Culture of Health Blog

New Jersey is ranked as one of the nation’s healthiest states—on average. But if you were to look more closely, you’d see the numbers mask significant differences in health across the state. For instance life expectancy in one Newark census tract is 75.6 years while just a few miles outside the city, it’s 87.7 years.

Race is a big factor contributing to this and other health disparities. For example, babies born into Black families in New Jersey are twice as likely to die before their first birthday in contrast to those born into white families.

Other factors contributing to health disparities include income, gender, and education. Some are less apparent, like the distance from people’s homes to parks and grocery stores or the availability of public transit. The point is that many things beyond what might immediately be thought of as health related do, in fact, play a major role in determining health. 

As COVID-19 swept our nation this year, the important influence utility services have on our health became clearer than ever. Running water is essential for washing hands to prevent infection. Electricity keeps individuals and families comfortable while they follow recommendations to stay home. And internet access allows employees to work from home, children to learn remotely while schools remain closed, patients to access needed health check-ups, and all of us to stay connected.

Conveniently powering up our laptops, logging onto the internet and turning on the faucet are things many of us take for granted. But the COVID-19 pandemic has also revealed fault lines in America’s aging infrastructure. These inequities especially impact people of color, rural and tribal communities, and low-income households. For them, energy, water, and broadband are often unavailable, unaffordable, unreliable—and even unsafe.

In the almost seven months since the novel coronavirus national emergency was declared, we’ve witnessed how it has magnified centuries-long inequities that have created deep-rooted barriers to health and opportunity in communities of color and tribal communities.

At the County Health Rankings & Roadmaps, my colleagues and I know the first step to action is knowledge. We cannot address the disparities the coronavirus has brought to light without first understanding the data, challenges, and historical context at play.

Through conversations with six leaders from Black, Latino, and tribal communities, we examined the inequities the pandemic has exacerbated and explored strategies and solutions for where we can go from here. Three lessons emerged from these conversations that can inform an equitable response and recovery.

A Personal Journey

It's hard to describe water to a fish while it’s swimming in it. I was that fish, growing up in a working-class, majority Black community in southwest Ohio. For instance, it hadn’t occurred to me to question why my school had metal detectors and armed police officers at every entrance yet so few textbooks that students had no choice but to share. Or why we had to travel to find affordable fresh vegetables while unhealthy food nearby was as easily accessible as  payday loans and other predatory financial products. Having unmet needs was normal in these waters.

I was in high school when I began wondering why there were so many of these unmet needs in my community. An invitation to a cancer research conference hosted at a neighboring public school was an eye-opening experience. The school was one of the top-ranked in the state, nestled in a wealthy neighborhood with a well-stocked grocery store and multiple banks within walking distance. 

These waters were different.

That sense of unfairness filtered into my own life from another angle. I attended a school with limited resources which meant that opportunities within the school were offered to only a few. Since my mother was a powerful advocate for my education, I had access to after-school activities and advanced placement classes while friends living on the same block did not. That bothered me too.

One of the most troubling aspects of the COVID-19 pandemic is how it is exacerbating long-standing and deeply rooted inequities in communities of color. Health disparities stemming from structural racism have contributed to COVID-19’s devastating toll on blacks and Latinos in America. Often overlooked is how heightened stress from this heavy burden is impacting mental health.

Yolo Akili Robinson, a recipient of the RWJF Award for Health Equity, is swiftly responding to this new reality the pandemic has created. As the executive director and founder of Black Emotional and Mental Health Collective (BEAM), he leads his colleagues in training health care providers and community activists, as well as non-mental health professionals (family members, peers, etc.) to address mental health needs in communities of color. Robinson is witnessing firsthand how lack of access to testing and fear of profiling while wearing face masks, among other issues are increasing toxic stress and straining mental health.

In the following Q&A, Robinson shares insights about the impact and implications of COVID-19 on mental health within communities of color.

As coronavirus sweeps our nation it has brought deep-seated health inequities, including those linked to incarceration, to the forefront. Overcrowding and poor sanitation are putting prisoners at risk now more than ever. Persistent, widespread reports that guards and prisoners are testing positive for COVID-19 are especially alarming, and a sobering reminder that quarantines are nearly impossible among incarcerated populations. To address this, many jurisdictions are releasing select prisoners.

