1. Achieving Health Equity Through “Undoing Racism” The Case of the Florida Health Equity Commission (FHEC) Deborah A. Austin, PhD Chair, Board of Directors Florida Health Equity Commission Director, Community Engagement REACHUP, Inc. APHA 141st Annual Meeting and Exposition Think Global, Act Local: Best Practices Around the World November 2-6, 2013 Boston, MA Copyright 2013

2. Presenter Disclosures Deborah A. Austin, PhD The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose 2

3. The funding for the Central Florida 2012 Undoing Racism® Community Organizing Workshop / Community Windshield Tour was funded through a partnership with the Genesee County (MI) REACH US Project Center of Excellence in the Elimination of Disparities as part of the Racial and Ethnic Health Disparities Action Institute, Centers for Disease Control and Prevention (CDC) and Tampa Bay Maternal & Child Health Partners 3

4. Presentation Goal Articulate the potential effectiveness of a focused community solution -- Undoing Racism® Community Organizing Workshop / Community Windshield Tour -- on reducing infant mortality disparities and promoting health equity in Central FL 4

5. Genesis of FHEC Florida Black Infant Health Practice Initiative, 383.2162, F.S. To create a practice collaborative to examine racial disparities in infant mortality CDC Racial & Ethnic Health Disparities Action Institute, FL Team Provide local and state teams with tools, resources, and strategies for developing evidence-based approaches to build healthier communities FL Closing the Gap in Infant Mortality, 381.7351, F.S. Stimulate the development of community and neighborhood- based organizations to improve health outcomes of racial and ethnic populations and promote disease prevention activities Equal Health for All Education Committee > Florida Health Equity Commission (FL Non-profit Corporation) 5

6. FHEC Vision & Mission Vision: To eliminate social and economic barriers to good health in the state of Florida. Mission: To address the root causes of health disparities by supporting and promoting community engagement, capacity building, health-related policy, government involvement, evidence-based practice, and research that highlight and change, when necessary, the connection between health and wellness and socioeconomic status. 6

7. FHEC’s Interest in “Undoing “Racism Racial differences in health often persist even at "equivalent" levels of SES 1 Racism works in a cycle to damage health. 2,3,4 People at a social disadvantage are more likely to experience stress from racism. People at a social disadvantage are less likely to have the resources to extinguish this stress, because they are at a social disadvantage. Merely the anticipation of racism, and not necessarily the act, is enough to trigger a stress response. 2 Women with very low birth weight babies were three times as likely to have reported experiences of interpersonal racism than women with children of normal birth rates. 8 Racism is a complex construct and should be examined as it is expressed at different levels. 5,6,7 Levels include cultural racism, institutional racism, individual/interpersonal racism, and internalized racism/self- stereotyping 7

8. References 1.Williams, D. R. (1999). Race, socioeconomic status, and health. The added effects of racism and discrimination. Annals of the NY Academy of Sciences, 896, 173-188. 2.Anderson, K. F. ( 2013). Diagnosing discrimination: Stress from perceived racism and the mental and physical health effects." Sociological Inquiry, 83(1), 55-81. 3.Sawyer, P.J., Major, B., Casad, B. J., Townsend, S.S.M., and Mendes, W. B. (2012). Discrimination and the stress response: Psychological and physiological consequences of anticipating prejudice in interethnic interactions. American Journal of Public Health, 102(5), 1020-1026. doi: 10.2105/AJPH.2011.300620 4.Brondolo, E., Brady, N., Libby, D. J., & Pencille, M. (2011). Racism as a psychosocial stressor. In A. Baum, & R. J. Contrada (Eds.), Handbook of stress science (pp. 167- 184). New York, NY: Springer. 5.Harrell, S. P. (2000). A multidimensional conceptualization of racism-related stress: Implications for the well-being of people of color. American Journal of Orthopsychiatry, 70(1), 42-57. 6.Jones, C. P. (2000). Levels of racism: A theoretic framework and a gardener's tale. American Journal of Public Health, 90(8), 1212-1215. 7.Krieger, N. (1999). Embodying inequality: A review of concepts, measures, and methods for studying health consequences of discrimination. International Journal of Health Services, 29, 295-352. 8.Lu, M.C. & Chen, B. (2004). Racial and ethnic disparities in preterm birth: The role of stressful life events. American Journal of Obstetrics and Gynecology, 191, 691- 699. 8

