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Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop (2023)

Chapter: 6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy

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Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
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6

Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy

Lourdes Rodríguez opened the next session by welcoming everyone into conversation to reflect on the prior discussions, focused on applying what has been discussed to “our thinking and our work moving forward.” She acknowledged meeting on the Indigenous lands of Turtle Island, what is now called North America, and noted she is currently on the land of the “Alabama-Coushatta, Caddo, Carrizo Comecrudo, Coahuiltecan, Comanche, Kickapoo, Lipan Apache, Tonkawa, and Ysleta del Sur Pueblo, and all the American Indian and Indigenous peoples and communities who have been or have become a part of the states and territories in Texas.” Rodriguez also noted she currently serves as senior program officer for women’s health at St. David’s Foundation and is bringing a public health perspective to this conversation.

The remaining discussants then introduced themselves. Monique Tsosie noted she is full Navajo and originally from Tucson, Arizona. She said she currently serves as a program analyst for the Inter-Tribal Council of Arizona based in Phoenix, where she is on Tohono O’odham and Piipaash land. Alejandra Hernandez explained she is bringing the philanthropy perspective to the conversation, as an Environment Fellow at the Kresge Foundation. Next, Dawn Alley introduced herself as head of health care innovation at Morgan Health (a business unit of JP Morgan Chase) and formerly the chief strategy officer at the Centers for Medicare & Medicaid Services. She said she would try to bring both a private-sector and government perspective to the discussion. Rodriguez then invited everyone in the audience to add questions, reflections, and calls to action during the conversation.

Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×

Rodriguez initiated the discussion by asking everyone to consider the keynote addresses from the opening session of the workshop. She noted these speakers “set the tone by reflecting on multiple examples of spatial injustice from the perspective of Indigenous, Japanese American, and African American communities,” as both scholars and members of these communities. She said one of the themes from the conversation that really struck her was the idea of history as structure instead of a series of discrete events. Rodriguez explained that this idea made her consider the world differently because structures are much more enduring than events; while events have a beginning, middle, and end, “structures exist so long as we use them, as we believe them to be true.” Rodriquez then described another key idea from the keynote remarks, namely, the framework of how urban planners think about spatial justice—accessibility, mobility, habitability—with the addition of epistemology, such that it is “not only the physicalness of space” that is considered, but also the culture and knowledge system that shapes understanding of and attachment to spaces and places. She said another concept that resonated with her was the idea of serial forced displacement and how the trauma of displacement accumulates as the experience of spatial injustice is recreated over and over again. Rodriquez then asked the other discussants to share their thoughts on the keynote addresses.

Alley mentioned the term erasure from the keynote session, which, she said, “just seemed so important and so much more direct than talking about displacement and relocation.” She also recalled Umemoto’s remarks, noting that much of the conversation during the workshop has been about how that anger and frustration can be turned into inspiration and action. Hernandez said what stayed with her, particularly as someone who works in philanthropy, was the framing of settler colonialism. She asked, “How does settler colonialism still inform our practices as we do foundation work? Are we still in the process of perpetuating injustices?” Hernandez said these are questions that she reflects on and invites others in philanthropy to reflect on as well.

Rodriguez then asked Hernandez about the second panel of the workshop, focused on climate change displacement and population resilience. Hernandez shared that panelists Klinenberg and Shandas underscored the importance of place and displacement in how people experience climate change. She noted that policies of segregation and redlining, and resulting spatial inequities, came up during the panel, with panelists describing how some neighborhoods experience more urban heat than others within the same city. Hernandez added that social infrastructure, such as libraries and neighborhood stoops people converse on, can “help bring communities together and make them more resilient to these changes in climate.” She also said the panelists left the audience with

Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×

“powerful questions” about how vulnerable peoples’ power and voices can be uplifted and where investments are being made. Rodriguez noted she left this conversation with a sense that “we understand how everyday inequalities translate to large-scale events”—that the data exist and no further research is needed. “Why then is our knowledge not used to prevent these catastrophes?” she asked. “Where is the political will? Where is the allocation of resources that is going to help us prevent these grand-scale catastrophic events?” Rodriguez also underscored the idea of “the importance of shifting the burden of proof from individuals to systems and processes,” which arose during this conversation.

