Addressing Health Equity Without Getting Stuck on the Issue of Racism
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 health 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 Colorlines.com 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.
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?