5
Final Thoughts
Numerous, actionable opportunities to demonstrably improve health and equity for families and children of color were outlined by several speakers throughout the workshop. These ranged from policy mechanisms that could be leveraged to improve data collection and, importantly, to enhance communication of the data and research emerging from economic and health systems. The presentations from the workshop argued that a return to prepandemic normalcy is not an equitable option for many children and families unless economic and health systems of care are reimagined. This chapter summarizes the presentations and discussions throughout the proceedings and offers highlights of the many suggestions to better promote well-being for children and families in the United States
Chapter 2 provided powerful arguments on the root causes of structural racism, the degree to which biases toward different racial groups are embedded, and the importance of “place” for health and economic well-being for children and families from David Williams, Florence and Laura Norman professor of Public Health at the Harvard T.H. Chan School of Public Health, and Brian Smedley, chief of psychology in the public interest and acting chief diversity officer at the American Psychological Association. Williams presented compelling data on wealth and income gaps between racial groups, as well as pervasive health disparities such as infant mortality, and demonstrated many of the linkages between systemic inequities and historical public policies such as segregation. Smedley highlighted the inflection point where American society currently stands, saying that there is an opportunity to move forward as a more equitable nation. He argued for a sustained, long-term policy agenda and the simultaneous use of both
place-based and people-based strategies to address structural racism for the greatest change.
To support the well-being of children and families, presenters in Chapter 3 outlined ways to reimagine economic systems, by first understanding the impacts of race, and then proposing various solutions. Darrick Hamilton, Henry Cohen professor of economics and urban policy at the New School, highlighted the stratification and inequality of systems when it comes to race and wealth, noting that the bottom 50 percent of earners own about 1 percent of the nation’s wealth. In addition to the pandemic causing Black Americans to have higher mortality rates and more businesses closings than White Americans, Hamilton highlighted the racialization of the public response to poverty and economic security in the country. He called for an increased understanding of the roles of power and capital in the U.S. political economy and advocating for structures that can equitably distribute needed resources. Kimberly Noble, professor of neuroscience and education in Teachers College at Columbia University shared initial data and policy implications of poverty reduction efforts from the Baby’s First Years study, noting that even small increases in family income at birth have been associated with increased earnings when the child grows up. Her study is the first randomized controlled trial of poverty reduction in early childhood in the United States, and it aims to provide direct evidence of the effects of poverty reduction on the developing brain to better inform debates on social services. This chapter also reviewed potential solutions such as cash transfer programs or proposals related to the concept of universal basic income. Mouhcine Guettabi, associate professor of economics at the University of Alaska, Anchorage, reviewed what has been learned about the longest running cash transfer program in the country after 38 years of the Alaska Permanent Fund. While research is limited, Guettabi said what has been published demonstrates the success of the program in terms of crime, health, employment, and poverty reduction. William Darity, Samuel DuBois Cook professor of public policy at Duke University, presented potential solutions to address the racial wealth gap in a more universal way. He shared that the average wealth difference between middle White American households and middle Black American households is nearly $800,000. With this in mind, he discussed the baby bonds proposal as one potential solution. The proposal provides an endowment for newborn infants calibrated on the basis of their family’s wealth. Chapter 3 also provided an overview of the small group sessions where workshop participants discussed short- and long-term goals for reimagined economic systems of care. Across groups, the suggestions for action and goals were related to the intersection and interconnectedness of fields, communication, improving data and research, and focusing on root causes and equity across the life course.
Chapter 4 also featured a reimagining of systems of care and also focused on behavioral and public health systems, with many speakers commenting on how racism impacts health and contributes to disparities. Maxine Hayes, former state health officer for the Washington State Department of Health, noted the dual pandemic of COVID-19 and racism the country is currently experiencing. Because racism is a key determinant of racial/ethnic disparities in health, she suggested that it’s a fair assumption that racism is also present in public health system policies, practices, and norms, and that considering root causes to solve some of these complex problems is key. Joseph Wright, senior vice president and chief medical officer of Capital Region Health within the University of Maryland Medical System, spoke about the importance of truth and reconciliation within organizations as a means for making systems antiracist. He shared his personal experience with the American Academy of Pediatrics as the organization develops an equity agenda, focusing on diversity and inclusion as well as bias and discrimination to begin reducing the toxic stress impacts of racism on children and families. Neal Horen, director of the Early Childhood Division at Georgetown University, advocated for confronting racism in systems more directly instead of passively just acknowledging it. To do this, he suggested applying an intersectional framing on strategic planning, implementation, workforce development, and financing. To guide efforts specifically focused on mothers and children, Michael Warren, associate administrator at the Maternal and Child Health Bureau of the Health Resources and Services Administration, shared the Accelerate Upstream Together Framework, which encourages a faster rate of progress in improving the system and taking a more comprehensive approach across sectors. He believes that this will help address pervasive disparities such as the 37-year delay for Black infants to achieve the same survival rate as White infants. For systemic reform solutions to address racial discrimination, Riana Elyse Anderson, assistant professor of health behavior and health education at the University of Michigan’s School of Public Health, called for increases in research funding to improve understanding of how racism-based interventions can be effective. She also suggested flipping the way issues are often framed for Black Americans. Instead of focusing on negative aspects, look for the cultural strengths and where Black American families are doing well to see how these can be applied as interpersonal solutions. Chapter 4 also offered short- and long-term goals for reimagining a more antiracist system for behavioral and public health. These included aspects such as policy, workforce, and funding, as well as focusing infrastructure at the community level to create equitable public health investments and incorporate lived experiences and family voices to develop more sustainable solutions.
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