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Black Lives Matter movement: The time for nice words and good intentions is over

2020; Wiley; Volume: 56; Issue: 9 Linguagem: Inglês

10.1111/jpc.15100

1440-1754

David Isaacs, William O. Tarnow‐Mordi, Juanita Sherwood,

Migration, Health and Trauma

George Floyd was brutally killed by Minneapolis police officer Derek Chauvin on May 25th 2020. Chauvin stared emotionlessly as he knelt on Floyd's neck for 8 minutes 46 seconds, while Floyd who was handcuffed gasped 'Please', 'I can't breathe'. Onlookers pleaded with Chauvin to stop, but did not dare stop him. Chauvin's brutality was presumably linked to his underlying personal, institutional and systemic racism. His violence was likely enabled by his world view of George as less than human. His act encapsulates racism as defined by many national bodies including the Australian Medical Association.1 What can those of us who care for children learn from this event and how can we contribute to meaningful change? The Black Lives Matter movement which advocates non-violent civil disobedience for police brutality against Afro-American people began in 2012 after George Zimmerman, a member of the community watch, was acquitted of the unprovoked shooting death of innocent 17-year-old Trayvon Martin. George Floyd's killing sparked global protests by people of all colours in over 60 countries on every continent except Antarctica. The protests took place during the COVID-19 pandemic, despite mass gatherings being banned or discouraged in almost all countries, a powerful indication that for huge numbers of people the immediate need to show solidarity outweighed considerations of personal or public risk from coronavirus infection. Importantly, protests proceeded despite the fact that Black, Asian, Indigenous and minority ethnic people are at increased risk from COVID-19. The George Floyd protests outside the US often raised issues of police brutality against indigenous people or migrants and of systemic racism. On 6 June, tens of thousands of Australians marched in major cities in support of the George Floyd protests and to highlight systemic racism in Australia against Aboriginal and Torres Strait Islander people, including failure to prevent Aboriginal deaths in custody (Fig. 1). In 1983, 16-year-old Aboriginal boy John Pat died in police custody following a drunken brawl initiated by four off-duty WA police officers. The policemen were acquitted of manslaughter. A Royal Commission into the many Aboriginal deaths in custody made 339 recommendations in its 1991 report.2 By 2018, only 64% of the recommendations of the Royal Commission had been fully implemented, and the rate of imprisonment of Australian First Nations people was almost twice that in 1991. Between 1991 and June 2020, at least 437 Indigenous people died while in police custody, many from violence or neglect. These included David Dungay, a 26-year-old man with schizophrenia and diabetes, who was attacked by police for eating biscuits and said 'I can't breathe' 12 times before he died from asphyxiation.4 No Australian policeman was convicted for David Dungay's death; indeed no Australian policeman has ever been convicted for the death of an Aboriginal person in custody, despite investigation of the suspicious circumstances of several of the deaths. One of the great ironies of the Black Lives Matter movement is that many countries criticise racism and police brutality in the USA while failing to acknowledge long-standing and systemic racism in their own country (Fig. 2). White Australians are ignorant of Australia's black history. On 11 June 2020, Australian Prime Minister Scott Morrison said there was 'no slavery in Australia'. The United Nations4 defines slavery as 'the status or condition of a person over whom any or all of the right of ownership are exercised'. The Australian Government acknowledged that Aboriginal people were enslaved in terms of forcing them to work without payment,5 and subjecting them to systematic physical and sexual abuse.6 Stolen wages and enslavement are key reasons for Australia's First Peoples' further impoverishment.5, 7 White people think Black people owe them a favour for ending slavery, not an abject apology for ever starting it. The White Australia policy and the Stolen Generation of Aboriginal children sundered from their parents gave Australia an unenviable reputation as a country whose racism was second only to South Africa. Australian politicians praise Australia's new multiculturalism while doing little to address institutional racism against its Indigenous Aboriginal and Torres Strait Islander population. In Canada too, people were quick to condemn US racism, but slow to acknowledge mistreatment of Canadian First Nations people. Acknowledging institutional racism is the first step to addressing it. Indigenous social disadvantage is associated with increased crime, compounded by aggressive and disproportionate punishment, creating a cycle of disadvantage. Closing the gap is easy to say but difficult to achieve. Education is one way out of poverty, but it is hard to convince Indigenous children to accept state education when for so many years the state refused to teach in their own language and forbade them from speaking it at school.7 It is hard to convince Indigenous children to stay at school when they are unlikely to be employed even if they graduate. Any solution to the cycle of disadvantage can only be achieved through real collaboration with Indigenous people, particularly through their elders, by listening to how they want to do business and implementing the recommendations. Equally important is to acknowledge unconscious bias which leads us unwittingly to condone and be complicit in the perpetuation of institutional racism. In her book White Fragility,8 US academic Robin DiAngelo points out that the definition of a racist has been reduced to 'an individual who consciously dislikes people based on race and who intentionally seeks to be mean to them'. By limiting ourselves simply to that narrow definition of racism, she says, most of us find it impossible to look deeply at the inevitability of internalising racist biases and of having investments in the system of racism which is comfortable for us and serves us really well.9 The first author (DI) felt a sense of temerity as a privileged White male in even attempting to address the complex issue of the pervasive, unconscious racism embedded within the medical profession. He invited WOTM, an equally privileged male of Anglo-Nigerian heritage, to provide a broader perspective as a co-author. On reflection, both acknowledged that failing to invite an Aboriginal or Torres Strait Island person to contribute to the first draft of this editorial was itself a manifestation of unconscious racism. Subsequently JS, a First Nations woman of Wiradjuri, Murri, Maori and Anglo-Celtic heritage, suggested revisions and agreed to be a co-author. The Australian Indigenous Doctors' Association now has over 400 members (non-Indigenous doctors can become Associate Members: https://www.aida.org.au/). They need help to change attitudes. Ngaree Blow and Alyce Wilson wrote: 'The time for nice words and good intentions is over. We are at a critical turning point and we now more than ever need "activist doctors" – doctors who can not only provide evidence-based, high quality care at the bedside, but who strive for health justice, advocate for more equitable health policies and are willing to challenge harmful systemic issues like institutional racism'.10 More broadly, racism is experienced by health-care workers throughout Australia, many of Asian origin. Non-White physicians must deal with patient prejudices regularly, particularly during the COVID-19 pandemic, often attributed to the 'Chinese virus'.11 It is critically important for all paediatricians, indeed all health-care workers, to call out racism whenever they encounter it, whether in institutions, in colleagues or within themselves. We live in apocalyptic times.12 The concurrence of the increasing advocacy for the Black Lives Matter movement with the coronavirus pandemic gives it added poignancy. Now is the time to listen to First Nations people across the world. Let us get educated. Let us get active. Join Australian Indigenous Doctors' Association. Let us do everything we can to destroy racism. We thank Ngaree Blow, Ngiare Brown, Tony Delamothe, Chris Elliot, Hasantha Gunasekera, Mark Isaacs, Stephen Isaacs, Tom Isaacs, Lynn Sinclair, Mike South, Paul Torzillo and Alyce Wilson for helpful advice on earlier drafts of this paper.