Tag Archives: Inequity

If Black Lives Matter, We Can’t Stay on the Sidelines

Let’s not sit on the sidelines.

With those words Dr. Mary Bassett, health commissioner of New York City, in a Perspective for The New England Journal of Medicine clearly and boldly declares that health professionals are accountable for fighting interpersonal and institutional racism, because of the undeniable truth that racism contributes to poor health outcomes.

In “#BlackLivesMatter: A Challenge to the Medical and Public Health Communities,” Dr. Bassett acknowledges that “tackling racism is daunting” and for many in the health community “often viewed as divisive and requiring action outside our purview.” She calls out the “dearth of critical thinking and writing on racism and health in mainstream medical journals,” pointing out that over the last decade only 14 articles in NEJM even contained the word racism. And she lists three ways we can – and should – make a difference:

  • Research: “By studying ways in which racial inequality, alone and in combination with other forms of social inequality (such as those based on class, gender, or sexual preference), harms health, researchers can spur discussions about responsibility and accountability. Who is responsible for poor health outcomes, and how can we change those outcomes?”
  • Internal reform: “Our target ‘high-risk’ communities, often communities of color, have assets and knowledge; by heeding their beliefs and perspectives and hiring staff from within those communities, we can be more confident that we are promoting the right policies.”
  • Advocacy: “Some [health professionals] may choose to participate in peaceful demonstrations; some may write editorials or lead ‘teach-ins’; others may engage their representatives to demand change in law, policy, and practice.”

Right on! These actions align completely with HIP’s new strategic direction – research, advocacy, and capacity building to bring the power of public health science to campaigns and movements for a just society. They also align with the work members of our Public Health and Equity Cohort are doing to advance racial and other forms of equity in their health agencies and communities, with an inside-outside strategy for change. And they reflect the way we do our work at HIP and what we advocate that other health professionals should do in their work.

Dr. Bassett is right. Addressing structural racism is hard. But we can’t sit this struggle out. Let’s remember why we’re in this: to improve health and reduce health inequities. We can’t back off when that means we must confront racism.

How Does HIA Bring Change?

There is a dirty little secret among HIA practitioners: We don’t all agree about what makes the work we are doing effective and about how doing HIA will lead to change. This became clear to me during conversations that started during the “Advocacy and Objectivity in HIA” panel at HIA of the Americas earlier this year. But these differences crystalized for me flying home last week from the National HIA Meeting.

The terms advocacy, bias and subjective have been thrown around a lot lately in the HIA field – terms that reveal deep differences among practitioners. I think there are at least three distinct theories of change held among our community.

1. Data alone.  Subscribers to this theory of change believe all HIA practitioners need to do is to provide decision makers with data about health and health disparities. Armed with that data, decision makers will make better decisions.

2. Data and consensus. Subscribers to this theory believe that the best way to make change is to reach out to stakeholders with diverse views, which usually include community members and, depending on the HIA, could include people from different agencies, project proponents, and decision makers from across the political spectrum. With data and good facilitation, consensus can be reached regarding the impacts, recommendations, and report. That process and the findings will lead to decision makers making better decisions.

3. Data and Power. Subscribers to this theory believe that change is most likely to come from strong data combined with an HIA process that is used to build power in disenfranchised communities that face inequities. With this increased power and strong data, the voices of those most impacted will be heard and decision makers will make better decisions.

Each of these theories has its merit and each may have its time and place. Each has examples it can hold up that show that it leads to decisions that improve health.

But, in our experience, if HIA is really a tool to achieve health and reduce inequities, combining data and power is the most effective way of getting there. History shows that the other two are challenging ways to truly change policies, plans, and projects that create inequities, especially if those in power don’t have the will to do so or if there is ideological tension around the proposal my ding. Those in power, in favor of a status quo that benefits them and is harming the disenfranchised, are simply not willing to yield power in the face of mere data.  And the compromises that result from consensus building between those who have power and those who do not usually support at best a middle ground that does not significantly benefit those most harmfully effected by decisions.

This is why at Human Impact Partners we do our HIAs in partnership with community organizing groups whose focus is building leadership in low-income communities and communities of color, lifting the voices of populations left out of decision-making discourse, and building the power of those communities.

We know the data and power theory works. With our partners, we’ve used it over the last couple of years to win over $40 million in affordable housing in South Los Angeles (our USC Specific Plan HIA and Farmers Field HIAs), substantial increases in funds for alternatives to incarceration in Republican-controlled Wisconsin, and better policies for racial integration of schools in Minnesota. We’ve used it to raise awareness about the harmful impacts of detentions and deportations on immigrant children and families. And, through those processes, we’ve left behind not just awareness and better policies, but more importantly, a community that is more engaged in our democracy and more empowered to fight on their own behalf in the future.

In Closing the Gap in a Generation, the World Health Organization Commission on the Social Determinants of Health declared: “Any serious effort to reduce health inequities will involve changing the distribution of power within society and global regions, empowering individuals and groups to represent strongly and effectively their needs and interests and, in so doing, to challenge and change the unfair and steeply graded distribution of social resources (the conditions for health) to which all, as citizens, have claims and rights.” The great Brazilian philosopher and educator Paulo Freire said it more simply: “Washing one’s hands of the conflict between the powerful and the powerless means to side with the powerful, not to be neutral.”