9. How do we even define racism? 9

10. The People’s Institute for Survival and Beyond Undoing Racism® Community Organizing Workshop Develop a common definition of racism and an understanding of its different forms Develop a common language and analysis for examining racism in the United States Understand one’s own connection to institutional racism and its impact on his/her work Understand why people are poor and the role of institutions in exacerbating institutional racism, particularly for people and communities of color Understand the historical context for how racial classifications in the United States came to be and how and why they are maintained 10

11. The People’s Institute for Survival and Beyond Undoing Racism® Community Organizing Workshop Understand how all of us are adversely impacted by racism Address surface assumptions about how your work is (or is not) affected by racism Develop awareness and understanding about ways to begin Undoing Racism Understand the role of community organizing and building effective multiracial coalitions as a means for undoing racism 11

12. Central Florida Undoing Racism Workshop & Windshield Tour Recruitment Special invitations to MCH organizations/agencies and collaborative partners Concerns & complaints about the time required (2.5 days) *Difficulty in recruiting representatives – Total 32 Latinos - 1 Whites - 5 All males - 6 * Need for more diversity mentioned in evaluation 12

13. Undoing Racism Workshop & Windshield Tour Evaluation Protocol Workshop’s specific focus was racism’s impact on infant mortality Evaluation of workshop utilizing quantitative & qualitative methods REACH US Team Paired-sample t-tests used to compare differences between the pre- and post-surveys Focused coding used to assess common themes among the written survey responses and workshop feedback Tampa Team Focused coding used to assess common themes from post conference organizational representative interviews and participant feedback 13

14. FHEC & Undoing “Racism” Creating a common definition… Racism refers to the structures of power and privilege that hinder social equity based on the concept of race 14

15. Major Data Points 77% of survey respondents agreed that the workshop showed the connection between racism and infant mortality ‘a great deal’ or ‘completely’ 96% of workshop participants reported that the Windshield Tour helped them to better understand the issues of racism and social and health disparities as regards community resources 15

16. Commitments for Personally Undoing Racism Change my thought patterns Be aware/learn more Bring strong problem solving skills Learn how to conduct a constructive conversation on race Confront someone telling racially insulting jokes Persuade my workplace to assess and take steps to end racism Begin specific dialogue with the Latino community about racism 16

17. Recommendations for Community Action in Reducing Racism Advocating for resources and policies Community engagement and organizing Helping mothers/community to find their own solutions Involvement in the Undoing Racism movement Educating others about racism Teaching health professionals and students Working with local organizations 17

18. Recommendations for Future Learning and Action for FHEC White Privilege Hispanics/Latinos as both victims and perpetrators of racism Policy advocacy Effective leadership Successful communications tools Research and activism to promote solutions 18

19. Next Steps for FHEC Address issues related to White Privilege Tim Wise and other presenters White Privilege Conference Book & film discussions Work with local chapters of National Council of La Raza and other organizations for “Black-Brown” discussions Ward off efforts to pit native-born black people against the immigrant rights agenda and vice versa Discussion of Hispanic “Race” Obtain resources for more Undoing Racism and other workshops With REACHUP, Inc. proposal submitted to FL Chapter March of Dimes for Undoing Racism (2014) Applied Research Center Center for Social Inclusion Partnership and collaboration with local, state and national racial justice movements and organizations (ex. Tampa Racial Equity Coalition) 19

20. Thank You Florida Health Equity Commission Genesee County (MI) REACH US Team REACHUP, Inc. Healthy Start Coalition of Hillsborough County Central Florida Partnership for Health Disparities Healthy Start Coalition of Pinellas County The courageous people of the state of Florida 20

21. Deborah A. Austin, PhD Chair, Board of Directors Florida Health Equity Commission Director, Community Engagement REACHUP, Inc. 2902 N. Armenia Avenue, Suite 100 Tampa, FL 33607 daustin@reachupincorporated.org (813) 712-6302 21

22. 22