Culture of Health Blog

"We are one of the only countries in the world that doesn't offer paid family and medical leave to those who need it."  —Robert Espinoza, Vice President of the Paraprofessional Healthcare Institute

A study by Better Life Lab and the Robert Wood Johnson Foundation reconfirms that the U.S. status quo of gender roles, both at work and home, is not working for many families. Men are missing out on caretaking roles that enrich their lives and enhance the bonds with loved ones, while women are struggling with role overload, feeling unsupported and missing out on income and economic mobility.

In contrast to the U.S., many nations are advancing gender equity through solutions that benefit health, child development, family well-being, and advance racial equity, like paid leave. The United States can learn from the experiences of other nations that are implementing paid leave policies and find approaches that encourage fathers to take advantage of these policies.

For generations, Indigenous Peoples have known that our health is intertwined with the health of our earth. Their worldview recognizes that being healthy means ensuring the natural resources that give us life are well cared for.

In contrast, Western mindsets tend to view the natural world as an inventory of useful commodities—separate from, and existing only in service to, humanity. Overusing, polluting, and extracting without considering the long-term impacts has created conditions that fuel health inequities in our country: contaminated drinking water, food scarcity, air pollution, and extreme heat are contributing to poor health and driving up disease, particularly in low-income neighborhoods and communities of color.

Transforming our relationship with nature is key to building a sustainable, equitable, and healthy future for all. Through the forcible removal, violence, oppression, and other injustices Indigenous Peoples have experienced, they have remained powerful stewards for many of our natural resources. Their values, practices, and policies can show us the way to heal and reclaim the health of our earth and humanity.

Bring horses and Native youth together, and connections are built that can change lives. 

Deep ties to the land and close connections with animals have long helped to define Native American culture and make their way of life possible. In Fort Peck, Montana, Charlie Four Bear reclaimed that legacy by helping young people develop enduring relationships with horses. Four Bear (Dakota and Lakota) was an elder on the Fort Peck Indian reservation and a former police officer.

 “First they took away our land,” he said, describing the destruction that occurred as White settlers pushed West. “And then they took away our buffalo. And then they took our horses away.” The theft of so much Native culture, and the inequitable distribution of resources and opportunity that continues to this day, have damaged lives and undermined communities. The scars are apparent in the substance use and loss of hope revealed in one horrifying statistic: in a single year, 28 of 223 students at the local high school attempted suicide.  

Our nation’s health is intertwined with the health of our rivers. And our rivers are unwell.

Drinking water, food, sanitation, clothing, transportation: almost everything we do involves an interaction with water. Yet many people in America take water for granted, not realizing that pollution, overuse, and climate change are putting a chokehold on the country’s natural water reserves—posing a direct threat to health, equity, and our way of life.

While many may think that new technology and innovation can resolve our water crisis, I believe that the solution lies with Indigenous practices that have fostered a holistic approach to living in relationship with the natural environment for millennia. Let me explain.

Our Relationship with Nature

Indigenous peoples share a common worldview of our relationship with the natural world. One that is guided by Indigenous values and principles of respect, cooperation and responsibility. These principles govern our individual and collective beliefs, behaviors and relationships—as given to us from our ancestors. While our customs may differ, our lived connection with our environment is universal. In sharp contrast, Western mindsets tend to view nature as a commodity, maintaining a relationship that is centered on resource-taking.

Darrick Hamilton, the Henry Cohen Professor of Economics and Urban Policy at The New School, has gained national recognition for shaping policy solutions to close the racial wealth gap, which refers to how hundreds of years of structural racism have deprived Black families of resources that accumulate and transfer from one generation to the next. The typical White family has 10 times the wealth of the typical Black family and seven times the wealth of the typical Latinx family. This stark and persistent racial wealth gap has harmed generations, driven disparities and appears to be growing, even after controlling for household characteristics and long-term education and income gains by Black people.

Hamilton’s early experiences provided an ethical orientation toward justice that shaped his career as an economist. Growing up in Bedford-Stuyvesant while attending the Quaker-run Brooklyn Friends School exposed him to two worlds in which fundamentally similar people experienced markedly different life trajectories—primarily due to one group benefitting from greater resources than the other.

