No one in the United States should have less of a chance to be healthy because of their zip code, income or race. Accounting for historical trauma must be part of solutions toward addressing health disparities.
My sons are both in college, one at Howard University in Washington, D.C., and the other at Knox College in Galesburg, Illinois. Raising African American boys into adulthood was often stressful. Despite the many advantages and supports we had as a family while they were growing up, I worried about their safety, whether their schools would see and nurture their greatness despite the color of their skin, and whether they would be able to live up to their potential.
As a public health practitioner, I’ve also had the opportunity to observe the amazing efforts of so many caregivers and families with limited resources who heroically “make a way out of no way.” I’ve seen what it takes, for example, for a mom to just get her children to a doctor’s appointment when they each go to a different school because the schools in their neighborhood are not the best she wants for them. I’ve seen the enormous emotional, physical, and mental energy families with fewer economic resources spend simply on surviving day to day—and I know that statistically, the burden of poverty falls particularly heavily on children of color.
I’m now director of University of Wisconsin’s Population Health Institute, which has for nearly a decade compiled the annual County Health Rankings. The rankings have helped communities across the nation see how where we live makes a difference in how well and how long we live. This year we’ve added a layer of analysis that hits home for me, highlighting the meaningful health gaps that persist by race.
We wanted to cover both place and race because county-level rankings can mask the deep divides we have in the health of different groups within communities. Even in counties with the best rankings—and the highest overall level of opportunity for good health—not everyone in every part of the county has access to opportunities for safe housing, adequate physical activity or a good education.
For me, knowing we still have gaps to fill is a call to action, especially as we mark National Minority Health Month. So how do we overturn the current reality and give everyone a fair shot?
Menominee Nation is improving health by reclaiming traditional culture and using trauma-specific interventions to foster healing from historical losses.
Accumulation of Disadvantage
The U.S. has a long history of racism and discriminatory policies and practices that have limited the opportunities of people of color. These include practices like denying housing loans to people of color, forcibly removing Tribal nations from their lands, and funding public schools in ways that disadvantage less affluent communities. The result has been an accumulation of disadvantage through decades and generations. Some groups have been denied or had limited opportunities for housing, health care, education, employment, food, safe neighborhoods and fair inclusion in decision-making.
There has been progress in my own lifetime. And yet, even in the decades since legal desegregation, numerous policy decisions—including those that have led to mass incarceration—have advantaged some groups and disadvantaged others.
Communities that have been left behind for years are less likely to be economically stable now and for generations to come. And the differences in opportunity people in those communities experience have a deep impact on health, leading to disturbing ongoing disparities that start at birth, as the 2018 County Health Rankings Key Findings Report shows:
Compared to white babies, black babies are twice as likely to be born at low birthweight and about twice as likely to die before their first birthday. Low birthweight babies have elevated lifetime risks of diabetes, heart disease, and high blood pressure.
Rates for Black and Hispanic children in poverty are worse than for whites across all types of counties. Children living in poverty are less likely to have access to well-resourced and quality schools and have fewer chances to be prepared for living wage jobs that can lead to upward economic mobility and lifelong good health.
1 in 4 American Indian/Alaskan Native, black, and Hispanic youth do not graduate from high school in four years, compared to about 1 in 10 white and Asian youth. In communities of color with more children in poverty, there are more under-resourced and overcrowded schools. Children who attend sub-standard schools don’t have a fair chance at a good education, which has major implications for their future job opportunities, financial resources, social networks, and life choices.
The Road Forward
No one in the United States should have less of a chance to be healthy because of where they live, how much money they make, or the color of their skin. We know that if we build strong communities then our children will become more resilient and healthier adults.
Culture of Health Prize winners Louisville, Kentucky and Menominee Nation in Wisconsin understand that effective approaches toward improving community health must address the impact of historical trauma.
As we work to put solutions in place, it is essential that we meaningfully involve the people who are experiencing poor health outcomes. Their input is key to identifying the right solutions and making them work for their communities. For example, Louisville, Kentucky, has brought together its arts, business, health, education, law enforcement and social service sectors and citizens of neighborhoods most affected by poor health. They’ve turned statistics and data into tools to rectify health inequity. Most recently, the Greater Louisville Project—which aims to improve education, jobs, and quality of place—estimated that the human, social, community and financial toll of poverty costs the city $200 million a year in economic growth. The city hopes to use the data it has collected on the barriers facing families in poverty to design coordinated interventions that reduce those obstacles.
It’s also essential to consider the impact of stress and historical trauma on people’s lives and health. For example, stresses disproportionately felt by Black women may be behind the distressing disparities in birth outcomes in the United States. Historical trauma has been connected to the high unemployment rates experienced by Native Americans and the gap in graduation rates between Native youth and White youth.
By embedding an understanding of historical trauma into its work to improve education outcomes for its young people, Menominee Nation in Wisconsin has been able to boost graduation rates. Trauma-informed care strategies—such as a morning “mood check-in” via computer and refuges such as “safe zones” in the corners of classrooms with grown-ups on hand to talk things out—keep students on track with their education. A goal is to arm young people with positive coping skills and avoid negative health behaviors like smoking, drinking and drug use.
In my own neighborhood of Sherman Park, community engagement and a historical view of trauma are both key components of an effort to spur economic development, remove obstacles for entrepreneurs of color, and improve opportunities to engage in healthy lifestyles. Following an “uprising” in 2016 after an officer-involved shooting, two local business leaders, Milwaukee philanthropies, state and local government and community residents, including me, are pooling investments to bring the Sherman Phoenix neighborhood center to life. In community conversations, neighbors spoke about the need for safe, welcoming neighborhood spaces and better opportunities. When the center is complete in fall 2018, it will offer space for small businesses-of-color, wellness services, and cultural activities.
I encourage every community to look at their County Health Rankings data and work together to find solutions so that everyone—regardless of their race and ethnicity—has the opportunity to be healthy. Community leaders can pave the way by listening, valuing relationships, facilitating and supporting change outside the health sector, and highlighting the ways everyone gains from programs that promote health equity. Together, we can make health disparities a thing of the past.
Sheri Johnson, Ph.D., is the director of the University of Wisconsin Population Health Institute. She has dedicated her 25+ year career to partnering with children, families, community organizations and systems to advance health and well-being.