Culture of Health Blog

Many COVID policies and practices exacerbated longstanding health disparities. Here’s how we can change that going forward.

The opening of the Tops Friendly Market in East Buffalo was a triumph of community activism, a victory for residents who struggled for years against food apartheid. In a neighborhood that had long lacked a full-service supermarket, the store became a symbol of local empowerment in one of the nation’s most segregated cities.

This segregation is a contributing factor in why White people in Buffalo have a longer life expectancy than their Black neighbors living on the East Side. To counter these conditions, residents persevered in efforts to shape a healthier, more equitable neighborhood—residents like 67-year-old Church Deacon Heyward Patterson. Deacon Patterson volunteered at a soup kitchen and even drove his neighbors to Tops Friendly Market to access nutritious food when they didn't have transportation of their own. He was murdered while helping load groceries into someone's car.

The murder of Deacon Patterson and others sparked outrage across the nation. But when the initial shock fades away, we need to look harder at the role of racist systems and structures that endure in the United States and how they contribute to unbridled violence and lives that are cut short.

Findings from a national survey underscore the need to continue educating people about the root causes of inequities and how racism affects health. 

We’ve come to expect a flood of polling around election time, conducted or commissioned by universities, media outlets, partisans, and others. So why would a foundation invest in putting a poll into the field? On what topic? And when? RWJF’s Research, Evaluation, and Learning (REL) team supports various surveys and polls to gain insight into the public’s opinion on a range of topics from health to systemic racism to the effects of COVID-19 on day-to-day life. Findings can help philanthropy, policymakers, and stakeholders better gauge public awareness of a problem and support for a particular policy intervention, reveal shifting attitudes and shed light on whether people think systems change can advance health and equity.

Carolyn Miller, REL Senior Program Officer talks with Anita Chandra, a Vice President at RAND, on what we can learn from one of the Foundation's numerous survey efforts—the months-long RWJF/RAND COVID-19 survey and how it can inform policy solutions designed to address structural racism and improve health and prosperity.

In Manhattan’s financial district, the average resident can expect to live until the age of 85. In East Harlem, life expectancy is only 76 years. Ten stops on the subway and a nine-year drop. That’s what Jasmine Travers, a nurse and New York University assistant professor, told me when we talked about the importance of digging out the root causes of health disparities.

As Black women in the nursing profession, both of us understand the need to “get real” about structural racism because we’ve seen how it plays out at the patient’s bedside and in our own professional lives. In fact, Jasmine left hands-on nursing to pursue research into the policies, practices, and structures that impede good outcomes. Talking about the realities of racism isn’t easy, but being uncomfortable isn’t an excuse to avoid tough conversations. The goal is not to accuse or shame anyone, but rather to shine light on enduring inequities, the forces that perpetuate them, and the ways we can heal the damage they do.

As an example, Jasmine described differences in how hospital staff sometimes approach pain control. The immediate response to a White patient’s complaint tends to be “let’s see how we can ease the pain.” But patients of color face more scrutiny. Too often, the first question a healthcare provider asks is, “what’s really going on here?”—the assumption being that pill-seeking behavior needs to be ruled out before considering the use of pain meds.

This post is the first in a blog series that explores how preemption has served as a double-edged sword in either supporting or undermining efforts to advance health equity.

On a host of issues ranging from commercial tobacco regulation to public health authority, paid sick time to advancing the health of children and families, a policy tool known as preemption can impede local decision-making. Preemption is when a higher level of government, such as a state legislature, restricts the authority of a lower level of government, such as a city council. Depending on how it is used, preemption can either support or undermine efforts to advance health equity.

In one example of the latter, we know that health and economic well-being are intertwined, which is why raising the minimum wage has been used across the United States to advance health equity for workers in low-wage industries. In 2016, the majority-Black city council of Birmingham, Ala., passed an ordinance raising the minimum wage from $7.25 to $10.10 per hour. But the new minimum wage never took effect because the majority-White state legislature responded with a law preventing municipalities from setting their own minimum wages. It effectively nullified Birmingham’s ordinance.

