Jacquelyn A. Brown, MPH, is the program officer for Communications and Outreach at the Consumer Health Foundation, a private, nonprofit grantmaking organization whose mission is to improve the health status of Washington, D.C.-area communities—particularly the most vulnerable members of these communities-and to support activities that enable people to be more actively involved in their own health.
Previously, Brown was a community outreach educator/coordinator at the Virginia Department of Medical Assistance Services. She performed community outreach to enroll children into the Family Access to Medical Insurance Security (FAMIS) program, Virginia's State Children's Health Insurance Program. Before that, Brown worked for five years as the assistant health editor at Essence magazine, where she edited, researched, and wrote articles on African-American women's health.
In an article prepared especially for BPA, Brown outlines some of the issues surrounding the health and well-being of Black and other communities of color.
How do social justice issues relate to public health for Black people?
First, let me provide some context. Racial and ethnic health disparities have been focal issues in public health for more than 20 years, yet the fact remains that African Americans and other people of color get sick faster and more often and die younger than whites. This glaring Black-white gap in health status and outcomes has primarily been attributed to socioeconomic issues that disproportionately affect African Americans, such as low-incomes, lack of access to regular health care, and little or no health insurance. However, having regular health care isn't a remedy in and of itself for better health or closing the Black-white health divide. Even with comparable access-related factors, such as higher income and having health insurance, African Americans tend to receive a lower quality of health care compared to whites, as illustrated in the Institute of Medicine's landmark book, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare." And despite many community-based health promotion campaigns and programs targeting African Americans with conditions like high blood pressure, diabetes, and prostate cancer, the Black-white health divide not only persists, but continues to increase in many instances, as evidenced by the data in "Healthy People 2000."
All of this has led many public health activists and researchers to look "upstream." They want to learn why Black folks get sicker and die faster than whites in the first place. What has been documented in the past decade or so is that health is more than just medicine and health care; our health is inextricably linked to our social condition and environment. In a nutshell, racial and ethnic health disparities exist because they are a byproduct of the cumulative and intergenerational effects of unrelenting social, political, and economic inequity and their associated effects, or more directly, structural racism. For an insightful analysis of structural racism and its impact on health, I strongly suggest reading, "Levels of Racism: A Theoretic Framework and a Gardner's Tale."
What are some examples of the current thinking around health and well-being in the Black community?
There is much research, dialogue, and movement in exposing, examining, addressing, and eliminating the conditions and circumstances that create racial health disparities and inequities. Termed the Social Determinants of Health or "health justice," this framework addresses the root causes of community and individual health and well-being—those societal conditions that determine the quality of our lives and, therefore, our health. Such causes include, but are not limited to, quality and affordability of housing, level of employment and job security, standards of living, the health of our surroundings (for example, air, water, and environmental quality), availability of mass transportation, quality of education, forms of clean economic development, racism, poverty, distribution of goods and services, chronic stress and workplace conditions. A publication called, "Health Report: Why "Place Matters" in the State of the Union," published by the Joint Center for Political and Economic Studies, describes these causes in more detail.
It's important to note that too often, most public health research and community health interventions and campaigns targeted to "reduce health disparities" tend to focus solely on changing individual behavior—programs that most foundations usually fund. While well-intentioned, these programs actually miss the mark in their attempt to close the overall health gap. Personal behavior is important, but only when it's addressed within the context in which people live and where they live because those factors determine how they live. This is why the Social Determinants of Health framework is so critical as a progressive, broader, and holistic approach to eliminating the racial health divide. It puts our health and related behavior into the context of our daily lives.
There are initiatives in place to address racial health inequities using the Social Determinants of Health framework. An example would be the Health Policy Institute of the Joint Center for Political and Economic Studies. The institute's mission is to ignite a "Fair Health" movement that gives people of color the inalienable right to equal opportunity for healthy lives. To this end, the institute has two important initiatives:
- PLACE MATTERS. This is a multiyear, cross-sectoral collaborative that uses a community-level approach to measure, address, and eliminate racial health inequity within a social equity context using evidence-based interventions. Thirteen counties are piloting PLACE MATTERS, including our region. Among the institute's partners are the W.K. Kellogg Foundation, The California Endowment, the National Organization of Black County Officials, and the National Association of County and City Health Officials. Check out the institute's website for more information.
