Tag Archives: Public Health Department

Gratitude for Being Invited into a New Community

 

Photo from LA convening of incarcerated women and women working in public health.
Charlene Sinclair, Center for Community Change, speaking at A Women’s Gathering on Criminalization and Community Health Inequities.

In mid-September, I attended A Women’s Gathering on Criminalization and Community Health Inequities. The gathering was different in many ways, but one aspect of it really stood out: We were being invited into a community that most of us knew very little about, a community of women who had been incarcerated at some time in their lives.

As Andrea James, founder of Families for Justice as Healing and The National Council of Incarcerated and Formerly Incarcerated Women and Girls (The Council) said, “I am a former lawyer, a community activist, the wife of a man who was incarcerated, an active resident of Roxbury, MA, and a mother. I have a lot of professional and personal experience. But I didn’t become a expert until I was incarcerated.”

Only now am I beginning to understand this reality. For the past two years, I’ve been researching the health and equity impacts of the criminal justice system and working with advocates to create a new system, one that puts health and wellbeing, instead of punishment, at the forefront. Some of the people I collaborated with had been incarcerated, and I felt as if I had some understanding of how the criminal justice system destroys people and families.

But, really, it wasn’t until September 15, 2016—when 30-plus women who had been incarcerated met with about 15 women who worked in the field of public health—that I became more profoundly and intimately connected to those experiences and impacts. The women I met drove home the urgency of needing to work together to create a system of justice that values every life, treats people with dignity, demonstrates compassion, promotes a restorative and rehabilitative approach, creates space for accountability, and improves both health and safety.

And particularly for women and girls.

The reality hit me that, as women, we all have some degree of familiarity with the conditions that led to the women being incarcerated. While I had not had the experience of being incarcerated, I had experience with many of the pre-cursors—and that was a connection I had not made until hearing their stories.

Consider this: No woman is immune to the threat of community violence, oppression, being judged by her looks, being harassed on the street. And so many of us women (1 out of every 3) have been physically, psychologically, or sexually abused. And out of women who become incarcerated, that number is even higher—a recent Vera Institute report showed that 85% of women in jail have been physically or sexually abused.

What I heard from the women who shared their experiences is that these exposures (as we say in public health) —combined with acute and ongoing bias, mistrust, and maltreatment among many government agencies and institutions—led to them making choices that were ultimately criminalized. Behaviors that a more humane society would respond to with an offer of support, healing, and recovery—were instead met with surveillance, arrest, and incarceration in the United States.

But while I felt a connection to those exposures, it became deeply clear that we experienced a different, and unequal, set of outcomes based on things like racism and where you live. My childhood and home life weren’t perfect and I had some of the same teenage behaviors that I heard about in the room. But growing up white, in a suburb, middle class—these worked in my favor. People—rooted in institutions and systems—gave me leeway to make mistakes and gave me second chances. That is what privilege looks like, and that is where much of my experience diverged from the women in the room. Being confronted with that in an honest and face-to-face dialogue was so important to our ability to establish trust and try and build an authentic partnership.

Another thing happened that also stretched my understanding of what it takes to build trust with communities who have experienced significant trauma. The public health women in the room, many of whom work in government, were held responsible and asked to own the fact that we worked in and with institutions that repeatedly harmed, alienated, and failed the formerly incarcerated women throughout their lives. The level of distrust that existed in the room—understandably—was, well, rough. But my level of respect and admiration for every single woman in that room went through the roof after hearing their honesty and their doubts. I had such respect for women who are formerly incarcerated for getting themselves to that room, sharing their stories, calling out institutions for failing them, but also having hope that we can work together. And I had such respect for women in public health who listened with compassion and anger at the stories of women, who were not offended by the call to be accountable for the sins of government, and who eagerly asked “What can we do? To help repair the harm.”

It was a full day. It was a day like no other I have ever had in my 20+ years of public health work. The Women’s Gathering on Criminalization and Community Health Inequities was a beginning and we are now figuring out what we can do together. Lots of ideas emerged: new research and advocacy campaigns, new collaborations and capacity-building efforts, invitations into our institutions to humanize each other. It is on all of us now to continue to build this fledgling trust.

To be explicit about my gratitude: thank you to all the women who attended from The Council, women who are formerly incarcerated but may not be part of The Council, and all the women from the public health institutions. Your open hearts and minds is what made the day such a meaningful experience.

And a special thanks to our Women’s Advisory Team who helped plan the gathering: Jeanne Ayers (Minnesota Department of Health), Solange Gould (California Department of Public Health), Donna Hylton (The Council), Paula Tran Inzeo (University of Wisconsin Extension and THRIVE Wisconsin), Andrea James (Families for Justice as Healing & The Council), Marilyn and Pamela Winn (Women on the Rise & Georgia Racial Justice Action Center)—and especially to Charlene Sinclair, Caitlin Dunklee, and Cindy Eigler from the Center for Community Change for organizing the gathering and including HIP as co-conveners. Thank you all!

 

Group photo
Group photo at A Women’s Gathering on Criminalization and Community Health Inequities

Organizing the Narrative for Health Equity: Minnesota Department of Health Leads with Race

Guest blog by Evan Bissell, Catherine Harrison and Susie Levy
UC Berkeley School of Public Health and Department of City & Regional Planning
For more information about the basis of this post, visit our web-based narrative.

