Tag Archives: Equity

The Long Road Home: Decreasing Barriers to Public Housing for People with Criminal Records

For individuals with a criminal history, finding affordable and stable housing becomes extremely difficult in a place like the Bay Area, with high cost and limited supply. People with a criminal history can legally be excluded from housing. In a survey from the 2015 Ella Baker Center for Human Rights and Forward Together report, “Who Pays? The True Cost of Incarceration on Families,” 79% of people who had been incarcerated were either ineligible or denied public housing as a result of criminal history. More than half of those released from jail or prison have unstable or nonexistent housing.

Safe and affordable housing is a fundamental basis for success in all areas of life, and without stable housing, an individual’s health, employment and education opportunities, family reunification and social networks are compromised. In Alameda County, California, nearly 20,000 people are at risk of residential instability because of having a recent criminal history.

Having housing improves health directly and indirectly, decreases recidivism, improves the chance of becoming employed and having more income, and helps with family reunification. These factors, known in public health as the social determinants of health, create opportunities to succeed and are known to be important for health and wellbeing. For example:

  • Moving often affects recidivism. The odds of recidivism increase by at least 70% for every time someone who is formerly incarcerated changes their residence.
  • Six randomized control trials analyzed supported employment in public housing against other approaches to help residents find jobs, and found 58% of public housing program participants obtained employment compared to 21% in the control group.
  • More than 70% of those leaving prison indicated that family is an important factor in keeping them out of prison, and up to 82% of people leaving prison or jail expect to live with or get help from their families.
  • Having stable housing upon leaving jail or prison decreases a person’s chance of having their probation revoked.

It’s clear from the research; the lack of stable and affordable housing forces families to frequently move and live in unhealthy and crowded environments, increases stress and depression, and can lead to homelessness. Homelessness brings higher rates of infectious diseases; substance use and mental health disorders; exposure to violence; overexposure to cold and rain; and suicide. Studies show that 25% to 50% of people who are homeless have histories of involvement with the criminal justice system.

Public housing admissions screening policies play an important role in creating the conditions for successful reentry of people who were incarcerated. HIP recently released a report called, “The Long Road Home: Decreasing Barriers to Public Housing for People with Criminal Records” done in partnership with Ella Baker Center for Human Rights (EBC). I worked closely with EBC staff starting in September 2015 to complete this Health Impact Assessment (HIA), as part of my Health & Equity Fellowship with HIP. We studied the Oakland Housing Authority (OHA) as a case study to understand the impacts of screening policies on health.

To fully understand OHA’s admission and screening policies, HIP met with two staff from their office. We learned that OHA denials due to a criminal history in the first round of screening have decreased significantly from 12% to 0.8% between 2010 and 2012. Of those who were screened out by OHA due to a criminal history, 75% request an informal hearing, and 64% of those have the decision reversed, allowing them to continue on in the application process. This is a powerful statement for the presentation of mitigating circumstances; at OHA, when people are allowed to tell their story and present supporting documentation, it often results in a reversal. We know that historical policies have created racial inequities in housing and health outcomes. However, data on race and ethnicity is not being recorded or reported, making it impossible in OHA’s case to analyze inequities in screening practices.

While more people with criminal histories are able to move forward in the screening process when OHA allows them to present mitigating evidence, there are additional changes OHA and other public housing authorities can make to improve housing stability for individuals with criminal history:

  • Allow mitigating circumstances to be presented in the initial application for public housing
  • Ensure proper implementation of policies that allow individuals with criminal history to join their family in public housing, and eliminate any practices of evicting existing residents from public housing for allowing a family member returning from prison or jail or denying admission if there is no valid reason for doing so
  • Collect, track, and publicly report the race and ethnicity of applicants and those screened out due to their criminal history to examine the potential impact of screening policies on people of color with a criminal history

Read more of the findings & recommendations in the full report.

Addressing Race & Power to Advance Health Equity: An Infographic

As HIP works with more community partners and public health departments to advance health equity, we’re looking for new ways to talk with folks about what we mean by equity.

This Equity Infographic contains user-friendly, visual content to share with organizations or individuals who may be less familiar with the term.

