Health Equity, a subversive concept

Race and Sustainability,Winter 2015

“In the twenty-first century, the visions of J.C. Nichols and Walt Disney have come fullcircle and joined. “Neighborhoods” are increasingly “developments,” corporate themeparks. But corporations aren’t interested in the messy ebb and flow of humanity. Theywant stability and predictable rates of return. And although racial discrimination is nolonger a stated policy for real estate brokers and developers, racial and socialhomogeneity are still firmly embedded in America’s collective idea of stability...”

-Tanner Colby

Health equity is the basic principle that all people despite race/ethnicity, gender,age, religion, geographic location, or sexual orientation have equal opportunity tolead healthy lives.The above principle is simple enough, and I would wager that there is none who couldlegitimately argue that in fact all people should not have equal opportunity to lead healthylives regardless race/ethnicity, gender, age, religion, geographic location, or sexualorientation. However, despite our proclaimed value of equitable health for all peoples, theinstitutional policies of our nation demonstrate a very different principle. To understandhealth equity, I think we first need to acknowledge inequity, as it relates to public health.It is my observation and informed conclusion that the social inequities that lead todisparities in health equity are avoidable, unfair, and unjust. It is this perspective whichleads me to view disparities in health equity as a matter of social justice. The reality isthat health is often determined by social factors and circumstances outside of one’scontrol. This is especially true for communities of color, and for people living at or belowthe poverty line. Statistics demonstrate that African Americans live sicker and dieyounger than any other ethnic group in the nation (LaVeist).

Skin color, along with residential zip code, has become a reliable predictor of a person’srisk for illness and dis­ease, and general health outcome. If you are brown skinned,and/or poor your risk for illness and disease such as hypertension, diabetes, breast cancer,or heart dis-ease increases exponentially. You are also predicted to have a significantlyshorter life span. These factors have very little to do with DNA or biology, and muchmore with the way that our society is organized and the social location that you haveinherited and inhabit.So what causes the extreme health disparities that plague the African Americancommunity and the impoverished? Our social narrative would have us believe that thedisparities are a matter of poor lifestyle choice and /or lack of ambition. However, wefind that public health issues and the health of an individual are closely connected and thechoice to engage in unhealthy lifestyle behaviors is not so much of a choice after all. It isargued that there are social determinants of health that either provide or deprive a personof the right to make free and informed choices about their health. These determinants arerace/ethnicity, culture, education, socioeconomic status, neighborhood, and occupation.

In our capitalist society, these determinants are interdependent. The quality of educationreceived, what neighborhood we live in, and the occupations we have are all aconsequence of our inherited socio economic status. The greater your economic status,the more access you have to social resources. The more access to social resources youhave, the better your health outcome.It is important for us to remember that the United States was founded on a system ofslavery and despite de jure legislation, structural racism is deeply rooted in ourinstitutions and in the public policy that these institutions generate. This means AfricanAmericans are specifically vulnerable to being deprived of access to social resourcesbecause institutions have the power to create unequal opportunities related to socialstatus. The social, economic, and environmental policy trends of our society create aninequitable distribution of wealth and economic oppression within the African Americancommunity, restricting and limiting access to quality education and higher payingemployment opportunities. Policy makers and city planners (along with developers)determine how schools are funded, which businesses get tax breaks, the choice to investin a neighborhood or divest, and even where a freeway or a grocery store is built. Thesepolicies are systemically generated in favor of people of higher economic status, at theexpense of those of lower economic status. Poorer performing schools, lack of jobopportunities, violence, abusive policing, environmental pollution, inadequate access tofresh food, and transportation barriers are trademark characteristics of low-incomeneighborhoods. In environments like this, where the stress of social subordination is high,resident choices are extremely restricted and limited. Maladaptive coping mechanismsmust develop to survive in such an environment (Unnatural Causes).Last year, I began an in depth study into how trauma shapes the function of the brain. Iwas focused specifically on how complex cultural and ancestral trauma affects the brainand in turn interpersonal relationships. I was led to study interpersonal neurobiology by adeeply personal need to understand the way traumatic experiences have shaped the waythat I engage with others. Personally, it was an effort to understand how lifelongconditions of poverty and the traumatic experiences associated with poverty had shapedwho I was. Until this class, I had only given exploration to how trauma affects our mentalhealth. I had not thought to ask how our physical heath is impacted by trauma. Thedocumentary, Unnatural Causes helped me make the connections between the constantoverproduction of cortisol not only on our mental health, but on our physical healthoutcome as well.

