The Past, Present, and Futurist Role of the Pharmacy Profession to Achieve Black Health Equity.

Efforts to mitigate racial health inequities by the pharmacy profession are largely hollow. In recent years, the highly publicized murders of Black persons at the hands of police have become a worldwide rallying cry for institutions to make definitive statements that "Black Lives Matter." The movement has, however, yet to manifest substantive institutional changes for entities to reassess the ways in which they, their methodologies, and their teachings have historically and contemporarily contributed to the dissolution of Black lives. The profession of pharmacy explicitly states it is committed to achieving optimal patient outcomes. However, teaching race as a socio-political construct is not an Accreditation Council for Pharmacy Education (ACPE) minimal standard requirement. This continued neglect is a disservice to the field and the communities served, and this informative article explores the role of pharmacy in perpetuating physical and psychological harm to patients within Black communities. Conflating race with ancestry and approaching race as a simple biological construction/predictor is misinformed, presumptuous, and simplistic, as well as physically and psychologically harmful to patients. Rather than default to racialized historical myths imbedded in contemporary society, pharmacy must answer the call and undertake definitive action to ensure comprehensive education to better care for Black communities. It is vital that schools and colleges of pharmacy actively seeks to correct curricular neglect based on negative, pseudo-scientific constructions of "race." The field of pharmacy must understand its unique positionality within systems of power to adapt a wholistic and accurate view of race and racism to approach, achieve, and maintain health equity in the United States.

Structural Racism and Supporting Black Lives - A Pharmacist's Vow amid COVID-19.

COVID-19 is disproportionately impacting Black communities in the United States due to racial structures that increase exposure (e.g., densely populated areas, substandard housing, overrepresentation in essential work) and promote underlying diseases that exacerbate COVID-19. This manuscript uses Oath of a Pharmacist as a framework to propose a set of best practices for pharmacists to mitigate inequities such as achieve competence in the ideology of structural racism; identify systems of power that jeopardize Black health; value Black voices; name the socio-structural determinants of health; define race as a socio-political construction; name historical and contemporary racism; apply resources equitably based on need; collect robust data to solve complex problems; diminish bias and view patients holistically in the contexts of inequities; and advocate for Black lives. While race is biological fiction, Black individuals are at an increased risk for COVID-19 cases, hospitalizations, and deaths than their white counterparts due to navigating generations of racist practices that often converge with other inequities-such as sexism, classism. To describe these racial health disparities, structured, racial disadvantage is commonly ignored while personal choices and clinical care are highlighted as the culprits. Achieving health equity requires comprehension, acceptance, and assessment of structural racism, and pharmacists are highly trusted, uniquely positioned healthcare professionals who, through their knowledge, skills, and resources, can help attenuate the effects of structural racism to support Black lives.

Correction: Structural Racism and Supporting Black Lives - A Pharmacist's Vow amid COVID-19.

[This corrects the article DOI: 10.24926/iip.v12i2.3411.].

"Not to exclude you, but ": Characterization of pharmacy student microaggressions and recommendations for academic pharmacy.

INTRODUCTION: Microaggressions are commonplace indignities that communicate slights to marginalized persons. Microaggressions have been shown to negatively impact student well-being and academic performance. We describe the experiences of students in relation to the occurrence of microaggressions within the learning environment of a college of pharmacy (COP). METHODS: Students in a COP were interviewed regarding their experiences of microaggressions. Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using a conventional content analysis method. RESULTS: Thirteen pharmacy students participated in the study. Six (46%) identified as women. Six (46%) identified as Black, Asian, or multi-racial. Experiences were first-hand, witnessed, or stories they heard. Three themes arose from the data: (1) feeling othered; (2) power, pain, pollution, and pervasiveness of microaggressions; and (3) responsibility of academic community to mitigate microaggressions. Microaggressions were described based on race, religion, gender, sexuality, age, English proficiency, and others. Students expressed confusion with responding to microaggressions, microaggressions disguised as jokes, divisiveness related to the 2016 presidential election, unawareness of biases, dismissal of their concerns, hopelessness for change, and centering dominant groups in the curriculum. Recommendations from participants to address microaggressions included longitudinal cultural competency in the curriculum, cultural competency training for faculty, guidance on conflict management, and open discussions related to diversity and inclusion. CONCLUSIONS: Students are unsure how to identify, address, and mitigate microaggressions. Actions are needed to reduce these incidents, facilitate healing of individuals who have experienced past microaggressions, and promote a diverse and inclusive learning environment.

Racial disproportionality of students in United States colleges of pharmacy.

OBJECTIVE: To describe the disproportionality of racial and ethnic people of color (i.e., minorities) among the student body in schools and colleges of pharmacy (COPs) compared to county-specific United States Census Bureau data. METHODS: Data were obtained from national databases and published reports from the American Association of Colleges of Pharmacy. In addition, demographic information for enrollees of minority-serving institutions and predominantly white institutions was obtained and racial disproportionality was assessed to determine the degree of concordance between enrollees and the demographics of people within the county that the school was located. Data were evaluated using descriptive statistics. RESULTS: Compared to the general population in counties where COPs are located, Asians are over-represented while all other students of color are underrepresented. The top schools that have a negative disproportionality rate for Black students included Thomas Jefferson University (-40.49), Wayne State University (-40.13), Philadelphia College of Pharmacy (-39.90), and the University of Tennessee (-39.74).The top five schools that have a negative disproportionality rate of Hispanic students included Loma Linda University (-45.67), California Health Sciences (-45.64), the University of Southern California (-43.79), the University of the Pacific California (-37.95), and Texas Southern University (-36.65). The enrollments within most COPs do not reflect the racial and ethnic diversity of the counties in which they are located. CONCLUSIONS: To meet the healthcare needs of an increasingly diverse population, each institution should establish a strategic plan for increasing diversity and evaluating and adopting best practices.