Content in the infographic is from HIP Co-Director Jonathan Heller’s article, “If we want to advance equity in public health practice, we must address race and power.” The infographic was designed by UC Berkeley School of Public Health Center for Health Leadership consultants Billy Luong, Briana Levin, and Carlos Cerda using Paper by FiftyThree.

Together we are Stronger: Intersectionality of Immigration and Incarceration

Last week the Haas Institute for a Fair and Inclusive Society launched We Too Belong: A Resource Guide of Inclusive Practices in Immigration and Incarceration Law and Policy at a half-day event that brought together the contributors to share their stories, their work, and engage in meaningful dialogue.

Immigration is often thought of as a Latinx issue, and incarceration thought of as a Black/African-American issue. However, the event centered on the intersectionality of these issues and highlighted that the immigration and criminal (in)justice systems are highly racialized. For those of us who have been impacted and involved in one movement or another, this is nothing too new — we’ve experienced the entanglement.

Experiencing the entanglement of immigration and incarceration is one thing, but this event generated the necessary uncomfortable conversations about how the systems have us working in silos, pointing fingers at one another, and fighting for resources. These approaches perpetuate oppression, fuel violence, hate, and pin us against each other. Working together makes us stronger, and is a key part of the process for liberation. I believe that these conversations need to be had among groups and organizations working on social justice and public health issues.

Particularly, I want to share a few nuggets of wisdom that panelists at the event announced and that I think anyone working for a more just and equitable society could reflect on:

  • Build transformational relationships instead of just transactional ones. We need to show up as much as possible for our partners; our work is not over after we’ve completed a project.
  • Elevate lived experiences, highlight non-traditional and inspiring stories, and create unified narratives. This is quite a task to accomplish especially while also recognizing that communities are not homogenous, even within the immigrant community, for example.
  • Expand the level of human concern in the policy work we do. This means making sure we use inclusive language and check ourselves.
  • Work towards what we want, not just towards what we don’t want or what we’re fighting against. Let’s use our energies effectively!

The overarching message I took was that while we work to dismantle oppressive systems, we must remember that at the core of it all are individual humans. Yes, poverty and racism are hurting and killing us, but we should equally acknowledge that we are also strong, resilient, and powerful.

The communities most impacted by policies are the ones with the solutions, we are not saving anyone—this was very clear based on the faces, stories, and histories panelists shared. Our task in public health (or whatever sector we work in) is to elevate that strength. By elevating community strength, we elevate our collective strength.

After each presenter shared their work and their story, the event attendees repeated these beautiful phrases, that reminded us how intertwined our work together is. I invite us all to contemplate these words as we continue our work together: Thank you. Thank you for your story. Thank you for your work. My freedom is bound to yours.

Strategic Questions to Ask To Explicitly Address Racism and Power in Your Public Health Practice

A few months ago, I wrote about the need for public health practitioners who want to advance equity to explicitly address race and power in their work. I received positive feedback, but also found that people are interested in how to actually do this. I recently created some materials for a training and it went well.

So, here goes an attempt to share it with a broader audience…

Let’s say you and your team – a team that hopefully includes people with a variety of skill sets and perspectives, including people from communities facing inequities – are working on a project on a particular social determinant of health in a particular location. As an example, let’s use policing, and mass incarceration more generally (i.e., the determinant), in Cincinnati and Akron, Ohio (i.e., the location). (Disclaimer, these examples stem from a recent HIA HIP released).

Questions about Underlying Issues

As you begin thinking about your project, here are a set of strategic questions that you can discuss with the team that get at the underlying issues of racism and power that are at play for virtually all social determinants of health:

1. What is your long-term equity goal, as it relates to the issue in that place?
2. What is the historical and current racial context for the issue, at the structural, institutional, and interpersonal levels?
3. What is the historical and current context with regard to other forms of oppression (class, gender, age, sexual orientation, disability, etc.) for the issue at the structural, institutional, and interpersonal levels?
4. Have race and/or other forms of oppression been used as political tools in decision making around the issue? If so, how?
5. Do you have the votes or other measures of buy-in to advance your equity goal? Explain.
6. Do you have a network of organizations and individuals strong enough to advance your equity goal? Explain.
7. What is the current societal narrative as it relates to your equity goal? Does it work in your favor or against you?