The reading material we've been covering in this class, along with the in classdocumentary, as well as the guest speakers have all broadened my understanding of theeffects of trauma. I am finding a ton of overlap between my studies of complex culturaltrauma, interpersonal neurobiology, and racial justice. Just one example of the way thatthis overlap has become evident during this course came during our visit with Lisa Batesand our brief discussion on Root Shock theory. This was my first introduction to theterminology used to explain the trauma associated with gentrification and displacementcaused by urban renewal policies. To learn more about root shock, I found MindyThompson Fullilove's book Root Shock: How Tearing Up City Neighborhoods HurtsAmerica and What We Can Do About It. Picking up this book following the readingof Bleeding Albina could not have been more perfectly timed. Looking at gentrificationthrough a contracted then broadened lens helped me remember to see gentrification as thepatriarchal tool for the structuring and restructuring of society that it is. When forgotten, Ihave a tendency to blame individual developers, city council members, and even the newpeople moving into the neighborhood. Already my brief read into this book is weavingtogether my knowledge of trauma, racial inequality, shock doctrine politics, and tacticsfor developing community resiliency. I believe that this weaving of knowledge will helpme in the work that I do in the community.

Policies for Change

The discussion on how to create policies for change is a conversation that I have onlyhalf­heartedly engaged in because I do not believe that small and incremental policyreform can bring about adequate and timely change. My politics were radicalized in myearly twenties and while my activism has been forced to acquiesce to the political reality,my social and political perspectives are what some may consider radical. While I dounderstand and can value the work of policy reform, I feel that we cannot rely solely onreform measures to do the revolutionary work of shifting the paradigm of state andcorporate collusion that we currently find our self subjected to. Corporations have zerointerest in the human element and will continue as they have, aggressively pursuing profitdespite the social or ecological impacts. Because government is and always has been bentto the will of the business elite, it is naïve to believe that we can find relief through thefaçade of a democratic system that they would have us work though.If we want to see timely health equity, there must be an informed and enduring socialmovement of the masses which can swiftly intervene to dismantle the system that makesit possible for some people to have restricted and limited access to resources, and othersto have unfettered access at their expense. There must be a movement that refuses toallow the continued exploitation of The People and our Mother. This I Believe. Though Ialso am a realist and have come up against the state institutions that keep such amovement from becoming too effective, as well as the fears and consequences that comewith being a part of such a movement. Not to mention the divisive tendencies that are soprevalent in activist circles, which have a way of turning us against each other. I mustadmit that colonization of the People and The Land was a very clever and efficientdesign. I have come to accept that the kind of radical social change that would rendercorporate interests benign may not be imminent. What then can be done under such circumstances? For those using the strategy of policyreform, there are infinite polices that can be used to address the current health disparitiesin health equity. I do not think that it is an issue of what policies would help, but ratherand issue of how to get these policies implemented and/or funded. Nevertheless, here area handful of policies/ strategies for change that I think are within political reality:

At the federal and state level, we could as a first priority, add an amendment to ourconstitution that clearly separates business and state. Make a national acknowledgementand apology to the injustices committed against indigenous peoples of this land, as wellas an acknowledgement and apology to the practice of chattel slavery. Make corporationsand the business elite pay taxes on the money they make. Dissolve all contracts betweenprivate corporations and state agencies; letting them be replaced by entities such as statebanks, small-scale businesses with fair practices, and collectives. Pass adequate federalfunding quality health care, childcare, and affordable housing and food programs alongwith free pre-k-PhD education. See to the implementation of a national stipend for allpeoples with the only requirement being that you are a living breathing human being.Pass national police reform and regulation that addresses the racial and economicinequities within the criminal justice system including the decriminalization of poverty.Require training to officers and evaluation of their practices to ensure that theyunderstand that being black or brown is not a crime. Hold individuals who abuse theirinstitutional power accountable.