In this Q&A, he shares powerful insights on the impact of the racial wealth gap, strategies to address it, and reflections on how events of the past year are shifting narratives and providing hope for change.

Closing the Medicaid coverage gap would save lives, reduce costs, and help eliminate the racial and ethnic health disparities that have persisted for generations.   

But 12 states have refused to expand their Medicaid programs under the ACA, denying health care coverage to more than two million people—disproportionately people of color—who would qualify for the program if expansion was implemented in those states. These holdout states have refused to budge even as the federal government would cover the vast majority of expansion costs; even as Medicaid expansion states reap a variety of health and economic benefits; and even as the United States remains in the throes of a deadly pandemic.

Rapid response is synonymous with moments of crisis. From first responders to communication experts, responding quickly to a crisis is critical for community health and well-being. But what about rapid response research? 

COVID-19 has epitomized a complex crisis of infectious disease, food and housing insecurity, and mental distress. People who are Black, Latinx, Native American, and living in low-income households are the most vulnerable to these conditions. It is clear that health and social policies enacted during the pandemic will affect communities for decades to come. 

To inform rapid response research and policymaking, my team at Boston University and I developed the COVID-19 U.S. State Policy database—also known as CUSP—in 2020. This resource aims to inform health and social policy decisions that promote health equity and focuses on policies that affect vulnerable and historically excluded populations. Now over a year after its inception, we are assessing what we have learned and where we have yet to go.

As the pandemic forced women out of the workforce in record numbers, a new survey reveals that men overwhelmingly value care work and want to share it equally with their partners. But the lack of supportive workplace cultures and public policies prevent them from doing so. Where do we go from here?

As pressure mounts to address the many challenges brought to the fore by the pandemic, our nation is experiencing a reckoning in caregiving, and what it means for families and our economy. A new nationally representative survey conducted by New America and funded by the Robert Wood Johnson Foundation, revealed that although our cultural norms have not caught up with our ideals of gender equity, men overwhelmingly value care work, and want not only to participate, but to share it equally with their partners. However, the lack of supportive workplace cultures and public policies keep them from doing so.

Both of us are proud of our immigrant roots and the paths our families forged after coming to the United States. Mona’s parents arrived from India, and Tina immigrated from South Korea as a toddler with her family. As members of the Asian American community, the past year’s wave of hate crimes has been painful and traumatic. But it is not new. What is new, though, is the attention these incidents and the Asian American community as a whole are receiving.

At times, these crimes bring back terrifying memories. Mona was just 10 years old when a hate group in Northern New Jersey sent a racist letter threatening Indians to a local newspaper, and the newspaper published it. The deep societal racism that letter exposed was manifested through verbal abuse, brutal assaults, and murders that occurred time and again over many years. Mona grew up hearing racist comments from police officers and teachers and seeing South Asian businesses and homes, including her own, vandalized.

At times, they remind us how few people seem to consider the intergenerational trauma and challenges faced by Asian Americans. Tina’s parents grew up in South Korea during the Korean War and her father remembers his family losing everything. Arriving in a new country not speaking the language while trying to navigate a culture with a different set of values was incredibly difficult for her parents. Adding to their stress was the need to lean heavily on their children to negotiate, translate, and serve as intermediaries with authorities and agencies.

At times, they compound the numbness and hurt we feel in the face of sometimes-profound insensitivity and endless microaggressions that add up over time and contribute to chronic stress that undeniably harms health.

Editor’s Note: This piece was originally published in the Grantmakers In Health Bulletin.

In Clifton, New Jersey, data on children in poverty, data on obesity, and data on the percent of uninsured residents revealed such pronounced disparities among neighborhoods that the city approved a satellite health office. Now, residents who previously had difficulty getting health screenings, immunizations and other necessary public services have better access.

In Waco, Texas, a nonprofit organization used the COVID Local Risk Index, a measure of city and neighborhood-level risk of COVID transmission and mortality, to pinpoint the level of COVID risk by neighborhood. Comparing this data to the city’s COVID cases added vital context to community preparation for and response to the pandemic.

Both of these cities used data from the City Health Dashboard ("Dashboard"). Launched in 2018, the Dashboard addresses the problem of data inaccessibility for cities and communities.