Example: Here are some quick and oversimplified answers for policing in Ohio:

1. Long-term equity goal? Eliminate the use of policing and incarceration as a form of control of black communities. Invest in necessary jobs, housing, education, etc. instead.
2. What is the racial context for the issue? FDR’s compromise with southern Democrats, who were segregationist (interpersonal racism), led to housing policies at HUD that have allowed whites to build wealth and simultaneously led to white flight and disinvestment from inner cities (institutional racism). Many communities of color, like those in Cincinnati and Akron, now suffer from lack of opportunity – in jobs, housing, education, etc. – and high crime rates (systemic racism). This has led to excess policing and incarceration. Listen to this NPR piece, for example, for more details.
3. What other context and forms of oppression are important to consider? The following populations have also been over-policed in communities of color and other communities: youth, men, LGBTQ, those with mental illness, and low-income whites.
4. How have race and other forms of oppression been used as political tools? Think of who the language of “tough on crime”, “war on drugs”, “super-predators” was really about (dog-whistling). Think about how heroin addiction – which is thought to be used more by whites – is treated as a health issue, in comparison to crack addiction – which is thought to be used more by blacks – which is criminalized.
5. Do we have enough votes or buy-in to advance our equity goal? No! Most people – including people of color – consider policing to be the best solution to addressing public safety needs in inner-city communities of color.
6. Do we have a network of organizations strong enough to advance our equity goal? No! This issue is just beginning to bring people together and a movement is starting. But still, policing and incarceration are seen as separate issues from jobs, housing, and education. We are still too siloed in our work.
7. What is the current narrative? It includes “Be afraid of black people”, “us vs them”, “individuals are at fault – they choose to commit crimes and are bad people”, “punishment deters crime”, and “we are protecting the innocent”. We see these themes everywhere – in the news, on TV, and in the movies. There is a lot more that could be said about this, but the way crime and policing are now thought of, we will have a difficult time achieving significant reforms.

After going through this exercise, your team will most likely have a better and a common understanding of the barriers you face in achieving your equity goal. That understanding should inform the approach you take.

Questions to Overcome Barriers Identified

If your project includes conducting research, like a Health Impact Assessment, a next step is to think about how you can use your research process to overcome these barriers. For example, your team could discuss the following questions.

How can you use your research process to:

1. Bring attention to the current and historical context regarding racial and other forms of oppression around your issue?
2. Unite people across the boundaries of race and other forms of oppression?
3. Diffuse the ability of opponents to use race or other forms of oppression as a political tool to block your ability to move your equity goal?
4. Build your ability to advance both your short-term and long-term equity goals by:
a. Winning enough votes or other measures of buy-in?
b. Building relationships and infrastructure to change what is on the political agenda?
c. Changing the dominant narrative related to your issue?

Example: Again, here are some quick and oversimplified answers for policing in Ohio:

1. How can we bring attention to the current and historical context of oppression? We can: discuss these with our steering committee; reflect them in our recommendations (e.g., recommend that communities come together to talk about this history); and have a section in our report that discusses this history.
2. How can we unite people across boundaries? We can discuss how both black communities and the police are negatively impacted by current forms of policing. And we can use the steering committee to start bringing people together and build trust.
3. How can we diffuse the ability of opponents to use oppression as a political tool? We can discuss approaches to overcoming dog-whistling during our research process. We can make recommendations about further and broader discussions about the use of race as a political tool as it relates to policing. We can also share information about how unconscious bias plays out today in terms of policing.
4. a. How can we build our ability to win enough votes or gain buy-in? We can use the HIA process to engage communities most impacted and help our partners build their leadership and sense of agency.
b. How can we build our relationships and infrastructure? By developing and engaging a diverse steering committee.
c. How can we use the research process to change the dominant narrative? This is hard! We can start to change the “us vs them” mentality by discussing that we are all impacted. We can humanize everyone. We can talk about wanting to have policies that improve everyone’s health and that address underlying social causes.

As you can see, these are difficult questions and advancing equity by addressing race and power is not easy. But this work is necessary and it is worth struggling – together – to figure out how to do it.

Tools You Can Use

In case it is useful, we’ve pulled these questions together as a worksheet to use with your team. And for HIA practitioners, after you go through these questions, you may want to use the Equity Metrics for HIA Practice as a planning tool for your project.