Pushing for health equity through structural competency and implicit bias education: A qualitative evaluation of a racial/ethnic health disparities elective course for pharmacy learners.

BACKGROUND AND PURPOSE: Health equity attainment requires dismantling implicit bias and structural racism. Mitigating bias in clinical interventions and implementing structural interventions to impact where people live, work, play, and eat fosters optimal patient outcomes. Consequently, pharmacy students need exposure to these concepts. The objective of this project was to evaluate an elective course focused on exposing students to the root causes of health disparities, contemporary factors that perpetuate disparities, and evidence-based policies to reduce health disparities. EDUCATIONAL ACTIVITY AND SETTING: This three-credit course emphasized critical thinking, robust discussions, and learning challenging constructs through self-discovery. Nine second-year and third-year learners were assessed by short-answer exams, learning management system discussion threads, weekly reflections, participation, and a class project. A qualitative descriptive design was used for this study. Weekly reflections were subjected to thematic analysis using a constant comparative analysis method to generate themes. FINDINGS: Five themes were derived from the data underlying strategies to facilitate this course: (1) create and maintain a welcoming and inclusive learning environment; (2) utilize experiential learning for personal awareness development and knowledge expansion; (3) incorporate intergroup diversity to empower learners to create change; (4) anticipate and acknowledge emotions to facilitate learning; and (5) provide students with an opportunity to complete a final self-reflection paper. SUMMARY: This course provided pharmacy learners with unique, differential skill sets and knowledge, potentially adding depth to their careers and impacting the way they will practice pharmacy.

Qualitative Analysis of Student Pharmacists' Reflections of Harvard's Race Implicit Association Test.

BACKGROUND AND PURPOSE: Identify and analyze pharmacy students' perceptions about their own implicit racial biases. EDUCATIONAL ACTIVITY AND SETTING: First year pharmacy students (n = 97) enrolled in a Pharmacy Practice course completed a test, Harvard Race Implicit Association Test (IAT), for homework to uncover their unconscious black-white racial bias. All students then wrote at least one paragraph reflecting on if they agreed or disagreed with their results and why. At the beginning of class, students were given a brief survey to capture their IAT results and demographic information. Retrospectively and following Institutional Review Board approval, pharmacy students' reflections were subjected to thematic analysis with the assistance of NVivo 10 and descriptive analyses were completed of their demographic info. FINDINGS: Out of the 97 students enrolled in this course, all completed the self-reflection. But only 90 completed the survey. From those that completed the survey, 54% (N = 49) self-identified as women. The average age was 22.6 years old. Most of the students (77%) identified themselves as White Non-Hispanic. Six percent (N = 5) identified as Black. Most students (66%) reported that their results from the Race IAT indicated some level of preference for European Americans; 13% of the students reported some level of preference for African-Americans. All students' reflections were categorized by their agreement or lack of agreement with their implicit association test results. Those that agreed with their results cited family, friends, and community contributing to their implicit biases. Students who did not agree with their results were subcategorized as denying their results, believing that their implicit association did not affect their behavior, or believing that the Race IAT was invalid. DISCUSSION/SUMMARY: Many pharmacy students were found to be unaware of their implicit biases and some do not believe that these biases will negatively affect the treatment of others. Pharmacy curricula should be developed to provide adequate self-awareness training and space in the curriculum so students can challenge these unconscious beliefs.

Navigating and Supporting Marginalized Identities in Dominant Pharmacy Spaces.

Addressing issues of diversity becomes more difficult when challenges impeding diversity efforts remain hidden. Issues like microaggressions, implicit bias, and lack of support are often present, but little is done by those in positions of power to mitigate or eliminate them. The purpose of this self-reflection is to address each of these areas and suggest six steps that may be taken to alleviate them: 1) anticipate microaggressions; 2) explore identities; 3) overcome internalized oppression and implicit bias; 4) recognize and mitigate stereotype threat; 5) differentiate yourself and provide space for others to differentiate themselves; 6) develop and reinforce support systems. The initial phase of the manuscript focuses on implicit bias manifestations, specifically microaggressions, and how to prevent them from disrupting inclusivity. Following that will be a review of implicit bias, as well as the importance of self-awareness in promoting inclusivity in the workplace. Finally, the discussion will center what can be done do to create the best environment for ourselves and others as we move together towards creating environments that do more than speak to diversity efforts and are actually welcoming to each person within that space. This manuscript is written for a few reasons. First, it provides insight on how to incorporate and integrate our multiple and sometimes divergent identities. Second, to discuss how our identities may influence how we react to diverse and non-diverse others. Third, this manuscript fills a gap in the field related to the experiences of those among us with multiple marginalized identities. This autoethnography seeks to empower not only myself but also others, especially those of us at the margins (e.g., people of color, women, the LGBT community) and those with dominant identities to speak up when they witness inequality.