1. What’s Race Got To Do With It? The Impact of Racism on Health 1st Annual Northeast Regional Community Health Network Area (CHNA) Networking Forum May 15, 2012

2. RACISM

3. BPHC Mission The mission of the Boston Public Health Commission is to protect, preserve and promote the health and well-being of all Boston residents, particularly those most vulnerable.

4. What are disparities in health? The NIH defines health disparities as “differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.”

5. Health Inequities Differences in health that are not only unnecessary and avoidable but, in addition, are considered unfair and unjust. References: Braveman P. Health disparities and health equity: concepts and measurement. Annual Review of Public Health 2006;27:167-194: Whitehead M, Dahlgren G. Levelling Up (Part 1): A Discussion Paper on Concepts and Principles for Tackling Social Inequities in Health. World Health Organization. Available at http://www.euro.who.int/ document/e89383.pdf. Health Disparities Differences in the presence of disease, health outcomes, or access to health care between population groups.

7. So, why are some people sicker and die sooner than others?

8. IS IT ABOUT ACCESS TO HEALTH CARE?

9. Racial and Ethnic Inequities in Breast Cancer Mortality

10. Racial and Ethnic Inequities in Cervical Cancer Mortality

11. IS IT ABOUT EDUCATION OR INCOME?

12. Racial & Ethnic Inequities Infant Mortality & Education NCHS 2002 10.2 6.8

13. Racial & Ethnic Inequities Infant Mortality & Household Income 16.6 11.2

14. IS IT ABOUT HEALTH BEHAVIOR?

15. Racial & Ethnic Inequities Infant Mortality & Cigarette Smoking NCHS 2002 13.2 9.2

16. Racial & Ethnic Inequities Infant Mortality & Prenatal Care NCHS 2002 12.7 7.1

17. IS IT ABOUT RACE?

18. Race has no clear biologic or genetic basis…”there are no characteristics, no traits, not even one gene that turns up in all members of one so-called race, yet is absent from others” (L. Adelman. Race and Gene Studies) The meanings of racial designations- White, Black, Asian- are subject to historical, cultural and political forces; “race justified social inequalities as natural”. RACE

19. Racial & Ethnic Inequities Infant Mortality & Nativity 9.2 14.2 Per 1,000 Live Births NCHS 2002

20. Low Birth Weight by Maternal Birthplace - Boston, 2004 SOURCE: Boston resident live births, Massachusetts Department of Public Health ANALYSIS: Boston Public Health Commission Research Office

21. WHAT ABOUT RACISM ?

22. The Experience of Racism & Discrimination Boston Adults Who Report Having Been Treated Worse Than People of Other Races At Work During the Previous Year, By Race/Ethnicity Boston Adults Who Report Having Been Treated Worse Than People of Other Races When Seeking Health Care During the Previous Year, By Race/Ethnicity Note: Data about Asian residents not shown due to inadequate sample size SOURCE: Behavioral Risk Factor Surveillance System, Massachusetts Department of Public Health and Boston Public Health Commission

23. Community Voices “ My doctor ignored my complaints that I was in pain as he removed my post-op tubes in the Emergency Room” “ My physician never looks me in the eyes or treats me like a person” “ When I was seeing the doctor for the flu, he wanted to talk about AIDS and drugs. It was like he thought all Latinos were addicts”

24. Racism Racial and cultural prejudice and discrimination, supported intentionally or unintentionally by institutional power and authority, used to the advantage of one race (Whites) and the disadvantage of other races. The critical element which differentiates racism from prejudice and discrimination is the use of institutional power and authority to support prejudices and enforce discriminatory behaviors in systemic ways with far- reaching outcomes and effects. In other words…Racial Prejudice + Power = Racism BPHC definition - adapted from a number of sources

25. Levels of Racism Racism operates on four levels: Internalized Racism Interpersonal Racism Institutional Racism Structural Racism

26. A Health Equity Framework Racism Transportation Food Access Socioeconomic Status Environmental Exposure Health Behaviors Access to Health Services Housing Public Safety Health Outcomes Employment Social Capital Education

28. BPHC Overarching Goals Reduce the low birth-weight rate among Boston infants and reduce the gap between the White and Black LBW rate by 25% Reduce obesity rates among Boston residents and reduce the gap between White and Black/Latino overweight/obesity rates by 30% for children and 20% for adults Reduce Chlamydia rates among Boston teens and young adults and reduce the gap between Black/Latino and White Chlamydia rates by 25%

29. Racial Justice & Health Equity Initiative Goals Align all BPHC programs, policies, practices, and operations within a racial justice and health equity framework Build capacity of BPHC to effectively reduce inequities across the city

30. Anti-Racism Advisory Committee (ARAC) ARAC’s Charge: “to review, assess and develop recommendations on policies, practices, structures and systems at the Commission in an inclusive process that engages all Commission staff”

31. Professional Development Series RACIAL JUSTICE AND HEALTH EQUITY INITIATIVE Professional Development Series Goal: To ensure that all BPHC staff apply the principles and practices of health equity and racial justice to all of the Commission’s work. Objectives: Increase staff understanding Equip staff with strategies, resources, and tools Create a culture of ongoing learning

32. How Can CHNAs Address Racism? Acknowledge the problem Educate ourselves and our partners Use data Be intentional about ensuring those most affected are at the table Focus on policy & system changes