This blog is part of a series that will highlight how structural racism in the health care system negatively affects the health of individuals of color. Community Catalyst is committed to exposing and dismantling policies, practices and attitudes that routinely produce cumulative and chronic adverse outcomes for people of color in the health system.
Our advocacy around race and health requires us to address racism as a cause of poor health, recognizing that without addressing this root cause, attempts at solving health inequities will continuously fall short. However, in order to bring full awareness to the consequences of racism on health outcomes, we must take a step even further back, and address the ways structural racism is embedded in health policy and health advocacy. When the foundations for the health advocacy strategies that shape our policies are flawed, we build structures that benefit some people above others. We then spend the rest of our time and energy trying to find resources for how it can benefit everyone that was left out, repeatedly finding that these systems do not work for people they weren’t originally built for. In doing health advocacy work, I am often taken back to childhood memories of translating important medical information and conversations between doctors and my mother, both of them speaking a different language in more ways than one, and even then I understood that the health care system was just one more place where we, a family of immigrants, didn’t belong. The system wasn’t made for us, and therefore very seldom did it meet our needs.
The story of health policy in the U.S. continues to be one of racial discrimination in coverage access and health care delivery, and advocates often find themselves fighting the same battle on many fronts. Even when health policy shifts towards racial inclusion we see that the impetus for the shift is often tied to the sudden realization that the issue also impacts whites. Take for example, conservative white America’s newfound support for the Affordable Care Act- Judy Lubin, a sociologist and adjunct professor at Howard University in an interview with CNN described the recent shift: “Americans now realize Obamacare helps millions of working class whites and that it’s not as once portrayed by conservatives a form of welfare pushed by the first black president to help people of color.” As health policy advocates working tirelessly to preserve the ACA and the coverage it provides millions of Americans, we must find ways to showcase the new voices of conservative whites without drowning out the ones of people of color whose sustained support helped pass and implement the law and whose lives will be disproportionately affected by its loss.
One way health policy advocates can stand against structural racism is by continuing to center our work on health equity, especially while in campaign mode. It is in these moments of chaos that we must ensure that the need for a “win” does not come at the expense of sidelining voices of color. The win that comes at the expense of marginalized people does not effectively support those people in the end. Instead, it guarantees that we will get less than what we need, and we will have compromised our values to get there. Take for example the current campaign to save the ACA, one where we recognize that those most likely to be hurt by a repeal are the voices least likely to have any sway with most Republican members of Congress. However, if we allow policy advocacy and negotiations to meet the standard of who is most likely to be heard, we fail all of the people who already feel left out of the process.
Equitable health advocacy requires that we build coalitions and the collective power necessary to ensure health policies serve diverse populations. Strategic power building elevates the voices of those most likely to be heard as a tool for bringing into the conversation those historically silenced. When equitable health advocacy is used to promote policies not on behalf of but rather in partnership with communities of color, we reset the expectation of who advocacy works for. This is the only way we can avoid elevating the plight of white people in hopes that there will be leftover resources for people of color. As a health advocate, and a person of color, I understand that through my proposed strategy approach of all of us – not just some of us. When we lose, we all lose. However any strategy that doesn’t see people of color as essential to the fight, also guarantees that even when there is a win – people of color continue to lose.
Only through the intentional inclusion of diverse communities can we continue to take active steps to interrupt and dismantle systemic racism. By working with government agencies across sectors, health care providers and community leaders we can identify opportunities for equitable health policies and create innovative strategies for addressing disparities as well as the continual investment in the health and success of communities where racism actively disrupts progress.