From as far back as kindergarten, Andrea Singh told people she wanted to be a pediatrician. Following a lifelong passion of helping people learn, the combination of science, advocacy and teaching that pediatrics offers proved to be a perfect fit for Andrea. All of this is reason enough to understand why Dr. Singh, now the department chair of pediatrics at Park Nicollet and the co-lead of the HealthPartners Children’s Health Initiative, is such a passionate champion for the health of children. But this drive to tackle disparities in pediatric care also comes from a personal place.
As a child of immigrants from the South American country of Guyana, Andrea faced a lot of internal challenges integrating the cultures of both her West Indian family and Minnesotan home. It’s a struggle that she recognizes in the increasingly diverse patients she sees today. Fortunately, it’s also an opportunity for Dr. Singh to help others understand child development at the intersections of different cultures and background experiences and how it contributes to the unique and positive identities that carry into adulthood.
It’s this drive that informs Dr. Singh’s work, creating safe environments to educate patients and families about good health while also acknowledging the cultural barriers that can exist. In today’s Off the Charts, Dr. Singh talks with Dr. Haley and Dr. Jackson about why vaccination disparities exist and how rethinking our approaches to vaccination and building healthier relationships between doctors, patients and families can create the trust necessary to narrow those gaps. Listen to the episode or read the transcript.
The “why” behind the current gaps in childhood vaccinations
When it comes to having a completed vaccination schedule at age 2, there’s currently a 20% gap between Caucasian children and kids that identify as patients of color. And these disparities aren’t just nationwide: Even when we think we’re being equitable, they can be found in our own states, neighborhoods and health systems. As Dr. Singh relates in the episode, it’s only when these gaps are acknowledged as real that we take the first step in truly closing them in our communities.
But why do these disparities exist now? The first reason is systemic within health care. If doctors aren’t objectively addressing the concerns of all patients and parents equally and aren’t effectively recommending vaccinations with compassion, major gaps form between different groups. Unconscious bias through language barriers, ill-translated explanations and cultural misunderstanding can also make vaccination disparities worse.
The second reason is that different communities can have different hesitations when it comes to vaccination. Whether it’s due to past community history with vaccinations, concerns about religious restrictions or general mistrust of health care, understanding these reasons is important in looking for a path forward.
Rethinking how to approach childhood vaccinations
To help reduce disparities in childhood vaccinations, pediatricians need to consider how they’re talking about the subject with parents and patients. Standardizing approaches to discussing childhood vaccinations and making recommendations universally acceptable and understandable is a good start, helping to address both unconscious bias and community hesitation.
But while there are ways to make progress on a broader level, closing vaccination gaps can also be tackled through everyday exam room conversations. By being open, honest and upfront about vaccination while listening and responding with compassion to patient concerns and hesitations, doctors can create a respectful environment where everyone feels heard.
It’s also crucial to make the “why” of vaccination personal. To motivate her patients, Dr. Singh talks about the research, facts and reasons why both she and her children got their vaccinations. By discussing the decision in a safe place, Dr. Singh’s patients can feel comfortable making their own informed choices without feeling animosity or judgement if they still say “no.”
As Dr. Singh says during the podcast, “I tell people all the time [that] 99.9% of the parents that I have come across in my almost 20-year career are parents that love their children. And when parents make decisions for their kids, they’re doing it out of love. They think that they are making the best choice.” When it comes to vaccine hesitation, Dr. Singh says that doctors like her “really have to stop and listen and not judge, and not say ‘OK, well, you don’t care about your kid, therefore you’re not doing what I recommend.’” Instead, by relating her “why,” she can show her recognition that while the situation of each patient and family is different, “the common circumstance we have is that we love our kids, and we would do anything for our kids.”
Building relationships, building trust
And it’s that recognition and empathy that helps build trust between Dr. Singh and her patients – the kind of trust that comes from relationships created over time. It’s also a trust that has different elements, from creating a medical space that is comfortable, inviting and secure to speaking honestly and directly about subjects like vaccination. It’s this consistent approach and maintained environment that builds the confidence of parents in their doctor’s sincere motivation – the health of their child.
It’s also in these relationships where gaps in care can be closed, but not through force. As Dr. Singh says in the episode, she has good relationships with families that aren’t ready for vaccinations. In those cases, she knows that it’s important to continue having the conversation, but it’s also important for those parents to know that she’s not going to push them into something they don’t feel comfortable doing. Otherwise, that can break the trust that’s been built, making it more difficult if their child faces an urgent health emergency.
However, if vaccinations aren’t discussed, the answer will always be “no.” It’s worth it to continue educating her patients and talk about her own personal “why.” Eventually, the respect and understanding shown on both sides of the chart can pay off, resulting in healthier and more resilient children, regardless of their ethnicity.
To hear more from Dr. Singh, including what she likes to say to a kid sitting in her exam room chair, what her favorite new question for patients and parents is, and why being asked to “spill the tea” is an ideal scenario, listen to this episode of Off the Charts.