Angela Glover Blackwell: NewPublicHealth Q&A

Nov 20, 2012, 5:13 PM

file Angela Glover Blackwell, PolicyLink

Health disparities and social equity were key issues addressed at last month’s American Public Health Association (APHA) annual meeting. Angela Glover Blackwell, founder and CEO of PolicyLink, a national research and action institute whose goal is to advance economic and social equity, participated in the APHA president’s panel on the topic, where a key part of the discussion focused on the language used to discuss health disparities in the United States.

NewPublicHealth followed up with Angela Glover Blackwell to get her insights on the language of health disparities.

NewPublicHealth: During the panel at the APHA meeting, you talked about the need to be mindful of the language we use when talking about improving health for all Americans. How should we be characterizing the issues?

Angela Glover Blackwell: It is certainly good to see that the health world, public health and beyond, is talking about health disparities. Because for many years this was not anything that people talked about and it was not a topic at the American Public Health Association or any of the other big main stream meetings where health professionals gathered. So it’s a good thing that people have begun to talk about health disparities.

But, health disparities really talks about things being unequal. That’s what disparity means—unequal, different. But I don’t think that disparity captures what the condition is, nor does it suggest what the solution is. What I have heard others say and I have taken it on myself is the term health inequities, because the term “inequities” suggests unjust, unfair, and not just different. When you call them health inequities you focus on a societal problem that needs to be corrected, not just studied. The goal becomes achieving health equity, just and fair health outcomes.

It’s time that we recognize that we have unequal, unjust, unfair health outcomes and that they are related to race, and income, and place and we need to get sharp strategies that move us towards being able to help all people reach their full potential.

NPH: Where do we need to take the conversation from here?

Angela Glover Blackwell: I am glad that people are beginning this conversation on health, but I hope that we won’t be so self-satisfied that we don’t delve deeper, look for nuance, put it in social historical context and begin to tie it to other important movements that are taking place in this country that I think are part of a real equity movement for full inclusion in America.

NPH: Can you give us an example of an equity movement where someone is looking at an equity issue that might serve as a strong model?

Angela Glover Blackwell: The Harlem Children’s Zone  is a wonderful example of achieving educational equity for children who are lucky enough to live there. In that geographic area, they don’t talk about how to deal with the disparity between the education of black and white children—they say we have to make sure that all children can be healthy, start school ready to learn, have access to a good school that prepares them to be able enter a career to reach their full potential. And the result is that, on average, black children that are in the Harlem Children’s Zone have surpassed white children in the New York School District [in average educational outcomes]. So you wouldn’t have wanted to just make your goal to try to close the difference between black and white, the goal is to try to create the conditions that allow all children to reach their full potential—their full educational potential, their full health potential, their career potential.

NPH: Are there ever important nuances that distinguish and differentiate different minorities that are important to identify for health and other issues?

Angela Glover Blackwell: Yes, I do think that once you take on the equity challenge of just and fair inclusion into a society in which all can participate, prosper and reach their full potential, it requires you to peel the onion. You keep peeling that onion and you will find that people’s individual journeys, their interaction with a larger society, but also their interaction with their culture, with their families, with their communities is contributing to what is going on. And the journey of being Caribbean is different from their journey of being African American living in Mississippi; the journey of being a Pacific Islander is different from the journey of living in Chinatown and being a person of Chinese descent. That peeling of the onion both helps you to see the individual but it also helps you to see the individual in relationship to society. And that helps us to develop particular strategies, but it also points to societal strategies, policies and refinements that we have to make about the way that we are seeing and stereotyping people. It helps us to understand the interactions of things like being poor and Black in urban America, which is different from being poor and Black in Mississippi and is different from being White and poor in New Haven, Connecticut.

NPH: Should there be just one term for the goal of improving health equity?

Angela Glover Blackwell: No, I don’t think so. I think that it is dangerous to come out with a decision or even a study that says not to talk about a subject in a certain way. It may be that the ways you say not to talk about it are precisely the ways you need to talk about it in particular communities.

So when I use my language, I always respect that other people may move at a different pace and work in a different way. We need to create a huge space, a lot of flexibility, a lot of openness and understand that many conversations have to happen simultaneously using different language in order for us to reach a plateau in this nation where we can come to some conclusions about who we want to be as America.

When we started PolicyLink we consciously chose to be an organization that was focused on equity at a time when no one was using that term because we wanted people to ask us what we meant by the term. We wanted to start a new conversation about inclusion in America. It was a conscious decision to use a new term rather than the old terminology because we thought we needed a new conversation. 

This commentary originally appeared on the RWJF New Public Health blog.