The path to justice exists, if we’re only willing to take it.
By Frances G. Padilla
As Health Equity Week in Connecticut comes to a close, I want to reflect on how the experience of the past year should strengthen our resolve to work for justice. Justice is within reach if we are willing to disrupt the status quo to achieve it. The American Public Health Association offers six key principles for advancing health equity. I believe these principles can help set a path toward justice.
We have to be explicit about the populations we’re talking about.
Black and Brown people. In CT, this means naming African Americans, Latin people from the Caribbean, Central and South America, Indigenous people, Asian Americans and Pacific Islanders, people of Middle Eastern and African descent. Immigrants of mixed status, including the undocumented. We need to clearly know who we are meaning to make a difference for.
We need to identify and effectively address racism and implicit bias.
Health disparities levy high economic costs to individuals, families, communities, government and business in the U.S. every year. COVID’s impact worsened disparities for Connecticut’s Black and Brown communities, too many of whom in the best of times are working-poor, but during COVID lost their jobs and access to needed health coverage and care.
Lack of safe, affordable housing; crowded living conditions; lack of public transportation; environmental pollution; lack of green spaces; suspension and expulsion from school; police violence; micro-aggressions in medical care; and doctors that do not accept Medicaid patients are all examples of structural barriers to good health.
The evidence is clear that racist policies and practices are baked into every single system we interact with through our lives. Acknowledging this as some towns and organizations in CT are doing is an important first step.
Adopt a “health in all policies” approach at all levels of government.
There are several bills in CT’s legislative session this year that name race and racism either directly or indirectly. Racism as a public health crisis, inclusive zoning, race, ethnicity and language data collection; expansion of coverage through Medicaid and a government-backed public plan; voter protections; a child earned income tax credit. These kinds of bills advance may advance health if intentionally designed to do so.
Public policies and practices should be measured by their impact on equity.
There are validated tools available for these kinds of assessments and elected and appointed officials must use them to assess policies both before and after they are enacted. And to make changes as needed.
Create an internal organization-wide culture of equity.
Every single one of us need to start within our own organizations. We need to take honest stock of how aligned what we say is with what we do through our policies, practices and people. And then make the needed changes. Set specific and measurable goals.
Anti-blackness and other racism are alive and well in CT. For example, it is well documented that young Black and Brown men get stopped by police at a higher rate than young white men. The educational achievement gap has been an issue in CT for at least 40 years. Pregnant women in the Willimantic area are at risk of giving birth in an ambulance on the way to Norwich or Hartford because of reductions in labor and delivery services by their local hospital.
Public will and political will have been insufficient at addressing these and the many other inequities that lead to five Connecticuts — — wealthy, suburban, rural, urban periphery, and urban core. CT’s regressive and unfair taxation system has lower- and moderate-income people shouldering the tax burden while the many millionaires and corporations pay a nominal share of taxes. The austerity mindset is killing Black and Brown people.
Do the bills under debate at the Legislature mean that the past year has made racism impossible to ignore and “change is coming,” as Sam Cook sang in the 1960s? Not unless there is intentionality at changing from within.
Our legislature continues to be not only predominantly white but also predominantly wealthy. It is steeped in white privilege. To combat racism, there needs to be intention in developing a pipeline of elected leaders that reflect the many different faces of CT.
Involve and respect communities in health equity initiatives.
No one is silent, they are just not listened to. People in communities know what they need and it’s the responsibility of decision-makers not only to listen but to be guided by what our communities say that need and want.
It is exceedingly hard for well-intentioned organizations to understand this, thinking we’re all working toward the same goals and positive outcomes. It takes organizational humility to stop, listen, reflect and act on what we hear, especially when it isn’t what we expect to hear.
If state officials had taken heed that the Centers for Disease Control age criteria for COVID vaccinations would mean urban residents would not become eligible to sign up for weeks (months, even), many more people in CT’s Black and Brown communities would be vaccinated by now.
Measure and evaluate progress in reducing health disparities.
We can’t change what we don’t measure. Connecticut state government struggles with requiring collection of race, ethnicity and language data by institutions — hospitals, health departments and other organizations serving the health needs of Black, Latinx, Indigenous, Asian and other people of color.
Without data and analysis, it is impossible to know how people are faring, whether policies and practices are equitable, and how they need to change. There is a bill in this legislative session that would significantly move Connecticut forward on this front.
I would add another principle to APHA’s six…
It’s time to drop the deficit-oriented language. Coded language like “at-risk,” “vulnerable,” “disempowered,” and “minority” minimizes people, infantilizes them, and takes away their agency. And it influences how systems and programs are designed. Why not think of Black and Brown people as full of potential that can be used to transform the world?
A few closing thoughts:
Achieving health equity may feel threatening to the status quo, but failing to make progress hurts us all. The recent anti-Asian violence in California, Georgia and New York shows us that racism is a rampant public health crisis. There is a need for allyship among groups.
Too often Black and Latinx communities are pitted against each other to fight it out for resources. White allyship is important too. There are many White people whose awareness and outrage have been awakened. This is not a “kumbaya” moment; it is a moment for genuine struggle to realize JUSTICE.