National Events Intensify ABP's Commitment to Diversity, Inclusion

In the spring of 2020, before George Floyd died under the knee of a Minneapolis police officer, the U.S. public had already heard that Black people were disproportionately affected by the novel coronavirus.1 Pediatricians who have seen health inequities in their patient populations for years — due to the social determinants of health (SDOH) or systemic racism — were not surprised.

Dr. Elizabeth Cuervo Tilson“Health disparities are driven by social disparities,” says board-certified pediatrician Elizabeth “Betsey” Cuervo Tilson, MD, MPH. Dr. Tilson is the State Health Director and Chief Medical Officer for North Carolina’s Department of Health and Human Services. “Social distancing is a privilege. Many people on the front lines, working in grocery stores or meatpacking plants, can’t work from home.”

Other factors that can contribute to the increased burden of COVID-19 and other health issues on minority populations include dense living arrangements, multigenerational households, access to transportation and nutritious foods, environmental pollution, underlying health conditions, health care access and utilization, and income, wealth, and education disparities.2

National Events Intensify ABP’s Commitment to Diversity, InclusionWhen the video of George Floyd’s death surfaced, widespread protests ensued. The unnecessary loss of human life, when combined with the trauma and known inequities of COVID-19, brought even more attention to the chronic and systemic racism that can cause social and health inequities.

These events and the relationship between racism and health inequities spurred the ABP to strengthen its previous commitment to diversity and inclusion (see the ABP strategic plan).

Dr. David Nichols“The ABP’s mission of advancing child health will succeed only if we work to improve health outcomes for all children,” says David Nichols, MD, MBA, ABP President and CEO.

Woven into the ABP’s Mission, Principles, and Strategies Prior to the events of 2020, the ABP was already on a path to promote diversity, equity, and inclusion (DEI) by:

  • Seeking and respecting diverse backgrounds, experiences, and perspectives in our volunteers that serve on our boards, subboards, and committees;
  • Promoting under-represented minorities in academic pediatrics;
  • Adding race/ethnicity questions to surveys for future analyses of the pediatric workforce and potential exam bias; and
  • Convening stakeholders and promoting the launch of a learning health network focused on sickle cell disease (see story at

But simply promoting diversity and inclusion was not enough. The ABP Board of Directors decided it was time to actively fight racism in children’s lives and eliminate racial disparities in health care:

Statement Released by the ABP Board of Directors in June

Racism is life-threatening and life-ending. As pediatricians, we see its pernicious effects on newborns and children of color and their families. In this moment of national mourning and anger over the lethal effects of racism, the American Board of Pediatrics pledges to do its part to fight racism in children’s lives. In particular, we commit to working with others to eliminate racial disparities in health care. Surely, better days are ahead when all children can grow up with the same expectation of safety, health, and opportunity, regardless of skin color.

Some of the ways we are now putting these ideals into action include:

  • Examining our certification policies and procedures to identify unintended biases and make changes if appropriate;
  • Embedding the topics of DEI in exam questions and in Maintenance of Certification activities;
  • Convening meetings to explore topics such as integrating health equity into quality improvement, improving DEI at teaching hospitals, and implementing screening processes for SDOH;
  • Making plans to include DEI requirements in entrustable professional activities (EPAs);
  • Strengthening our bias prevention training materials for volunteer pediatricians who write, review, and approve test questions and assessing individual test items (questions) for bias; and
  • Focusing on our internal procedures and relationships by surveying staff, engaging a DEI and racism consultant, observing Juneteenth to commemorate the end of slavery in the United States, sharing personal experiences with racism, collecting educational resources for staff, and conducting an independent analysis of bias in salary structure.

“While we work to help the pediatric community overcome health inequities, we have an obligation to lead by example,” says Dr. Nichols.

COVID-19 Cases, Hospitalizations, and Deaths by Race/Ethnicity

Rate Ratios Compared to White, Non-Hispanic People American Indian or Alaska Native,Non-Hispanic People Asian, Non-Hispanic People Black or African American, Non-Hispanic People Hispanic or Latino People
Cases 1.8x higher 0.6x higher 1.4x higher 1.7x higher
Hospitalization 4.0x higher 1.2x higher 3.7x higher 4.1x higher
Death 2.6x higher 1.1x higher 2.8x higher 2.8x higher


Table: COVID-19 data illustrate higher incidence rates for Indigenous, Asian, Black or African American, and Hispanic or Latino people when compared to white people. Source: CDC.3

1Gold JA, Wong KK, Szablewski CM, et al. Characteristics and clinical outcomes of adult patients hospitalized with COVID-19 - Georgia, March 2020. MMWR Morb Mortal Wkly Rep. 2020 May 8;69(18):545-550. doi: 10.15585/mmwr.mm6918e1.

2Centers for Disease Control and Prevention. COVID-19 racial and ethnic health disparities. Updated Dec. 10, 2020. Accessed Dec. 31, 2020.

3Centers for Disease Control and Prevention. COVID-19 hospitalization and death by race/ethnicity. Updated Nov. 30, 2020. Accessed Dec. 31, 2020.