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Uprooting Racism to Advance Health Equity

Jan 4, 2022, 11:00 AM, Posted by Najaf Ahmad

Can we break free from a history of racism that has taken a brutal toll on health? These trailblazers offer hope through their efforts to advance racial justice and health equity.

Race, Health and Equity

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.

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How Love and Hate Influence Health and Racial Equity

Oct 27, 2021, 1:00 PM, Posted by Sandro Galea

To provide color and context for RWJF’s call for racial equity research, physician and epidemiologist Sandro Galea shares personal and professional insights on why we must turn to compassion and evidence-based action to heal the nation.

Girl with umbrella. Photo Credit: Pixabay, Yumu Hunzhu CDD20

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.

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Parks and Green Spaces, For the People and By the People

Oct 25, 2021, 1:00 PM, Posted by Toody Maher

Communities should be empowered to create safe, green, vibrant spaces and parks that everyone can access. Read how a group of citizens worked to support park equity, and how you can play a role, too.

A boy plays on a seesaw in a park.

The first time I visited Elm Playlot was on a bright, sunny afternoon in May 2007.

Elm Playlot is a small, one-half acre pocket park in the heart of Richmond, California’s “Iron Triangle” neighborhood. It is one of the few city parks and playgrounds in the Iron Triangle. The park serves a densely populated, diverse neighborhood that I knew was chock-full of children. However, when I visited Elm Playlot that afternoon in May, I didn’t see a single child playing there.

It wasn’t hard to figure out why.

A group of men sat on Elm Playlot’s benches drinking alcohol. The play structure and swings were tagged top-to-bottom with graffiti and menacing gang slogans. Litter was piled up around the picnic tables, the slide, and the swings: broken glass, hypodermic needles, cigarette butts, used condoms, empty liquor bottles.

Later, in conversations with community residents, I would learn that parents had regularly told their children not to play at Elm Playlot; it was too dangerous.

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What the United States Can Learn From Other Nations on Paid Leave Policy

Oct 13, 2021, 1:00 PM, Posted by Brigid Schulte, Jennifer Ng'andu

Policies like paid leave are working to advance gender equity at work and at home in other nations. We just need to expand them here in the United States.

Parents hold their infant child.

"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.

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Learning with Indigenous Communities to Advance Health Equity

Oct 7, 2021, 11:00 AM, Posted by Karabi Acharya

Tribal Nations, resilient stewards of the natural resources that give us life, can lead the way to a more sustainable and healthy future. Indigenous Peoples' Day marks the urgent need to embrace the expertise they’ve held since time immemorial.  

A woman speaks into a microphone at a dance show. A Tlingit Native welcomes an audience to a community house. The traditions and leadership of the Tlingit, the people indigenous to Sitka, are infused throughout the community, including through educational and environmental programs.

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.

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How a Native American Tribe Found Healing Through Horses

Oct 6, 2021, 10:00 AM

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

Editor’s note: Shortly after this video was published five years ago, Charlie Four Bear—the Native elder featured—passed away. His teachings about how to build resilience, however, continue to endure.

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.  

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Healing Our Rivers and Ourselves: Learning with Indigenous Peoples of New Zealand

Sep 22, 2021, 10:00 AM, Posted by Aleena M. Kawe

Our health is inextricably connected to the health of land, water, and all living things. The ways in which Indigenous peoples live that connection offer lessons that could benefit all of humanity. 

A woman stands on a walking trail bridge over a river.

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.

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Why Building Black Wealth is Key to Health Equity

Sep 9, 2021, 11:00 AM, Posted by Najaf Ahmad

To dismantle structural racism, says a renowned economist, our nation needs a new narrative—and systems and policies that advance racial and economic justice.

Illustration for racial wealth gap. Illustrator: Cat Willett

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.

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Closing the Medicaid Coverage Gap is a Health, Economic, and Moral Imperative

Sep 7, 2021, 11:00 AM, Posted by Avenel Joseph

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

Illustration of the U.S. highlighting states without Medicaid expansion.

“I am grateful for Medicaid because I can live on my own,” said Theresa, who has Spastic Quadriplegia Cerebral Palsy. Medicaid covers the costs associated with Theresa’s physical and occupational therapy, a wheelchair, and personal care attendants.

“I wouldn’t be alive if it wasn’t for Medicaid,” said Laticia, who received Medicaid coverage while growing up in the foster system that allowed her to receive care for both physical and mental health conditions.

“Medicaid has been a blessing,” said Regina, who relies on Medicaid to cover her daughter’s routine medical and preventive care that would otherwise be unaffordable.

There are approximately 75 million people in the United States enrolled in Medicaid, making it the largest health care provider in the country. And while each participant’s story is unique, Theresa, Laticia, and Regina have at least one thing in common: each lives in a state—Montana, Missouri, and Iowa, respectively—that has expanded Medicaid under the Affordable Care Act (ACA) to provide quality and affordable health care coverage to more of its residents. In fact, 38 states have done so since that landmark law was enacted.

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.

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Database Tracks Health Equity Implications of State COVID-19 Policies

Jul 28, 2021, 2:00 PM, Posted by Julia Raifman

A publically available database is helping researchers, policymakers, journalists, and others understand how over 200 state policies implemented during the pandemic are impacting health equity.

COVID-19 U.S. State Policies image.

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.

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