Reflections on Racism and Early Childhood

by Dr. Elizabeth Isakson, Executive Director, Docs for Tots

Edward Deming once said: “Every system is perfectly designed to get the result it gets.” At Docs for Tots we know that far too often, families and young children struggle to reach their full potential and pursue their happiness – not because of issues inherent in the families and the children, but due to failures in the everyday systems that they interact with. Docs for Tots was founded, in part, to disrupt and correct early childhood systems, which like many of our systems are inherently racist. We have been doing this work for over 15 years and know that it is needed now more than ever. The racism within systems – be they health, education, or criminal justice – beget the substandard and disparate outcomes that have been tolerated for too long. The systems are designed to get the results they get.

In the wake of George Floyd’s death and the ever-growing list of Black Americans that have died unnecessarily by police and vigilante violence, and the general public’s awakening to the significant morbidity and mortality disparities for Black Americans, most recently as the result of the COVID-19 pandemic, the nation has been forced to address the racism evident in many aspects of our society. It is more than “one bad apple,” or even one bad apple branch. That is the thing with systems: they are the sum of all their parts.

Systemic racism is evident in the most recent news of violence and death but can also be experienced in more subtle ways. Families with young children, like those served by Docs for Tots, often face racism as described by Toni Morrison:

“The very serious function of racism … is distraction. It keeps you from doing your work. It keeps you explaining, over and over again, your reason for being.”

This endless distraction is what young children and their families of color on Long Island face. Long Island is one of the most segregated and economically disparate regions in the country, and must now address a long history of racist policies in services and practices that have led to a disproportionate number of Black families and other families of color having lower average incomes and needing to overcome barriers that are invisible to many of us.

Docs for Tots, as a systems-changing quality improvement organization, is its own “system” too. We aim to ensure that all our team members feel respected and safe, and that racism does not create unseen barriers for our colleagues of color to thrive and achieve their goals. We hire and retain diverse colleagues that match the specific needs of the families we serve. Our leadership strives to create a diverse mix of voices that leads to better decisions for everyone. But these efforts are not enough. It is on all of us to stop the racism in the systems in which we work so that all families and individuals can benefit from the health, education, and freedom that is our equal birthright. This is hard work that happens every day, not just in the wake of tragedy.

At Docs for Tots, we are doing our part by:

  • Continuing to meet the needs of families via Help Me Grow – Long Island: documenting barriers that families face, analyzing data by race and ethnicity to highlight disparities and advocate for systems-level change to county and state policy decision makers
  • Working with New York State to train and evaluate early childhood mental health consultants to work in child care settings, with the ultimate goal of reducing preschool expulsions – an outcome that disproportionately affects children of color
  • Providing technical assistance to physicians to ensure that all families receive the help they need– be it developmental interventions, parental support, or basic needs across Long Island and all its diverse communities– because the trajectory of health disparities is set in early childhood

In this critical moment, we can leverage Docs for Tots’ work, data, and knowledge to capitalize on the current focus on inequity across the board. We bring attention to the earliest years and the long-term impact and benefits of working to change the systems that affect young children and their families.

I hope to someday write a follow-up letter with the same quote, “Every system is perfectly designed to get the result it gets,” to illustrate pride in how we improved the results, and thereby the lives of families, by changing the system.

Elizabeth Isakson, MD, FAAP






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