Danielle Laraque-Arena1-3, Jin Ye Yeo4
1New York Academy, New York, USA; 2Columbia Center for Injury Science and Prevention, Mailman School of Public Health (in Epidemiology) and Vagelos College of Physicians and Surgeons (in Pediatrics), Columbia University, New York, USA; 3SUNY Upstate Medical University, Syracuse, New York, USA; 4PM Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. PM Editorial Office, AME Publishing Company. Email: pm@amegroups.com
This interview can be cited as: Laraque-Arena D, Yeo JY. Meeting the Editorial Board Member of PM: Dr. Danielle Laraque-Arena. Pediatr Med. 2024. Available from: https://pm.amegroups.org/post/view/meeting-the-editorial-board-member-of-pm-dr-danielle-laraque-arena.
Expert introduction
Dr. Danielle Laraque-Arena (Figure 1) is a Senior Research Scientist and Professor at the New York Academy of Medicine, New York, USA, and the Columbia Center for Injury Science and Prevention, Mailman School of Public Health (in Epidemiology) and Vagelos College of Physicians and Surgeons (in Pediatrics), Columbia University in New York, USA. She is also the President and Professor Emerita at SUNY Upstate Medical University, Syracuse, New York, USA.
Dr. Laraque-Arena’s national and international work has focused on education and research addressing the needs of underserved populations. Her career is distinguished by research involving comprehensive, community, and youth-engaged approaches addressing the major causes of morbidity and mortality, especially those focused on injury science and violence prevention, child abuse, mental health, adolescent health risk, and protective behaviors. In addition to her research portfolio, she helped define systems changes that facilitate the integration of the identification, diagnosis, and treatment of children’s mental health problems in primary care settings and has founded 3 child protection teams. She is a noted researcher in injury science and prevention and serves as the Co-Director of the Columbia Center for Injury Science & Prevention Teaching and Education Core funded by the Center for Disease Control & Prevention.
She has authored over 120 peer-reviewed publications in addition to multiple review articles, chapters, and educational materials, and presented over 150 invited and peer-reviewed lectures. She edited the books Principles of Global Child Health: Education and Research (2019); the special series in Pediatric Clinics of North America, Ending the War against Children: The rights of children to live free of violence (2021); the special series in Pediatric Medicine (Shanghai, China), Integrating Mental Health in the Comprehensive Care of Children and Adolescents: Prevention, Screening, Diagnosis and Treatment (2021); and is the senior editor for the book Leadership at the intersection of gender and race in Healthcare and Science: Case Studies and Tools. (2023). Planned for 2026 is the publication of the Pediatric Clinics of North America series on Imperatives for Action and Impact of Humanitarian Crises Affecting Children.
Figure 1 Dr. Danielle Laraque-Arena
Interview
PM: Can you share what inspired you to focus on the needs of underserved populations and how this focus shaped your professional journey as a researcher, educator, and advocate for children’s health?
Dr. Laraque-Arena: My motivation to focus on underserved populations is triggered by my lived experience, my observations as I trained as a physician, and my assessment of the inequities in access to care as a practicing pediatric clinician-researcher in the United States. I was born in Haiti, a small island country in the Caribbean. Haiti is the most impoverished country in the Western Hemisphere and among the poorest in the world. Despite a remarkable history that led to Haiti’s liberation from French rule in 1804, a rule that was based on slavery, Haiti has been besieged both externally and internally. I credit my parents for sharing the rich history of writers, poets, artists, and people of conscience who have always struggled for justice in Haiti. As a physician in the United States (US), I understood early on that health and health care should be a human right. However, income inequality and systems of care did not provide the opportunity for all populations to achieve optimal health. My research, initially on calcium status and lead poisoning in Black preschoolers, identified children in impoverished circumstances who were exposed to environmental toxins. My research in injury science focuses on firearms -now the leading cause of death for US children and young adults aged 1-24 years. Firearm-related harms disproportionately affect Black youth and those underserved. For me, health equity translates to full access to the application of evidence-based interventions that promote and ameliorate health for all. I have published in peer-reviewed journals, written commentaries, book chapters, and books detailing what we can do collectively to improve the health of all populations. I have tried to integrate the rendering of clinical care into my understanding of the essence of my role as an educator, my research goals, and my role as an advocate for children and families. As an academician, this has meant writing in scientific journals to disseminate the results of my research and my clinical observations and conveying the policy agenda that could ameliorate the lives of children.
