Addressing Health Equity Without Getting Stuck on the Issue of Racism

October 29, 2013

Today’s guest post was written by Tanya Barrett, Senior Vice President, 2-1-1 Health & Human Services of United Way of CT.

Talking about heTanya Barrett 2013alth equity and addressing the enormity of the barriers to achieving it can overwhelm me. Never mind that many people struggle to understand it, even more are afraid to explore it because it gets into the uncomfortable territory of race and racism.

(to be honest, I struggled with what I wanted to say in this blog and took an extra-long time to complete it!)

The result is that I – and I suspect some of you – tend to avoid the issue and we get stuck. How do we address the issue of health equity without being on the same page about race and racism?   The answers came to me at The Connecticut Health Foundation (CT Health) annual Health Leadership Fellows.  This year Rinku Sen, President and Executive Director of the Applied Research Center and publisher of gave us some fresh perspectives on how to move forward.

Impact rather than intention, or “But I didn’t mean to…”

If someone harms you with words or actions, whether or not they meant to do so doesn’t change the fact that you are injured. Sen suggests changing the ensuing conversation away from proving whether the injury was intentional. Likewise, let’s look at racism in the context of impact rather than intention. This context immediately helps move the conversation from blame to solutions. If we focus on proving whether the injury was intentional, we may spend all our time on something that we are not likely to build consensus on. We usually can come together around helping someone impacted by an injury.

Impact Assessments

I think we can help correct negative impacts to health equity and increase health equity by being intentional and systematic about assessing the impact of policies. Sen spoke about the use of impact assessments as a tool in policy making. Will this policy have an impact on health disparities? This question alone can be a powerful first step.  When the answer is yes, it is important to dig deeper and examine the type of impact it will have. A health equity impact assessment helps us to drill down on how a policy will effect populations experiencing racial and ethnic health disparities. With this insight, we can avoid building or strengthening systems that result in health disparities by assessing the potential impact on health equity, proactively.

Addressing the Outer Rung First

Another way to create policy that positively impacts populations experiencing racial and ethnic health disparities is by targeting the objectives to meet the needs of this population first. Sen advocated for addressing the needs of your hardest to reach/ less connected folks first (the outer rung). The concept is that when you start with the hardest to reach, it helps to ensure that the needs of this population are built into policies from the beginning and not as an afterthought. Typically, when developing policies, we start with the largest affected population and build targeted approaches to impact or reach the largest number of people. This makes sense to me too.  Do we start with the hardest to reach/less connected or the easiest to reach/most connected?  I don’t have the answer but we should be thinking about this when we are at the table discussing policy solutions to the issues faced by clients.

I have been thinking about these concepts and sharing them with colleagues, since the presentation.  Fellows, what did you get out of Sen’s presentation?  Were there other concepts you found particularly powerful?

4 Responses to Addressing Health Equity Without Getting Stuck on the Issue of Racism

  1. Lina Paredes says:

    Tanya – thank you for reminding us all of some of the strategies Rinku Sen suggested for keeping our work on health equity focused on being effective and moving the needle forward.

    • Tanya Barrett says:

      Thanks to you and CHF for bringing Rinku Sen to Connecticut. Fresh perspectives and new ideas are so important!

  2. Pam Meliso says:

    Shifting the health equity conversation away from intent and towards impact seems like the only way to meaningfully move forward to action. I think the whole idea about addressing the outer rungs of harder to reach/less connected populations also makes sense, although I think it might be a very difficult “sell.” While this strategy doesn’t help the largest number of people, it still may have the biggest impact on the issue we are trying to address. The other concept that Sen addressed, which I am a big advocate for, is story telling and framing. If we can keep the message on impact (unintended or not) and on fairness, maybe we really can move forward.

  3. Tanya Barrett says:

    Good points. I agree that how we tell stories and frame the issue of health equity can be a key factor in whether we can move forward and bring others with us.

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