Culture of Health Blog

Janet Chang, PhD, is an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections Program and an assistant research scientist at the University of Connecticut. Chang received a PhD from the University of California, Davis, and a BA from Swarthmore College. She studies sociocultural influences on social support, help seeking, and psychological functioning among diverse ethnic/racial groups.

In the past year, there has been heightened national press coverage of anti-minority sentiments, and public outcry over discriminatory incidents in the United States. The publicized nature of these events stimulated intense debate. Some, especially those who believe in racial colorblindness, have argued that outraged individuals are overly sensitive and quick to assume that prejudice and discrimination are the cause. On the one hand, this perspective provides psychological comfort by downplaying the importance of race, minimizing the impression of bias, emphasizing our common humanity, and upholding egalitarian principles. On the other hand, it is upsetting and harmful because it denies the lived reality of racial/ethnic minorities. Colorblindness renders well-documented racial/ethnic disparities invisible.

Belief in colorblind ideologies perpetuates false notions that discrimination is rare. As a result, colorblindness, along with a complex host of factors, promotes ethnic/racial disparities in wide-ranging important domains, such as health and health care, criminal justice, housing, education, and employment and advancement in the workplace. Colorblindness reinforces the myth of meritocracy, which places value on individual effort and ability but overlooks structural factors that inhibit positive outcomes for vulnerable or disadvantaged populations.

Thomas LaVeist, PhD, is founding director of the Hopkins Center for Health Disparities Solutions, and the William C. and Nancy F. Richardson Professor in Health Policy at the Johns Hopkins Bloomberg School of Public Health. He is the chair of the National Advisory Committee for the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry Medical College. 

Yesterday I had Camara Phyllis Jones, PhD, MD, MPH, as guest lecturer for my seminar on health disparities. It was a homecoming of sorts for her. She and I first met in the early 1990s when I was a newly minted assistant professor and she was a PhD student at the Johns Hopkins Bloomberg School of Public Health. Jones’ work should be well known to readers of this blog. She has published and lectured on the effects of racism on health and health disparities for many years. She played a leading role in the Centers for Disease Control and Prevention’s work on race, racism, and health in the Behavioral Risk Factor Surveillance System.  And she was just elected president-elect of the American Public Health Association. She is a fantastic lecturer and often uses allegory to illustrate how racism affects health. 

About midway through her lecture, a student raised his hand and got her attention to ask a question about the utility of “naming racism.” My interpretation and rephrasing of his question—is it helpful to use the word racism or is the word so politically charged and divisive that it causes people to “tune you out?”

The student’s question raises a major challenge for those of us who seek to address health disparities. On one hand racism is fundamental to understanding why disparities exist and persist. I would go as far as to state that in most race disparities research, race is actually a proxy measure for exposure to racism. But, on the other hand, the word racism makes some people uncomfortable, causing them to become defensive or sometimes simply block out your message.  

Maya M. Rockeymoore, PhD, is president of the Center for Global Policy Solutions, a nonprofit dedicated to making policy work for people and their environments, and director of Leadership for Healthy Communities, a national program of the Robert Wood Johnson Foundation (RWJF). On December 5, RWJF will hold its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health.  

When I think of the resilience of disadvantaged communities disproportionately affected by health disparities, I think of the Arabbers of Baltimore, Md. They are not Arabic speaking people from the Middle East or North Africa, but scrappy African American entrepreneurs who started selling fresh foods in Baltimore’s underserved communities in the aftermath of the Civil War.

Their relevance continued into the modern era as supermarkets divested from low-income neighborhoods, leaving struggling residents with few options aside from unhealthy fast food and carry-out restaurants. Driving horses with carts laden with colorful fresh fruits and vegetables, Arabbers sold their produce to residents literally starving for nutritious food.

Nancy López, PhD, is an associate professor of sociology at the University of New Mexico (UNM). She co-founded and directs the Institute for the Study of “Race” and Social Justice at the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at the UNM. On December 5, RWJF will hold its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. 

How should we measure race and ethnicity for the 2020 Census? How can health disparities researchers engage in productive dialogues with federal, state and local agencies regarding the importance of multiple measures of race and ethnicity for advancing health equity for all?  

If we depart from the premise that the purpose of race, ethnicity, gender and other policy-relevant data collection is not simply about complying with bureaucratic mandates, but rather it is about establishing communities of practice that work in concert toward the creation of pathways (from harmonized and contextualized data collection, analysis and reporting) to effective policy solutions and interventions that address the pressing needs of diverse communities across the country, then we have planted the seeds of a culture of health equity and social justice.

