OCTOBER 4, 2016 – Achieving health equity requires confronting racism, according to the president of the American Public Health Association.
Camara Jones, MD, PhD, MPH, delivered an address on campus yesterday at an event co-sponsored by the School of Nursing & Health Studies and the Office of Institutional Equity, Diversity & Affirmative Action.
“What I want to do today is engage us in a conversation,” the renowned physician and epidemiologist told the large audience gathered in the W. Proctor Harvey Clinical Teaching Amphitheater.
A Cliff Metaphor
Jones used a four-part metaphor of a cliff to describe individuals’ experience of maintaining health.
Point four – the very bottom of the cliff where a person has fallen – is when direct medical care is needed. Before hitting bottom is point three, or a safety net. At the top of the cliff is point two, a fence, representing primary prevention like vaccines. Finally, on the other side of that fence is point one, or pushing people back from the cliff’s edge altogether – meaning addressing the social determinants of health like education and poverty.
“We need some of all of it,” she said.
But, she added, not everyone’s experience in this four-part model is the same and health disparities emerge – access to and quality of health care is different, and there is a “difference in life opportunities, exposures, and stresses that result in difference in underlying health status.”
“We must acknowledge the three dimensionality of the cliff . . . if we want to achieve social justice and eliminate health disparities,” Jones said.
Causes for the health inequities along the cliff, she noted, are rooted in economic circumstance, heterosexism, racism, and sexism.
“As APHA president, I have launched a national campaign against racism,” Jones said at the event’s outset. Racism, she went on to describe, is a “system of structuring opportunities and assigning value based on the social interpretation of how one looks (which is what we call ‘race’)” with some individuals and communities unfairly experiencing disadvantage and others advantage.
Jones added that racism “saps the strength of the whole society through the waste of human resources.”
It emerges in three interrelated forms, she noted, including “institutionalized racism” – or systematically keeping people, because of race, from accessing opportunities and resources, “personally mediated racism” – such as an individual’s attitudes about another’s “abilities” and “motives” and subsequent unlike treatment because of those attitudes, and “internalized racism” – when the disenfranchised group accepts “negative messages about [its] own abilities and intrinsic worth.”
To illustrate the damaging effects of the three, Jones discussed her allegory of “a gardener’s tale,” published in the American Journal of Public Health in August 2000. According to the article abstract, “This allegory illustrates the relationship between the 3 levels of racism and may guide our thinking about how to intervene to mitigate the impacts of racism on health. It may also serve as a tool for starting a national conversation on racism.” (Click here to read the article.)
Health Equity Think Tank
“I am going to share these tools with you so they become your tools,” Jones offered.
Her talk, “Achieving Health Equity: Tools for a National Campaign Against Racism,” took place as part of a new three-credit NHS course, “Health Equity Think Tank: Exploring Realities and Solutions” (HEST-355).
The class is open to juniors and seniors across campus and was developed with funding from the NHS Office of the Dean through the 2015-2016 Dean’s Challenge.
Course leaders and event organizers are – pictured above, left to right, with Jones – Christopher King, PhD, FACHE, assistant professor of health systems administration, Ella Heitzler, PhD, WHNP, FNP, RNC-OB, assistant professor of advanced nursing practice, Edilma Yearwood, PhD, RN, PMHCNS-BC, FAAN, chair of the Department of Professional Nursing Practice, and Brian Floyd, MS, assistant dean.