Bridging the Gap: Implementing Race-Conscious Clinical Guidance in Pediatrics

Pediatric clinical guidelines and algorithms have frequently included race as a risk factor to be considered in clinical decision-making. This practice, commonly known as "race-based medicine" or "race correction," substitutes race as a flawed proxy for socioeconomic status and genetic ancestry. The American Academy of Pediatrics has called for the elimination of race-based medicine and endorsed "race-conscious medicine" as a preferable alternative. Race-conscious medicine embraces race-neutral clinical tools and supports efforts to tackle the structural barriers to health that cause racial disparities. We aimed to assess recent progress and identify ongoing barriers in the implementation of race-conscious medicine in pediatrics. First, we review the role of medical societies and the research community in generating race-conscious alternatives to race correction, while noting that many pediatric tools continue to include race in ways that may negatively impact equity. Second, we discuss the role of health care organizations in implementing race-conscious guidance locally, drawing upon specific local and regional efforts to reveal organizational, cultural, technical, and financial factors that may facilitate or impede success. Third, we identify medical education governing bodies as essential in integrating the principles of race-conscious medicine into every stage of medical education. Fourth, we highlight the need for third-party clinical algorithm platforms and biomedical device manufacturers to provide access to race-conscious tools through their products. Finally, we address the role of the policy and regulatory landscape in accelerating or slowing the rate of progress, and the importance of patient engagement and redress of historical harms.