PM: Your research has tackled major health issues affecting youth, such as injury prevention, mental health, and violence. Could you elaborate on the specific challenges you have encountered while working on these issues, especially in underserved communities?
Dr. Laraque-Arena: The challenges are multiple. First, there are insufficient numbers of mental health specialists (e.g. child & adolescent psychiatrists, psychologists, social workers, psychiatric nurse-practitioners) to meet the mental needs of children, adolescents, and young adults in the United States. In addition, children and families may be reluctant to engage with the mental health system, but more readily develop longitudinal relationships with their pediatricians. However, a challenge is that there are not effectively trained child health clinicians in primary care settings who can recognize, screen, assess, and provide evidence-based treatment to children. I have been involved as a founder of the REACH (REsource for Advancing Children’s Health) Institute’s PPP (Primary Pediatric Psychopharmacology) three-day training with six months of case-based teleconferences. This evidence-based training of child health professionals aims to build the capacity for the primary care setting to meet the emotional and mental health needs of children and their families. However, a second challenge relates to the financing of care. Mental health services are inconsistently paid for through private or public means. Additionally, the United States is an ethnically very diverse country, and mental health care is often not culturally responsive to the needs of children and families of varying ethnic backgrounds. Language challenges are also present in a country of immigrants from all over the world. Access to linguistically competent clinicians (e.g. Mandarin, Cantonese, Spanish, Creole, etc) is necessary to render appropriate assessment and treatment – as well as to engage families in ongoing care. Reducing the stigma surrounding a diagnosis of mental health challenges remains a challenge, especially for underserved populations. Normalizing the recognition of mental health challenges and their integration into primary care offers the opportunity to eliminate such stigma and improve the acceptance of services by families.
PM: What do you see as the key factors driving violence among youths? How can communities, policymakers, and healthcare providers work together to reduce these risks?
Dr. Laraque-Arena: The drivers of violence and its lethality are multifactorial. Looking upstream to the social determinants of health (e.g. poverty, discrimination, gender bias, unequal access to employment and educational opportunities, unjust criminal justice systems) and the structures that perpetuate disadvantage and inequities require broad systems-wide interventions to change the ecology of a child’s life. In the United States, the outcomes of violence are aggravated by the widespread gun ownership that renders violent interactions lethal.
PM: In your work, how has the integration of public health, epidemiology, and pediatrics in your work helped advance the understanding and prevention of childhood injuries?
Dr. Laraque-Arena: Understanding epidemiology is critical to identifying the communities most affected by injuries. Technologies such as Geographic Information System (GIS) have helped to identify discriminatory housing practices (redlining) that have led to the intensification of poverty and injury risk. My work has sought to connect the dots in relating upstream structural inequities and discrimination to the downstream impact on health outcomes such as firearm-related harms in children and adolescents. My work and that of others have looked to legislative and system-wide interventions to reduce access to firearms and to address the social determinants of health. Evidence published by noted authors has shown that the presence of a gun in the home increases the incidence of homicide, suicide, and unintentional injuries. Most recently, we have demonstrated the relationship between maternal mortality and firearms, with the leading cause of maternal mortality being firearms. Black mothers are also 3 times as likely to die related to pregnancy as compared to White mothers. While race is a social construct, structural racism and structural inequities in general are being studied as the drivers of disparate health outcomes. Research helps to advance the knowledge of the risks of injury as well as the protective factors that can mitigate harm. Our Harlem Hospital Injury Prevention Program in the 1990s clearly demonstrated the power of the partnership between academicians and communities in identifying risks and creating solutions that provide safe places for children to live and play. For example, it is not surprising that children get hurt in the streets if there are no playgrounds and safe places for them to be. Addressing the social and physical environments in which children live echoes largely in how safe they are in their communities.
