Racism and Public Health: Seeking an Improved Approach for the New Decade
As a nation, we’ve erred deeply—both historically and in our inadequate efforts to counteract that history—and our mothers and babies of color are paying the ultimate price with their lives.
A little over two months ago, I attended a two-day summit organized by First Year Cleveland and the YWCA Greater Cleveland: 400 Years of Inequity: A Call to Action. The summit, which marked the 400th anniversary of the enslavement of the first Africans in North America, called on attendees to acknowledge racism as a public health crisis and advocate for change.
While at the conference, I listened to three women of color from Milwaukee describe how their local government made history by declaring racism a public health crisis; I watched a woman tell us through her tears how much hope that public declaration gave her.
Milwaukee’s alarming statistics on racial disparities are not unique to Milwaukee; they are reflected in towns and cities across the country. Racism is a public health crisis. It harms women, children, fathers, grandparents, aunts and uncles across the country. It harms all of us—it has for over 400 years and continues to today.
And so, when I considered what to share with you at the beginning of this new decade, it wasn’t difficult to decide how to spend this space and your time. NICHQ’s vision and priorities for the next decade will focus on addressing racism as the public health crisis that it is.
Yet despite knowing what I wanted to say—the challenge for me has been exactly how to say it. Because as a white male, who benefits from white privilege, I struggle with how to find my place in this conversation about racism. But I’m learning how to sit in my discomfort and push through it, because my discomfort is not what’s important.
Talking about racism is what is important. And that brings me to my first goal, both personally and professionally, as we embark on this new decade:
1. Acknowledge and accept that this conversation can be uncomfortable and engage in authentic dialogue.
If we don’t do this—if we instead let discomfort stop us from engaging in these conversations—then our silence ultimately helps perpetuate racism and its consequences. Our silence encourages its continuance.
To dismantle racist systems then, we must all engage in conversations about those systems. I am certainly not the first person to acknowledge this need, which is why I want to both affirm it and add to it: I believe that for these conversations to be inclusive and inspire trust, they must be authentic. And to do this, we need to create space where people are willing to be vulnerable. This means being honest about who we are and the biases we inherently bring; and being willing to sit with and address those biases.
For over three decades, I’ve been deeply committed to improving health outcomes for all children and families: First, as a young pediatric emergency physician scrambling amid the controlled chaos of an emergency room; then as a public health professional committed to preventing illness and injury from occurring in the first place; next, as a father trying to save his child—and others across the globe—with a rare disease that does not discriminate by zip code or country of origin; and now, as the CEO of a quality improvement organization committed to helping health care professionals, families, and communities tackle the most complex health issues facing children and families.
With each day, across my entire career, I’ve come to realize just how personal this work is and the introspection it requires. We can’t hold our personal selves as separate from the systems we acknowledge are flawed; our personal selves are wrapped up in the very flaws of these systems. We all have a personal responsibility to advocate for change within these systems. And if we don’t, we are ultimately complicit in their endurance. Change, then, depends on personal commitment and responsibility and being honest and authentic in this process.
This goal of authentic engagement, then, leads me to my second goal:
2. Lead with humility.
I use the word “lead” here purposefully, as it encompasses more than one meaning. It describes how we “lead” as an organization, both on our projects and as an institution; and it refers to what should “lead” our intentions and actions, whether we are in a leadership position or not. When addressing racism, humility must be the answer in every instance.
We’ve seen this in our work as the Technical Assistance Center for Healthy Start. In this role, NICHQ is supporting communities where institutional racism and implicit and explicit biases gravely impact the health and well-being of moms, babies, entire families, and communities. To engage in this work fully, we must be humble. We are new faces among the Healthy Start communities. Building true partnerships with them depends on demonstrating trustworthiness. And that can’t happen unless we give up and share power, so that the communities’ knowledge and experiences guide every change strategy.
This same mindset holds true as we assess our own internal structures at NICHQ. In 2016, we launched a five-year strategic plan with a stated focus on equity. Over the past four years, I’ve seen our organization make important steps in pursuit of this goal. We are more purposeful in identifying and promoting hiring practices that support diverse staffing. We are building an internal culture of inclusion and accountability and equipping our staff to tackle these complex conversations both personally and on their respective projects. I’m proud of this improvement. I am also deeply aware that this is a journey and there will always be more to do. I am eager to continue on this path with an open mindset. As our internal efforts continue towards greater equity, we know we don’t have all the answers. We will celebrate our successes; we will acknowledge our blind spots; we will not be afraid to consistently re-evaluate our approaches; we will engage in continuous improvement; and we will hold ourselves accountable, both internally and publicly.
The beginning of a new decade to promote change.
2020 is the 401st anniversary of enslavement. On the one hand, this marks one more year that African Americans in our country will be forced to navigate the consequences of enslavement; on the other hand, it means that we are one year closer to changing that narrative for African Americans and other people of color in this country suffering the negative effects of racism. We are one year further on a journey towards equity.
As we enter into this new decade, this hope is at the heart of NICHQ’s vision. It informs each of our initiatives and motivates every one of us. But I believe that this hope won’t become a reality unless leadership within the health care industry and institutions—especially those of us who are white—pause, rethink our approach, and move forward with a true intention to be authentic and lead with humility. As NICHQ’s CEO, I pledge to embrace that approach and to actively encourage it among others, both personally and professionally, as we embark on a new decade of improvement. I invite you to hold me and our organization accountable.
Looking for resources? Register for NICHQ’s new webinar, From Awareness to Action: Strategies for Combating Racism in Health Systems.