The Robert Wood Johnson Foundation (RWJF) has long recognized how incarceration adversely affects health and health equity for prisoners as well as families and communities. With some 2.2 million adults and youth in juvenile detention facilities, prisons, and jails, the United States incarcerates many more people—and a higher percentage of our population—than any other nation in the world. There is widespread agreement that incarceration has adverse effects on health and health equity, not just for prisoners themselves but also for families and communities. That’s why, in 2018, RWJF included it among 35 illustrative measures we are using to track our progress toward building a Culture of Health in America—that is, becoming a country that values health everywhere, for everyone.

The measures linked to RWJF’s Action Framework are intended to be viewed together to identify priorities for investment and collaboration, and to understand progress being made toward realizing our vision. We are also considering the impact each individual measure has on efforts to build a Culture of Health. Because mass incarceration is a pervasive problem that undermines health and health equity, tracking it allows us to examine how it compounds the persistent challenges associated with achieving health equity nationwide and affects communities.

Note: This piece was originally published in February 2018.

One of my earliest and most vivid childhood memories is watching from my bedroom window as my city burned in the riots that erupted after Dr. Martin Luther King Jr.’s assassination 50 years ago.  

The next afternoon, my mother brought me to the playground at my school in Southeast Washington, D.C., which somehow was untouched. As she pushed me in a swing, she asked if I understood what had happened the day before and who Dr. King was.

“Yes,” I said. “He was working to make things better for Negroes like you.”

My mother, whose skin is several tones darker than mine, stared at me in surprise. Somehow, even at 4 years old, I had learned to observe differences in complexion.

That is particularly interesting to me now, as I eventually came to believe that “race” is a social construct.

Of course racism and discrimination exist. They are deeply embedded in America’s history and culture—but so too is the struggle against them.

The Tale of Two Boys Growing Up in Cleveland

Let’s ask two hypothetical 9-year-old boys a question: What is it like to grow up in Cleveland? 

Each boy attends school, and enjoys riding his bike and playing with Legos. Both live in Cleveland. Beyond these similarities, their life experiences are—and will continue to be—starkly different based on multiple, complex factors that lie within their neighborhoods.

Neighborhood A 

The boy living in Neighborhood A faces a host of obstacles to opportunity and well-being. 

Economic adversity is the norm. One in four families struggle with poverty, and nearly 83 percent of his peers in school need free or reduced-price lunch.

The literal translation of the word “sankofa,” from the Akan tribe in Ghana, means "go back and fetch it.” Figuratively, it captures an important belief in Akan culture: While the future brings new learning, knowledge from the past must not be forgotten.

This principle guided our efforts to transform 10 formerly blighted lots into a vibrant community of 50 modern “green” apartments in Providence, Rhode Island’s diverse West End community. The $13.5 million development is connected to 30,000 square feet of community garden space. Single fathers come with sons, pastors come with children and people sit under the garden’s pergola, which was built by local youth volunteers. It is, as one article put it, a “beehive of activity.”

Next year will mark 30 years since the Americans with Disabilities Act (ADA) became federal law—first of its kind legislation that outlawed discrimination against people living with physical or mental disabilities. It was a culmination of decades of challenging societal barriers that limited access and full participation of people with disabilities.

And yet in spite of the ADA’s passage, we still have a long way to go before society is fully inclusive of the 61 million people living in this country with some type of disability. Judy Heumann understands that while the ADA is important, in practice, “we’re not done yet." She is currently a leading advocate for disability inclusion and has been an advisor to institutions like the U.S. State Department, the World Bank, and the Ford Foundation. As a child, Judy was barred from going to school because she used a wheelchair. Years later, she was denied a teaching license for the same reason. These obstacles to education and employment are just two of many barriers that stand in the way of inclusion. Judy understood the need for strong advocacy in partnership with others experiencing continuous discrimination because of their disabilities. This discrimination is also often compounded by class, race, ethnicity, religion, gender, age, or sexual orientation among other characteristics.

I had the chance to personally meet Judy at the first convening of the Presidents’ Council on Disability Inclusion in Philanthropy this year. Darren Walker of the Ford Foundation and I are co-chairing this group of 13 other foundation executives to champion inclusion of people with disabilities in our own institutions and within philanthropy. We have a lot to learn from Judy and many others who have challenged systems and paved the way to making our nation more inclusive.