Health agencies across the country are working to develop leadership in advancing health equity. These efforts often look to build power through developing partnerships through an inside-outside strategy.

In one such effort, last February the Minnesota Department of Health (MDH) released its Advancing Health Equity Report to the state legislature. The report was striking in its explicit analysis of structural racism – the normalization of an array of dynamics, historical, cultural, institutional, and interpersonal, that routinely advantage white people while producing cumulative and chronic adverse outcomes for people of color. The report says:

“Race is not the only factor in structural inequities, but is a significant one. Even when outcomes related to other factors such as income, gender, sexual orientation, and geography are analyzed by race/ethnicity, greater inequities are evident for American Indians, African Americans, and persons of Hispanic/Latino and Asian descent. A concerted effort to specifically address the issues of structural racism and to develop the language and tools to uncover and change the structures shaped by racism will be invaluable for addressing other structure-based inequities.”

According to the report, “Health is something we create as a society and as communities, not something an individual can purchase or produce alone.” It recommends an array of actions that focus on many sectors of governance and the structure of the Department of Health itself. The report received prominent news coverage and its analysis has been used by community groups fighting for minimum wage, workers rights, and other issues. But the story of MDH leading with race did not start with the release of the report.

Image credit: Evan Bissell
Image credit: Evan Bissell

For many years the Department and community partners have worked to reframe the narrative of what creates health for Minnesotans, but have faced political pushback when working to address the social determinants of health. For MDH to address issues like housing, education, transportation, and incarceration, it needed to build relationships externally, across agencies and with community partners. The Healthy MN Partnership, a collaboration between the Health Department and community members and organizations, was formed and has proved influential in shifting the narrative of health. By challenging MDH to shift its view from measuring sickness to ensuring healthy living conditions, the broader lens of social determinants of health was adopted.

Image credit: Evan Bissell, adapted from MDH image
Image credit: Evan Bissell, adapted from MDH image
Image credit: Evan Bissell, adapted from MDH image
Image credit: Evan Bissell, adapted from MDH image

This shift didn’t happen in a vacuum. The theory of change guiding this work is grounded in a community-organizing perspective, which moves beyond the connection between health and living conditions, and recognizes that the capacity to act is critical to impact health.

According to MDH, the capacity to act – another way of saying power – is built through organizing people, narrative and resources in the following ways:

  • People: Develop accountable relationships and partnerships that align interests and directly impact decision-makers.
  • Narrative: Build public understanding and public will to support action that reflects health equity.
  • Resources: Shift the way resources, processes and systems are structured to advance health equity.

To learn more, see our web-based narrative, from which the infographics above are reproduced.

Beyond Band-Aids: How Public Health Can Address Root Causes of Health Inequities

The Ebola outbreak in West Africa is an unambiguous reminder that social and economic conditions, like the lack of reliable public infrastructure in Liberia and Sierra Leone, are at the heart of many public health problems. In such an extreme case, public health and medical officials agree that once the epidemic gets under control, we must focus on improving these root conditions to prevent future crises. But even in the United States, where most places have reliable public infrastructure that protects people from such heart-wrenching scenarios, social and economic conditions lie at the heart of most serious public health issues and the inequities that result.

A new book, Expanding the Boundaries: Health Equity and Public Health Practice, released by the National Association of County and City Health Officials (a collaboratively written document with primary authorship by my friend Bob Prentice), focuses on the importance of social and economic conditions as keys to public health. Its central thesis is that “Health equity practice should consider the underlying social inequalities that are the root causes of health inequities, rather than only their consequences.”

Expanding the Boundaries begins by tracing the history of public health in the United States. Public health today takes a biomedical science approach – vaccines, laboratories, clinics, screening for disease. But many of public health’s most important advances were part of social reform movements responding to industrialization and urbanization. Reforms in sanitation, urban planning, food safety, child labor, and other areas resulted from public health advocates working with reformers in labor, women’s rights, housing, and other social movements.

The book argues that we must return to such collaborations to truly address the social determinants of health and health inequities:

The notion of an expanded health equity practice that can directly confront the sources of social inequalities is not a wistful claim to a romanticized history of public health. It is, rather, an argument that a public health that uses its resources, perspectives, commitment, and savvy to challenge the structures of power that create and maintain social inequalities and unhealthy living conditions is grounded in its own history.

It examines the root causes of health inequities – class, racism, gender inequity and heterosexism – and the structures that perpetuate these inequities. Disaggregating data, improving clinical management, and health education for specific demographic groups are all necessary, but not sufficient if we want to address inequity. “An expanded health equity practice,” NACCHO writes, “. . . asks how these [populations] came to be the way they are, and how public health might influence the forces that shape them rather than contend only with the consequences.”

Inspiring case studies – from Alameda County and San Francisco in California, Ingham County in Michigan, and the State of Minnesota – show how this can be done. Public health agencies in these places have been tackling such issues as goods movement, foreclosures, displacement, public transit, minimum wage, and planning and zoning.

Expanding the Boundaries identifies seven elements of health equity practice. For me, one resonates most and reflects where HIP is heading: “Some health departments have learned how to participate strategically in campaigns initiated and led by others, which might not be primarily about health but nonetheless advance health equity goals.”

This approach to public health is far from commonly accepted today and far from what is possible now in many places. But as the book concludes, “Developing health equity practice … is best seen as a movement-building strategy. It is a long-term process that requires a transformation of organizational culture and practice, and the larger public understanding of what most influences health.”