Let us know if you use these tools and, if so, what feedback you have for us! Thanks!

How Payday Loan Reforms can Improve Health for the Most Vulnerable Minnesotans

“Every two weeks I was just paying interest. And I think I got frustrated with it because knowing that the interest you’re paying really isn’t even close to what you took, and by the time you know it, you paid more than what you took from them. . . It eats you up, really, and it’s very stressful to deal with that, not knowing where you’re going to live next, or how you’re going to come up with your rent, yeah, it doesn’t really help much.” — Mercy, borrower

Human Impact Partners and ISAIAH are excited to release the report, Drowning in Debt: A Health Impact Assessment of How Payday Loan Reforms Improve the Health of Minnesota’s Most Vulnerable. After examining literature and data from many sources, the study found that the payday lending debt trap harms the health and wellbeing of Minnesota’s payday borrowers, their families, and their communities. And there is no available evidence that access to payday loans has beneficial impacts on borrower health. Ultimately, eliminating the payday lending industry in the state – or else implementing significant reforms – provides the best opportunity to ensure that health risks to borrowers, their families, and communities are minimized.

Here are the facts: Payday loans are marketed as short-term, quick, and easy loans, but the industry thrives on repeat borrowing—90% of their revenue comes from borrowers who cannot pay off their loans when due. Furthermore, between 1999 and 2014, the wealth drain from payday loan fees and interest amounted to more than $110 million from communities in Minnesota—and more than $13 million in 2012 alone.

The evidence also points to that the payday loan business model targets vulnerable populations. Storefronts are more likely to locate in communities with higher proportions of low-income residents, people with lower levels of education, immigrants, renters, and particularly, African Americans. The industry perpetuates the inequities these communities experience. For example, African Americans in Minnesota lag in homeownership, an indicator of wealth, with only 21% owning homes compared to 75% of whites who own homes. African Americans also have a higher poverty rate than whites in Minnesota, 38% versus 11%, respectively.

Along with this wealth drain, targeting of vulnerable communities, and worsening of economic inequities, payday loans were found to directly affect the health of borrowers and their families. Borrowers experience high levels of stress from worrying about being in debt and repaying loans. Chronic stress, particularly financial stress, has profoundly negative effects on health, including cancer, heart disease, stroke, diabetes, hypertension, ulcers, and compromised immune function.

Most counties with a payday loan store rank in the bottom half of the state for health outcomes, and payday loans exacerbate existing health inequities between white Minnesotans and people of color who also have higher rates of infant mortality, obesity, diabetes, heart disease, and premature mortality.

Minnesota is the worst state in the country in terms of the wealth gap between whites and people of color, and payday lending is only one factor that contributes to that reality. These outcomes are the result of long-standing social and economic policies that converged to drain wealth from low-income communities and communities of color, and have resulted in an economy where chronic underemployment, stagnant wages, race and gender discrimination, and other experiences are the norm for many lower wage workers. All of this comes at the expense of health and wellbeing of communities throughout Minnesota and the nation.

In our research, we talked with Gynnie Robnett of the Americans for Financial Reform, who refutes lender claims, and said:

“[Lenders] say, ‘We are providing a service to people who need money. Without these loans where would people go?’ We respond – if someone is drowning you don’t throw them a deflated life raft. People are struggling in this country; they are not making enough money. The loans are marketed as a quick fix, one-time thing and they are not used this way. The loans are used for everyday expenses and they trap people in long-term debt. Instead of relieving a crisis you are creating a new crisis.”

Our report supports the findings of many researchers that regulations are needed to prevent the payday loan industry from taking advantage of the most vulnerable Minnesotans. Stronger regulations on payday loans would help protect more than 50,000 Minnesotans and their families from these impacts.

However, the absolute greatest benefit to health and equity would be the elimination of the payday lending industry altogether. The opportunity has arrived for lawmakers to curb predatory lending practices and help improve the health of Minnesota’s most vulnerable communities.

Follow the conversation on Twitter at #DrowningInDebtMN.