- The Health Policy Institute published the "Dellums Commission Report," a series of studies highlighting the public policies of the past 25 years that have hindered opportunity for young men of color and the effect of those policies on their social and physical health and well-being. The report offers ambitious policy recommendations in the critical areas of education, family support and child welfare, workforce and economic development, juvenile and criminal justice, the media, and health and health care.
How can BPA, its members and their foundations advance health care outcomes for Black people in the region?
There is a distinction between health care outcomes and health outcomes. The DC Primary Care Association's Medical Homes DC Initiative is on track to become one of the most comprehensive health care safety-net systems in providing regular, quality health care to all D.C. residents, regardless of their ability to pay. In terms of health care coverage in the District, the DC HealthCare Alliance and the DC Healthy Families Insurance Program are among the progressive health programs in the nation in terms of coverage. Many local foundations, including mine, are big supporters of Medical Homes DC and programs that enroll families in the DC HealthCare Alliance and DC Healthy Families. These programs have the strong potential to help decrease the Black-white gap in access to health care. However, understanding the critical role social determinants play in health status, these programs alone are not enough to address inequities in health status and outcomes in the region.
To truly eliminate racial health inequities, we must have effective policies that tackle health challenges by addressing the underlying social conditions that make our communities more vulnerable. But I believe that first we must all be educated on racial health inequities within the Social Determinants of Health context—that is, tangibly connecting the dots between social inequity and health inequity—in order to have a shared understanding and a common language around these issues. While the concept of addressing health through a social justice lens is not new, it is new to many, including many who work in public health, and it is this disconnect that causes concern among many public health workers, activists, leaders, and funders as to how to address health as a social justice issue. A great primer on this is a draft working paper called, "Creating Health Equity Through Social Justice," by the National Association of County and City Health Officials. I also suggest looking at the work of national organizations based here in DC like The Opportunity Agenda, Praxis Project, and CommonHealth Action. These organizations take various approaches to advancing community health through social justice. For a global perspective, visit the World Health Organization's Commission on Social Determinants of Health webpage.
Most of our foundations fund "vulnerable" populations, which are usually members of low-income communities of color. We fund in health, in education, in housing, or youth, the elderly, or some other distinct identity group or issue we feel includes the most underserved or under-resourced. The thing is, we're all working in the same communities. In order to gain any real traction in creating healthy communities, we need a long-term, holistic, and integrated approach and one that ultimately addresses both the acute day-to-day conditions of people's lives. We must also work on the "upstream" issues, such as the policies—including the data and faulty belief systems that create them—which ultimately determine people's life opportunities and community environment. We can no longer accept racial and ethnic health disparities as an unfortunate side effect of social inequality and keep doing what we've been doing to address health disparities. Just as these policies were created, they can be un-created. If we create policies that give communities of color unfettered opportunity to live in clean and safe environments, have equal access to necessary goods and services, affordable homes, affordable healthy food, a quality educational system that values, nurtures and supports its teachers and students, jobs with fair wages and benefits, and power to determine what happens in their communities, we will virtually eliminate all disparities across the board.
How can BPA members learn more about this topic?
BPA members and their foundations can learn more about Social Determinants of Health initiatives like PLACE MATTERS and the work of the abovementioned organizations and support their efforts. They can also learn how other philanthropists in the field are supporting this work, such as the BlueCross and BlueShield of Minnesota Foundation's Social Determinants of Health initiative Moving Upstream: Working Together to Create Healthier Communities.
An easy way to get started is to learn more about and become a partner in California Newsreel's Public Impact Campaign for its "Unnatural Causes" series to help reframe the national debate on health disparities and to educate communities and policymakers via foundation-sponsored, community-based viewings and town hall meetings on what we as a society can and should do to eliminate health inequities. Foundations can also use the series to inform their own institutional work as well.