BUILD Initiative Blog | Eradicating Racial Inequity: Adopting a C
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By Melissa R. Franklin, Ed.D.
Chief Executive Officer
Growth Mindset Communications

It is beyond noteworthy that the first person in the US to receive the coronavirus vaccine was a Black woman; it was a moment laden with significance. With the coronavirus killing people of color at disproportionate rates, Sandra Lindsay, director of critical care nursing at a New York City hospital, volunteered to take the vaccine to demonstrate its safety to those who are reluctant to do the same. Lindsay knows that, for Black people, this reluctance is rooted in medical exploitation of the Black community. From the 19th century gynecological experiments conducted on enslaved Black women, without anesthesia, to the cells taken from Henrietta Lacks’ body in 1950 without her consent, to the Tuskegee syphilis experiment that lasted from 1932 through 1972 in which “researchers provided no effective care as men died, went blind, or insane or experienced other severe health problems due to their untreated disease,” it stands to reason that many Black Americans often do not trust the public health ”system,” let alone vaccines. Many would agree there is a need to address both this mistrust and the root causes of present-day disparities but efforts to so have often fallen short. Here’s how I think we should go about it.

Where to Begin: Understand the Root Causes, Look for the Disparity in the Data, and Check Our Own Biases

Before even the first inclinations of an intervention are conceived, make sure you have a grounding in structural and institutionalized racism and its impact on birth disparities. There is no point in going about goal setting, action planning, and accountability development if our understanding of root causes is not accurate and we have not looked for the evidence of disparity in our health data, let alone disaggregated it first. Oftentimes, the folks who are doing equity work are harming the Black leaders sitting next to them at the table because they haven't addressed their own understanding and thinking habits. They can end up bulldozing and disrespecting Black colleagues, extracting their knowledge while not crediting them with innovation, or trusting them to be the authors of their own community’s breakthrough strategies. Then that harm gets replicated in the work that they do in communities, recreating trauma. It sounds dramatic, but I have seen it played out. I once was once asked by a clinician who has worked in communities of color for years and sees herself as an ally, "Why can't Black women just overcome racism?" I tried to explain how the harm just keeps replicating and that when I have an interaction that hurts me because of someone's biases, it's on top of a host of interactions - my parents growing up in segregation; seeing my father and other men in my life harassed, falsely accused, or denied opportunity; being told, myself, unimaginable things in the workplace about my skills (“You speak well!”); knowing that my kids could be targeted, and that Black kids are failed, suspended, and expelled at higher rates. I also have seen my fellow Black co-laborers in movements die of disease and heart attacks, leaving the rest of us with an aching feeling that we could be the next sacrifice. It's all that. Racism lives in our interactions and in the systems from which many involved in the work—many people with the greatest of intentions—have benefitted and thrived.

We can't ignore the fact that Black people endure poverty at greater rates and that this exacerbates the problem. But if we look at it solely from that lens, we'll totally miss the point because that's not the root cause. The root cause of our experiences with poverty is slavery and racism and systematic denial of opportunities across the board and the fact that Black women who have MBAs are still having disparate outcomes -- outcomes that are barely on par with white women who haven't completed a high school education. Black women who don't smoke have worse birth outcomes than white women who do smoke. So that tells us that the disparity is not about behavior – well, at least not about the behavior of the Black person. It tells us about the behavior of systems and society.

In addition to understanding the root causes and effects of institutionalized racism, we must do the work on ourselves to address our own implicit biases, our own assumptions, our own language and how we speak about equity work, how we activate it, and how we model that for our peers and colleagues. We have to make sure that such transformed beliefs and actions are a part of every planning conversation, program implementation, hiring decision, funding allocation, and grant making. Every new partner that comes to the table has to have that grounding shared with them in order to move forward shared values.

Adopt a Critical Race Theory Frame
How we approach the work, the frame we adopt, is just as important as the work itself. If we enter into work with the belief we have all the answers or that birth inequity has to do with the behavior of Black people, then we have totally missed the point, as these approaches do not address the root causes. We have to look at the benefit this country has reaped from the harm of Black slaves as a contributing factor and really settle into the fact that, even today, we are benefiting from it. Entering into the work with a frame of humility, of repentance, means, for example, not having the expectations that the community is immediately going to respond when we approach it with something we may find amazing - especially if we haven't included the community in our decision making. If we haven't included community in spaces where there's power and investments are being determined, we’re going to find ourselves spinning in circles and wondering why folks aren't being responsive. And given that birth equity work inevitably involves collaboration with a community, how do we do that effectively and in a way that does not create more harm? If we don't start with a critical race theory frame and a grounding in the harm done by the health care system, we're going to be looking back 10 years from now still asking why poor outcomes in Black communities are just so persistent. Allies who are not Black will go back to the drawing board and try again, and Black people in the work will continue to experience the loss of their loved ones and sometimes their own lives.

Assess if You/Your Organization is Ready
It is particularly important for communities to have deep knowledge not only of the harms of racism perpetrated on the bodies of Black people, but also of the types of harmful habits that have informed modern medicine and exist in public health, public policy, and philanthropic structures that exist today. Drawing such connections is vital to the development of strategies and approaches that specifically address the disparity and root causes without unintentionally (re)creating more harm. They are also vital to achieving system transformation and healing at last.

Organizations need to make time and space for difficult conversations about race and racism, and ensure they have staff that is representative of and from the populations they want to serve and have hiring and promotion practices in place that support equity. They need to focus on data that is disaggregated by race, ethnicity, class, and neighborhood and establish a culture of self-reflection. And they need to ask themselves if they are willing to invest in addressing disparity among a few (versus focusing only on the “big numbers”).

Moving Equity Forward: Healing from the Inside Out
It may well be a Black woman who will be the saving grace of public health endeavors regarding the coronavirus vaccine, whether by creating it, receiving it, or modeling the importance of having it. This would not be the first time the Black community, women in particular, will have persevered through the harms perpetrated on us in order to help our communities move forward. We understand the need to take that risk, to lock arms with public health, government entities, and philanthropy. Do you want to know why? Our ability to heal, access joy, forgive, and to love is quite remarkable. And we know that solidarity is key to healing systems, starting with the wisdom and compassion that comes from a shared understanding of the root causes of racism and the enduring inequities we must eradicate once and for all.

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