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Lillian Rivera, RN, MSN, PhD, administrator/health officer for the Florida Department of Health in Miami-Dade County, responds to the question, “Minority health is advanced by combating disparities and promoting diversity. How do these two goals overlap?” Rivera is an alumnus of the RWJF Executive Nurse Fellows program.

In order to address this question, it is important to identify the areas within your jurisdiction where there are identified health disparities and to develop initiatives with those needs in mind.

Miami-Dade County in Florida is one of the few counties in the United States that is “minority majority,” meaning the minority makes up the majority of the population. More than two-thirds of the 2.5 million residents are Hispanic; 19 percent are Black; more than 51.2 percent are foreign-born and most of  them speak a language other than English at home (mostly Spanish and Creole);  19.4 percent live below poverty level; and 29.8 percent of the population  under age 65 (more than 700,000 individuals) is uninsured .

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Jamar Slocum, BS, a third year medical student at Meharry Medical College, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Slocum is a participant in Meharry’s RWJF Scholars’ program.

In virtually every public health venture, health departments are confronted with the consequences of social poverty, institutional racism, and other forms of universal injustice. It is my belief that in order to make any significant change to a society, it is essential to have leaders who are in the forefront of the upcoming generation. Young professionals will ultimately bear the responsibility for implementing the policies and programs necessary for sustainable development. Budding physicians and researchers are exposed to an extensive array of sustainable development perspectives at a formative age in their professional development. This strengthens their own knowledge base and advances their capability to comment substantively on health disparity issues and to become effective agents of change.

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Janet Chang, PhD, an assistant professor of psychology at Trinity College in Hartford, Conn., responds to the question, “Minority health is advanced by combating disparities and promoting diversity. How do these two goals overlap?” Chang is an alumna of the RWJF New Connections Program; she studies sociocultural influences on social support, help-seeking, and psychological functioning among diverse ethnic/racial groups.

Given the rapidly changing demographic landscape, ethnic/racial minorities will constitute the majority of the U.S. population by 2043 (U.S. Census, 2010). This inevitable shift to a majority-minority population has far-reaching implications for our society. The future of the United States will largely be determined by how we address growing disparities in income distribution, health care, and health outcomes. Yet, frank discussions about disparities and diversity lag behind the rapid population growth of ethnic/racial minority groups. In this respect, educational systems play a pivotal role in facilitating and shaping the dialogue about diversity. By promoting diversity, we can combat health disparities and advance minority health.

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Raymond Perry, MD, MS, medical director of Los Angeles County Juvenile Court Health Services, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Perry is an alumnus of the RWJF Clinical Scholars program (UCLA 2009-2012).

Racial and ethnic minorities are significantly overrepresented in the U.S. correctional system. As these men, women, and adolescents spend days, weeks, months, or years detained in jails, prisons, and juvenile detention facilities, the health care system must recognize the health implications of the disproportionate incarceration of minorities, as well as the opportunities for addressing minority health issues in our society—namely, inequitable health care access and disproportionately negative health outcomes. 

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Kate Driscoll Malliarakis, PhD, ANP-BC, MAC, an assistant professor at the George Washington University School of Nursing, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” She is an alumna of the RWJF Executive Nurse Fellows program.

The quick answer is to admonish legislators in state and federal governments for failing to gain consensus on what care they will provide and then for actually failing to provide the care. 

Government bureaucracy is certainly a barrier to attending to the health needs of the people in the United States, but government is only one of the issues we face. Often, our society fails to step up and acknowledge inherent prejudice. We surround ourselves with “our kind” and observe others from a distance. We develop a kind of detachment from those who are not like us, and we fail to acknowledge the richness of cultural diversity. The volatile world economy in the past few years has proved that many of us are but a few paychecks away from personal ruin; in other words, we too can easily become a disparity statistic.

Thomas A. LaVeist, PhD, is the William C. and Nancy F. Richardson Professor in Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, and founding director of the Hopkins Center for Health Disparities Solutions. He also chairs the National Advisory Board of the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry Medical College and is a former member of the National Advisory Committees for the RWJF Health & Society Scholars program and Investigator Awards in Health Policy Research.

The Institute of Medicine (IOM), perhaps more than any other institution, sets the country’s standards and agenda. The field of health disparities offers a great example. In 2002 the IOM published the report Unequal Treatment. The report compiled the scientific evidence documenting substantial racial and ethnic inequities in the quality of health care received by Americans. The report placed health inequalities on the front burner of the nation’s health policy agenda. Understanding the causes and solutions to racial inequities in health has been the primary focus of my career. While the findings were not a surprise to me, I was elated that the IOM had lent its considerable credibility to this long-standing and vexing problem. I am even more elated, now, to have been elected to membership in the IOM.