Achieving Health Equity Through “Undoing Racism”

The Case of the Florida Health Equity Commission (FHEC)

Deborah A. Austin, PhDChair, Board of DirectorsFlorida Health Equity CommissionDirector, Community EngagementREACHUP, Inc.

APHA 141st Annual Meeting and ExpositionThink Global, Act Local: Best Practices Around the World

November 2-6, 2013Boston, MA

Copyright 2013

Presenter DisclosuresDeborah 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

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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

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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

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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

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

FHEC’s Interest in “Undoing “Racism• Racial differences in health often persist even at "equivalent"

levels of SES1

• 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

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References1. 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.

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How do we even define racism?

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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

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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

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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

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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

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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

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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

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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

racism16

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

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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

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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)

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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

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Deborah A. Austin, PhD

Chair, Board of DirectorsFlorida Health Equity Commission

Director, Community EngagementREACHUP, Inc.

2902 N. Armenia Avenue, Suite 100Tampa, FL 33607daustin@reachupincorporated.org(813) 712-6302 21

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