PM: In your recent book, Leadership at the Intersection of Gender and Race in Healthcare and Science, you address crucial issues around diversity in leadership. How do you think diversity in leadership can drive meaningful changes in healthcare and public health research?
Dr. Laraque-Arena: Human beings are complex. In order to bring excellence in the sciences and the rendering of effective medical care, diversity in the health professional workforce is essential. So, it can be asked, what does diversity do? Early on in my career, I learned that the most important part of research is the research question being posed. Through the lens of equity and cultural humility, I believe, as many researchers do, that the right questions must be asked and can only be answered by the full inclusion and participation of those who are being studied. In addition, many of us have derived the concepts of co-researchers with communities and members of diverse communities in posing the right questions. Community-based participatory research and youth-participatory research, I believe, can assist in asking the questions that are relevant to alleviating harm for identified populations. Use of the best qualitative and quantitative research methods can then be used to answer complex problems. I believe that an emic perspective is critical for respectful research that has the opportunity to first understand the root causes and contributors that detract from positive health outcomes, followed by effective methods to improve the health of diverse, culturally rich populations. Who is at the table of research and the policy agenda that is set are both essential. I believe that the framing of a health issue and its possible solutions can only be understood with the inclusion of gender-specific and culturally relevant analyses provided by the breadth of participants within communities.
PM: Looking ahead, what do you see as the most urgent research priorities in child health?
Dr. Laraque-Arena: This is a hard question and may be different depending on the socio-political context of each country. An acknowledgment of child rights is, however, a good beginning. I have advocated for full support of the 54 articles of the United Nations Convention on the Rights of the Child as a first step. Then, the analysis of what is in the Best Interest of the Child (globally defined as those 0-18yrs) must engage all nations in securing the rights of children to health, freedom from violence, economic security, freedom from oppression of any kind, the right to education, and the opportunity for all children to reach their fullest potential as human beings.
PM: Given your extensive work in injury science and prevention, what innovations in technology and research do you think hold the most promise for improving pediatric injury prevention?
Dr. Laraque-Arena: This is an important question, and the answers will derive from teams of scientists and public health professionals with acute knowledge of artificial intelligence, simulation technologies, geographic information systems, urban planning, scientific innovations, prevention strategies rather than mitigation of harm, and the restructuring of health care for all. I know it is a lofty aspiration, but perhaps achievable if not in my lifetime in the next several generations. Specifically, to improve pediatric injury prevention, the application of engineering modalities (e.g. in the reduction of motor vehicle crashes), legislative solutions (e.g. in the regulation of firearms as consumer products in the United States), the promotion of overall health through the reduction of poverty, the promotion of environmental justice in the built environment, and establishment of health as a universal right with access to health for all -all can contribute to the reduction of the harms of injury. Corollary to this is the importance of addressing mental health and substance use as they contribute to adverse injury outcomes such as suicide, overdose deaths, and exacerbation of injury risk related to driving.
PM: How has your experience been as an Editorial Board Member of PM? As an Editorial Board Member, what are your aspirations for PM?
Dr. Laraque-Arena: I have enjoyed my participation as an Editorial Board member of PM. The editors and staff have been extremely helpful, supportive, and professional. I do wish there was more opportunity to get to know the pediatric leaders in China and throughout the world who contribute to the journal. My colleagues who contributed to the published series on the mental health of children and adolescents were very pleased with the publication of their work. I do look forward to the journal being fully indexed in PubMed, Google Scholar, Scopus, etc. Thank you for the opportunity to be part of the editorial board.