How Love and Hate Influence Health and Racial Equity
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.
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.
Choosing love to advance health and racial equity starts with acknowledging both the harms that have been inflicted upon some populations and a celebration of all that we have in common and how we are stronger together. Then we must move from acknowledgement to action, confronting the structures that have undermined equity and removing barriers to opportunity. The starting place is respect and acceptance, and only then can we journey on toward equitable access to opportunities for health and well-being.
The polar opposite of love is hate. Sometimes, that is expressed overtly, through violence and cruel rhetoric, but often, it lodges in the more subtle forms of discrimination embedded in our systems, policies, and practices. Racism, an antithesis of compassion, has been a dominant form of hate in this country for centuries, marginalizing people on the basis of a single characteristic, the color of their skin. Hate is expressed in other ways, too, as when individuals elevate a single identity, value, or point of view above all others or when institutions discriminate on the basis of gender, religion, immigration status, or sexual orientation. All of that allows us to “other” people, a mindset that makes it easy to see them as less deserving and thus justifying disparities in access to healthcare, education, housing, and so much else.
The counterweight to the forces of hate must be love. By fostering compassion and reminding us of our shared humanity, love can clear a path through social, economic, and environmental inequities. Turning to love means refusing to tolerate injustice anywhere, to anyone, and instead embracing diversity and inclusion. When a broad mix of people with differing perspectives and lived experiences participate fully in the process of analyzing challenges, generating ideas, and making decisions, the conditions to pursue equity are ripe. But frustration, rage, and the spread of misinformation too often blinds us to our common cause. A reluctance to hear opinions across the political spectrum can close doors. If we are unwilling to listen to those with whom we vehemently disagree, we not only minimize their concerns, but also lose the opportunity to sharpen our own thinking.
My own life, blessed by privileges that so many others have been denied, has taught me much about the forces of love and power. I am profoundly grateful for the opportunities I have had in this country, but as an immigrant who came to Canada from Malta at the age of 14 and then moved to the United States in my late 20s, it would be naïve to pretend my path was burden free. I do not talk readily about some of the slights I encountered on that journey, and that I continue to encounter, in part because I know that others have endured so much worse. But let me share one story that speaks to the careless treatment of those who are perceived as different.
In high school, my English teacher kept grading my essays with a C-minus. I could not understand why—until I realized he was not actually reading them, but rather assumed they could not be well written because I spoke with an accent—as I do to this day.
My experience as an immigrant has allowed me to see the world through the eyes of an outsider. Those of us who are not native born bring a distinctive lens to the legal, physical, and symbolic barriers that exclude some people from full participation in American society. Our personal awareness of how structures and systems are set up to sideline certain populations readily translates into an unyielding sympathy for those who cannot access power and privilege.
An Imperative to Advance Collective Healing
The COVID-19 pandemic is a perfect example of the health-damaging consequences of being so locked into our mindsets that we are unable to talk to one another. It is hard not to wince at the schisms that have allowed so clear a societal benefit as vaccines to become a divisive tool. But if their safety and effectiveness is clear to most of us in public health, the intensity of the resistance in some quarters tells us not only that we are deeply fractured, but also that we have enormous incentives to come together. Dismissing people who are mistrustful of vaccines undermines our ability to articulate counterarguments and change minds.
And here I think we have to consider the nature of power and its role in shaping our thoughts, desires, and beliefs. Too often used to amplify and reinforce the societal inequities that generate a wellspring of anger and suspicion, power can also be applied to advance the collective good—to spread love, not hate, in our communities. Wielded properly, power can be a tool to alter the structures that have preserved racism, intensified economic disparities, and harmed so many. For example, researchers have identified ways to identify policy interventions that minimize economic and health disparities. Another study finds early evidence that guaranteed income improves health and well-being in a medium-sized city. We need to seek innovative opportunities to inform decision making and catalyze the structural changes that enable racial and health equity.
A Funding Opportunity: Innovative Research to Advance Racial Equity
“Othering” mindsets, my experience as an immigrant, power dynamics: All of these have very much informed the ways in which I think about health, and how I perceive the impact of marginalization and hate-fueled racism. RWJF’s Evidence for Action (E4A) program encourages and supports innovative, rigorous research on the impact of programs, policies, and practices on health and well-being, focusing on research that will help advance health and racial equity. We already know that racism is detrimental to health and are not looking for science to re-establish that unassailable fact. Rather, we want to know exactly how structural racism expresses itself and what we can do to confront it.
That is the focus of Evidence for Action’s funding opportunity. We seek proposals on a rolling basis that studies how we can dismantle unjust systems and practices. We want to hear ideas from a wide range of people—researchers, practitioners, community leaders, advocates, policymakers—and we welcome multidisciplinary teams.
Together, we can move toward health and racial equity by focusing on the foundational and structural drivers of health. Learn more and apply today.
About the Author
Dr. Sandro Galea is the dean of the Boston University School of Public Health. He is the former Chair of Epidemiology at the Columbia University Mailman School of Public Health, among other leadership positions, and author of the forthcoming book, The Contagion Next Time.