Our Politics are Killing Us

Today’s blog post is written by Dr. Rajiv Bhatia, a physician, health scientist, Principal of The Civic Engine, and co-founder of HIP. The post was first published on December 18, 2015 by Medium

Doctors train to find the diseases behind the symptoms and signs. But, social diseases, like poverty, are usually hidden behind the ones that afflict our bodies. It’s something that medicine doesn’t often talk about it. And, our politics is what keeps these social diseases alive. Read more… 

If we want to advance equity in public health practice, we must address race and power

This week’s blog post was originally posted on The Pump Handle on January 7, 2016.

Most public health practitioners, and those who work on health impact assessment specifically, want to improve the health of vulnerable populations. Most efforts to do so are well-intentioned, yet they often don’t lead to significant change. What do we need to do differently? Below is an analysis we at Human Impact Partners put forward. Read more…

Report-back from National Public Health and Criminal Justice Convening

On November 9, Human Impact Partners and the Vera Institute of Justice co-convened over 40 criminal justice advocates and public health practitioners from around the country at a groundbreaking, first of its kind convening. The event grew out of the idea that health and justice system leaders’ work in the pursuit of health equity, public safety, and social justice could be magnified by a powerful partnership across the fields of public health and criminal justice to advance these collective goals.

ConveningGroupPictureAn advisory committee – with leaders from JustLeadershipUSA, The Sentencing Project, Ford Foundation, WISDOM, and Drug Policy Alliance – helped HIP and Vera envision what the gathering could accomplish, and ultimately proposed a bold and audacious goal: to develop an alternative vision for a justice system that works to improve population health and wellbeing at every step and to develop an agenda for collaborative work to achieve that vision.

The convening was envisioned as a space to build relationships between people working at the intersection of public health and criminal justice and had an ambitious agenda. We began with participants recounting the modern history of mass incarceration and its disproportionate effects on communities of color. Participants spent time describing how they using a public health approach to issues such as drug policy and drug use, sentencing, over-incarceration, victims’ services, and reentry. Over and over, the group kept coming back to the significance of the current political moment and recognized that the progress we’re witnessing today was due to the committed efforts of community organizers – many of whom were formerly incarcerated and some of whom were in the room – who kept a constant spotlight on the injustices of the criminal justice system over many decades.

The group then turned to a discussion of their vision for an alternative justice system, and principles that should ground that vision. It was a robust dialogue, with participants highlighting the need to make a broad statement about our societal obligation for health and safety and that both the criminal justice and public health systems need to be transformed to focus on creating the social, economic, and political conditions necessary for all to thrive. This includes making the criminal justice system the choice of last resort for addressing social problems, and instead, upholding and supporting communities to overcome those challenges. The group agreed on the need to explicitly name race and racism as a root cause of poor health and over incarceration, and that the vision should be framed as a call to action. At the end, the group came to agreement on points of unity for the vision and clarity about who the vision was for. It was quite an accomplishment!!

Finally, the last part of the day focused on identifying a set of joint goals to move the vision forward. It was another rich conversation with many ideas of how the group could collaborate. The group was able to come to consensus on a set of research, communications, policy, and community building goals to advance together. Working groups are kicking off their efforts in the New Year, and we anticipate convening again in 2016.

We continue to be inspired by the energy and commitment of convening participants. A deep thanks to them for working hard and giving each other the benefit of the doubt as they explored what it means to be in relationship with one another. A special thanks to Mari Ryono – our fearless facilitator – as well as Ford Foundation for hosting the event and Open Philanthropy for funding it.

This work is part of HIP’s Health Instead of Punishment Program, which grew out of our recently adopted Strategic Plan. Contact us if you’re interested in learning more!

Stress on the Streets (SOS): Race, Policing, Health, and Increasing Trust, not Trauma in Ohio

Today, Human Impact Partners released a report that examines a critical perspective undervalued in current conversations about policing: the health perspective. Shocking cases of mistreatment, injury, and death grab headlines and go viral on social media; this report fills in the less often discussed mental, emotional, and behavioral impacts of policing for communities of color and police officers.

Developed in partnership with the Ohio Justice & Policy Center and Ohio Organizing Collaborative, and with the assistance of a 14-member Advisory Committee, Stress on the Streets (SOS): Race, Policing, Health, and Increasing Trust, not Trauma describes how policing practices affect the health of black communities and police. The report draws upon research evidence in health and criminology from across the US, as well as new information from a survey of 470 residents in select neighborhoods of Cincinnati and Akron, eight focus groups that included police and community, and conversations with key informants.

