By Tekisha Everette, Executive Director of Health Equity Solutions

“All of us need to recognize that racism exists, that it’s a system, that it saps the strength of the whole society through the waste of human resources, and that we can do something about it.” – Dr. Camara Jones

Black History Month 2021 is like no other in our history! Celebrated since 1969, this is the first time we are acknowledging and recognizing the rich history and legacy of Black people during a global pandemic that has taken a disproportionate toll on Black people, Black communities, and the Black population broadly. We are still moving through, reckoning with, and overcoming the summer of 2020, where the outrage at inequities in the hardships caused by the pandemic and stay-at-home orders converged with outrage at police violence against Black people. These two combined traumas left many of us asking, “What can we do?” People sought opportunities to take action that wouldn’t quickly fade away or offer the illusion of addressing deeply entrenched problems in one, quick step. A movement urging elected officials to declare racism a public health crisis grew out of an urgency to hold leaders and policymakers accountable for dismantling racism.

Across the country, over 180 cities, towns, counties, and states have made statements. Dozens more have come from health systems, professional associations, academic institutions, and organizations like the American Public Health Association. Why? These declarations are an opportunity to acknowledge the physical and emotional trauma caused by racism.

Our county’s rampant health inequities are rooted in structural inequality that has privileged some individuals and communities and disenfranchised others. People of color are disproportionately likely to live in densely populated neighborhoods, work wage-based jobs, have less wealth, and suffer from chronic health conditions such as asthma and diabetes. These disparities are the result of discrimination in employment, banking, education, civic, and health systems, and other systems with deeply rooted racism. As Dr. Sara Goza, American Academy of Pediatrics President, puts it: “Racism harms children’s health, starting from before they are born.” She adds: “Our nation did not get here overnight, and the road to progress and healing will be long and difficult, but the work we have before us is essential.”

In Connecticut, Health Equity Solutions has supported local elected officials and activists in dozens of cities and towns working to pass resolutions and then take concrete action. Since June, 20 Connecticut municipalities have made declarations that racism is a public health crisis, as has the Mashantucket Pequot Tribal Nation. The process has spurred productive and often passionate conversations about the role that every town, regardless of size or demographics, can play in addressing racism’s harms and in examining and correcting the racism in the processes and policies of government. Connecticut’s state legislature is discussing a similar proposal, with the goal of embedding an equity lens in policymaking.

What happens next? Many towns have formed working groups to complete equity audits of town policies. Tools like those created by the Racial Equity Alliance and ChangeLab Solutions can guide these processes. Others have held public hearings or are debating action on issues central to health and racial justice such as housing and education policy. Among the many opportunities for advancing health equity through policy, embedding anti-racism in decision-making processes is a clear opportunity for ensuring the work doesn’t end with one change or progress in a single sector. For example:

• Health equity in all policies is a collaborative, cross-sector approach that can be leveraged to apply an equity lens to all institutional policies. Several states have created a structure in their executive branches to oversee this approach and to hold stakeholders accountable for identifying and carrying out policies and processes that address equity. This is an adaptation of the American Public Health Association’s “health in all policies” approach

• Racial impact assessments are analyses of the potential for proposed policies to exacerbate or mitigate disparities. Some state and local governments use such assessments to identify unintended adverse consequences before enacting legislation. This is one way of embedding an equity lens in legislative or municipal decision-making and can also be applied by organizations and systems to avoid perpetuating racism so embedded in the status quo that we may not immediately identify it as racism. 

• Standardized collection and consistent reporting of race, ethnicity, and language data is necessary to identify and address inequities in health. Frequently, organizations and governments claim to be acting in an anti-racist manner, while also being unable or unwilling to evaluate and adjust initiatives to ensure they are effectively addressing the inequities caused by racism. For example, states report on race and ethnicity for measures of the COVID response at varying levels of completeness and detail.

A good starting point for action is publicly acknowledging that racism—through structural disadvantages and the “weathering” of daily experiences—is a public health crisis that results in far too much preventable suffering and death.

A value statement does not dismantle generations of injustice deeply entrenched in our ways of doing and governing. No one statement or change can. This is a place to start, because we can’t address a problem we are unwilling to acknowledge.