At the city/ county level we could start by equitably investing in all neighborhoods.Change the way that public schools are funded to be more equitable and just. See to theequitable redistribution of all public land that is being held for “future development”.Create a free public transportation system, and offer free classes to youth on how to getaround via public transit. Donate vacant buildings or land to neighborhood associationsand offer lucrative neighborhood grants for the development of Community healthcenters, community gardens, and community recreation centers. Change city code tomake it easier to establish an urban homestead. Reestablish the commons, areas that areheld in land trusts for use by The People. Pay parents to be active in their children’sschools. Hire grassroots organizing groups to capture and represent the concerns andneeds of the community. Let the minimum wage reflect the cost of living. Cap the salaryof all city and county officials to be not more than 20% above minimum wage. Regulatethe number of convenience stores, pawnshops, and fast food stores that are allowed tooperate within a given radius. Free recreational sports leagues in low-incomeneighborhoods along with free music and art classes. Make police accountable to thecommunity. Abolish police unions and standardized testing in our schools.These ideas for policy reform may seem like a tall order, but I am convinced that theseare not radical ideas though they may seem radical in contrast to our capitalist society. Ifwe were to somehow address and sever the toxic relationship between business and state,

I believe that we would be able to use policy reform to make ground on the numeroussocial issues that we have discussed this term. Though I came to this class with a knowledge base already in place, and felt aware andinformed of the deep disparities in racial equity. My decision to take this class was basedoff of a desire to engage with people outside of my normal social circle about issues ofracial inequality. I wanted to explore these conversations with people who did notnecessarily share my worldview, social perspective, or skin color. The majority of thepeople I organize with come from an academic background, and identify as white. Mostof the people of my circles also come from a background of socioeconomic privilege. Inorganizing for the Black Lives Matter campaign, I was offered the opportunity to workwith organizers who were not white and whose activism was not inspired by books, onprinciple, or political philosophy. I found that more than anything I wanted to support andempower my co-organizers to shape the work we were doing to address their livedexperience and concerns with racism. What I saw was many of the white organizers I hadworked with over the years stepping into leadership roles to tell these “new” blackorganizers how to organize. I am familiar enough with these people to know that theywould not see themselves as oppressive to work with, nor would they want to be.However there it was. Racially oppressive tendencies and a paternalistic approach toorganizing with black activists. This was crushing because we all had an opportunity toalign frontlines across movements and connect as allies. Not to mention the opportunityto create the kind of culture that we were demanding of the state, a culture in which blacklives matter. I think that part of the reason these oppressive tendencies came up is due toour neglecting to really understand the black experience in depth and how thoseexperiences have shaped contemporary conditions. From my own experience, I canunderstand and resonate with economic oppression but I cannot share the intimateunderstandings and feelings of what it is like to be a brown or black person in a societysteeped in white supremacy. Our oppressions are not the same and I cannot presume toknow how to organize a campaign to address racial inequity but I can do the work ofmaking sure that I am as informed as is possible to the ways in which as a white skinnedperson, I am afforded privileges at the expense of black and brown lives so as to notreplicate in our movements the systems which we oppose.

The material in the class has given me the opportunity to move from just being aware ofthe consequences of Portland’s Urban Renewal projects to becoming informed about thelong history of intentional disinvestment in and displacement of the black community. Iam also appreciating my new understanding of the economic life cycle of a neighborhoodand Planned Abandonment, which Bleeding Albina offered.

Works Cited

Dr. Thomas LaVeist. 2013. The Skin You're In.

Adelman, L., Baynard, J., Chisolm, R., Fortier, J. M., Garcia, R. P., Herbes-Sommers, C.,

Krause, D., ... Pacific Islanders in Communications. (2008). Unnatural causes: Is

inequality making us sick? San Francisco, Calif.: California Newsreel.

Fullilove, Mindy Thompson. 2004. Root shock: how tearing up city neighborhoods

hurts America, and what we can do about it. New York: One World/Ballantine

Books.

Karen J. Gibson. 2008. Bleeding Albina: A History of Community Disinvestment,

1940-2000.