The report shows that for many black people, the perceived color of their skin means more uneasy interactions with police than white people, and stress and anxiety that in turn result in poorer physical and mental health. Among black respondents, nearly 59 percent said they have stress specifically because of police encounters compared to about 40 percent of white respondents. The report also shows that for police, heightened stress and anxiety put officers at greater risk of cardiovascular disease, substance abuse, depression, and suicide.

Survey findings include:

  • About one in seven black respondents reported being stopped by police one or two times a day, and almost one in five reported being stopped one or two times a week. Only three percent of white respondents reported being stopped once or twice daily, and just another two percent said they were stopped once or twice weekly.
  • Among white respondents, almost 70 percent said they trust the police in their community either “somewhat” or “a lot” compared to about 40 percent of black respondents.
  • Nearly two-thirds of black respondents said they had feared police would injure or kill them, or had those fears for someone else in an incident they witnessed. The response from white respondents was almost the exact opposite – nearly two-thirds said they’d never had those fears.

The good news is the report finds that changes in policing models and practices can build trust between police and black communities, improving public health and public safety.

The report looked at four widely accepted models of policing, finding that the problem-solving approach in combination with community policing is most effective in reducing crime, building trust, and addressing inequities. The standard model is least effective for these outcomes. The report also finds that based on available information, Akron’s approach is similar to the standard model with some indication of community policing, while Cincinnati’s approach combines the community-oriented and problem-solving models.

The report assessed four specific practices getting a lot of attention these days – civilian review boards, body-worn cameras, department-wide performance measures, and training, supervision, and evaluation of officers. If fully implemented as described in the report, these practices can increase public trust, and some can reduce the use of force. If not properly implemented, these practices can actually lead to harms.

To improve public health and public safety – in Akron, Cincinnati, other cities in Ohio, and nationwide – the report makes five priority recommendations (the full report details specific actions for implementing recommendations and who can do them):

  • Publicly recognize the historical contexts that have shaped current relationships between the public and police.
  • Implement community-oriented and problem-oriented policing according to promising practices, with primary aims of improving public safety and building trust.
  • Fully implement the four specific practices described in this report.
  • Issue an annual State of Police report and identify, regularly collect, and publicly report department-level measures that include and go beyond crime statistics, and report statistics by race or ethnicity.
  • Match police department resources – including staff skill sets – to the responsibilities necessary to serve all communities and create MOUs with community-based organizations to fill gaps beyond the skill sets of police.

Visit www.TrustNotTrauma.org for a full electronic version of the report, executive summary, and appendices. Be sure to follow #TrustNotTrauma to find out more about any additional activities related to these findings.


Advisory Committee members include the following (in alphabetical order; organizational names are included for identification purposes): Amy Bush Stevens of Health Policy Institute of Ohio, DaMareo Cooper of Ohio Organizing Collaborative, Erik Crew of Ohio Justice & Policy Center, Patrisse Cullors of Ella Baker Center for Human Rights, John Eck of University of Cincinnati, Victor Garcia of Cincinnati Children’s Hospital Medical Center and CoreChange, Raymond (Ray) E. Greene, Jr. of Altruistic Organization and My Brother’s Keeper, James Hayes of Ohio Student Association, Maris Herold of Cincinnati Police Department, Stephen JohnsonGrove of Ohio Justice & Policy Center, Camille A. Jones of Cincinnati Health Department, Iris Roley of Cincinnati Black United Front, Amaha Sellassie of Ohio Student Association and Sinclair Community College, and Susan Shah of Vera Institute of Justice.

Ensuring Development in South LA is Equitable, Sustainable, and Community-Led

Today’s blog post is written by Ramya Sivasubramanian, a Staff Attorney at Environmental Justice in Santa Monica, California. The post was first published on November 30, 2015 by Switchboard, the Natural Resources Defense Council Staff Blog. 

“Development is not for us, unless it is led by us.”

Dawn Phillips of Causa Justa delivered this powerful yet succinct statement at the recent PolicyLink Equity Summit that I attended along with a number of my colleagues and community partners. This statement captures what equitable development ought to be. Yet as simple as it is to articulate, it has proved more challenging to ensure developers and planners alike put it into practice. Read more…