Eight years later, Alabama still follows the federal minimum wage of $7.25 an hour. At that wage, someone working 40 hours a week, 52 weeks a year, earns about $15,080. Birmingham decision-makers recognized in 2016 that $7.25 an hour is not a living wage. Yet to this day the state still prevents the local government from acting.

Thirty-five local non-profits will be awarded up to $40K to work with local data to dismantle structural racism via a new funding opportunity.

Editor's note: This funding opportunity is now closed. 

As a mother of two girls, I often wonder what would it look like if women didn’t have to exit the workforce to cover childcare? If men taking paternity leave was the norm, rather than the exception? If our kids had more female and LGBTQ role models to look up to in elected office?

I became hopeful last year when the White House launched the United States’ first-ever National Strategy on Gender Equity and Equality—a concerted effort to make these “what ifs” a reality.

While we have seen important advances toward gender equity in the U.S, most improvements in employment, education, and income happened before the turn of the century. Progress has dwindled or stalled entirely in the past decade. The COVID-19 pandemic, which has forced women out of the workforce in record numbers, is a stark reminder of the gender inequities that still exist. It's time to reinvigorate our nation’s fight for gender equity.

This is the question at the heart of the award-winning film by director Raj Patel, "The Ants and the Grasshopper." It follows farmer, mother, and teacher Anita Chitaya as she travels from her home in Malawi across the United States to engage farmers, food justice advocates, and climate skeptics in conversations about how we can build a healthy future.

Malawi is struggling with severe child malnutrition. Rising temperatures and extreme drought have made it tougher to grow nutritious food and pushed more families into hunger and poverty. In the film, we meet and travel with Anita, who mobilizes people in her village—encouraging farmers to try new agriculture methods and plant nutrient-rich food, and even getting men involved in cooking family meals to help children in Malawi grow up healthy. We learn that Anita and the people in her village have achieved the seemingly impossible—tackling the issues of patriarchy, child malnutrition, and climate change in interconnected and impactful ways.

In 1966 our nation’s great civil rights leader, Dr. Martin Luther King Jr., proclaimed that of all the forms of inequality, injustice in health is the most shocking and inhuman. All these years later, this remains painfully true.

Study after study documents racism's brutal impact on health. Compared to White women, Black women are 3 to 4 times more likely to die in pregnancy, childbirth, or within a year after giving birth; Indigenous women face that prospect 2 to 3 times more often than Whites. Black and Latino adults disproportionately report being treated unfairly in healthcare settings because of their race or ethnicity and Blacks experience adverse patient safety events more frequently, even in the same hospital and with comparable insurance coverage. Even the consequences of climate change do their greatest damage to people of color, who are consistently exposed to higher levels of air pollution, live in hotter neighborhoods, and face greater food insecurity as agricultural patterns shift.

The impact of structural racism—the system in which our nation’s policies, institutional practices and cultural representation perpetuate racial inequity—became glaringly more visible during the COVID-19 pandemic and the racial reckoning that followed the anguishing murder of George Floyd. In an important step to advance racial equity and justice, many states and cities across the nation have declared racism a public health crisis.

Love and hate are not always words that come first to mind when we consider strategies to advance health and racial equity. But as I watch the divisions that continue to tear people in America apart—and bear witness, too, to the compassionate love that creates space for community—I have become convinced that these are foundational influences.

I have quoted the poet W.H. Auden on the brink of World War II to highlight the stakes. “We must love one another or die,” he wrote. Seven simple words that should guide us, both as individuals and as a collective force, in deciding what to say and how to act.

If talk of the redemptive power of love sounds abstract, let me explain just how directly it influences the Culture of Health at the core of the Robert Wood Johnson Foundation’s mission.