Alley added that many of the same ideas struck her, along with “the value of maps as a tool … as a way of engaging people and really visualizing these inequalities,” mentioning the example of the map of Portland illustrating the large temperature differences within the city. Tsosie noted that a lot of research and data are being collected, but that her question is how that will benefit the tribal communities she works with, especially those in remote, rural areas. She suggested acknowledging and recognizing these communities and considering how they can build their capacity to use those data. She noted tribal and Indigenous communities are very connected to and rely on land, making it particularly important that they have a voice in climate change conversations. Rodriguez said these comments reminded her of Vicenti Carpio’s statement that “we are all Indigenous to somewhere,” and that a path forward requires recognizing that and seeking one’s connection to land.

Rodriguez then brought up the conversation that concluded day 1, which explored how policies and investments shape spatial injustice and displacement. She noted each of the four panelists—Abello, Bader, Mitchell, and Venable-Thomas—brought a different perspective: that of a journalist, sociologist, lawyer, and developer, respectively. Alley said this conversation around policy opportunities struck her, as she is always wanting to move beyond discussion of political will—albeit important—and begin discussing what can be done. She noted a key theme from that discussion and the larger workshop is the importance of acknowledging these injustices “have been intentionally created and exacerbated over multiple generations,” and thus addressing them will require “coordinated, intentional, systematic action.”

Alley shared a few examples the presenters identified, including Heirs’ Property Standard Law, a state-based statutory framework that has been implemented in 18 states, which “shows, once you develop a template for something, how that can take off with a lot of hard work.” She added that another example that came up during the conversation was around leveraging processes like qualified allocation plans for low-income housing tax credits by including requirements around engaging

Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×

and examining impact on particular communities, especially those most at risk of experiencing climate-related events. Alley noted, “that feels like such an important way to change the actual structure of decision making, to make sure that we are engaging communities as a matter of course and not as an afterthought.” She also shared another theme from the conversation around the importance of the suburbs, given the growth of racial and ethnic minority populations and the access issues experienced in that context, and the particular role of health care systems as a place to begin addressing those inequities. Alley added that as someone sitting within JP Morgan Chase, the discussion around the decline of Black-owned banks struck her. She noted the conversation about the opportunities and dangers of race-blind messaging, which she connected to Agyeman’s comments in the prior panel about how “you don’t get to social justice; you need to start with social justice.” Alley said the questions during this conversation about whether or not to lead the messaging with social justice stood out to her. She asked, “Where does it work better to have a really inclusive message around something like property rights, and where is doing that actually obscuring the important conversations that we need to have about historical inequities?”

Rodriguez then mentioned that this panel’s conversation reminded her of a short video from Fullilove’s team called the Domino Effect, which describes serial forced displacement. She explained that there is a “domino effect of back-to-back forms of … government-endorsed forms of displacement” like foreclosure and eminent domain that are intentional and “sold as race neutral” even though they are not. She also noted that within the context of urban renewal, there are “racist ways [used] to value spaces” based on who lives there. Rodriguez emphasized the importance of “calling [racism] what it is” in order to undo the harms of those intentional policies, as well as the idea of “holding power with you, not over you,” and “bring[ing] that with you when you enter into spaces.”

Rodriguez then asked the discussants for their takeaways from the session on public spaces for cross-sector partnerships that drive change. She summarized the focus of the session, which included strategies, frameworks, and policies for spatial justice, moderated by Jackson, and included Agyeman (who brought a planning perspective), Bronen (who brought a legal and practitioner of social justice perspective), and De Lara (who brought a geographer and scholar of immigrant and working-class communities perspective). Hernandez said one of the things that stuck with her were questions around the autonomy and sovereignty of the impacted community in the context of climate adaptation, including how to ensure approaches are in place for community to lead decision making and have the resources needed to make those decisions in time. Tsosie mentioned the idea of data being updated with and for the community.

Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×

She said that working with the community and developing that relationship “is where it should begin … because each community is different.” She also noted, “we all each have different definitions of what the measuring of success might be.”

AUDIENCE QUESTIONS

Rodriguez then shared the first audience question, which noted abuse of Haitian migrants at the border underscores racialized policy implementation, and asked, “Can we undo anti-Black racism?” She responded by sharing Fullilove’s discussion of her and her team’s work via the 400 Years of Inequalities project, which invited people to consider the way this country was built, including the history of slavery, the labor movement, women’s rights, and treatment of Indigenous people. Rodriguez noted that “in that exercise, you could see that our destinies are a lot more closely linked than we let ourselves to think.” She said that as a Puerto Rican woman on the U.S. mainland, undoing anti-Black racism is “also about the plight of Puerto Ricans for living in the context of colonialism,” recognizing how her life is also impacted by that racism, and “stand[ing] up in solidarity with my Black brothers and sisters.” Hernandez added that as a Latinx daughter of immigrants, she also feels that “my fight is definitely tied to Black liberation.” She commented on the “intersectionality between our fights and [the] history of oppressive colonization that really binds us together.” Alley said that for her, “almost any answer to this question feels like a drop in the bucket in the sense of the historical legacy” and “intentional multigenerational creation of the systems that we have today.” At the same time, she noted, it is vital to “not let the sheer size and complexity of this issue let us off the hook for addressing it head-on and taking action.” Alley shared that JP Morgan Chase has made a $30 billion commitment to racial equity over five years, including investing in Black- and Latinx-operated community development and financial institutions. She added that while no single investment will “turn the tide on generations of racism and oppression,” it is important that major institutions invest concretely in these areas. Rodriguez said Alley’s comment made her think about “how the biggest barrier to antiracist work is inertia,” and that even though one may feel overwhelmed and like one drop will not make change, it actually does.

Rodriguez then shared the next audience question, asking the group to reflect on how best to work across sectors and disciplines to advance spatial justice. Alley responded that there is a need to seek opportunities to “concretely weave this into our processes,” such as via health impact assessments, examining the health and health equity implications of policies. “By weaving in that kind of required element in the process, we

Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×

have an opportunity to catalyze those multisector conversations,” she said. Alley added that it is also not only about working across sectors but also bringing communities in. She noted that she recently left the federal government, which “uses notice and comment rulemaking as a regulatory way to seek public input.” However, she said, that public input was often really industry input since “those entrenched stakeholders are the ones that are paying attention to potential regulations that might affect them.” Alley asked what it might look like to seek opportunities to broaden that conversation or require different kinds of engagement besides posting to the Federal Register. Hernandez said she agreed with Alley’s comments and wanted to underscore the importance of foundations doing the internal work to understand the intersectionality of their funding streams and their work, to make sure their approach is robust and sustained long term. Tsosie added that listening to community stories and defining what spatial justice is for them is also critical. Rodriguez agreed that storytelling can be powerful, citing a proverb that “so long as the hunter is the one who gets to tell the stories, we will never know the stories of the lions.” She noted that if multiple perspectives are not brought to the table, “we’re going to be stuck with the perspective of whoever is in a position of power.”

Rodriguez then asked all the discussants to share the implications of these two days of conversations for their work and what they see as their call to action. Alley said she would “take really seriously the idea of holding power with you, not over you.” In addition, she mentioned the role of businesses as anchor institutions and the choices businesses make about priorities, ensuring “the voices of the people that we employ in the communities we serve have a prominent place in that decision making.” Hernandez reiterated the need to ensure that foundations and philanthropies understand they are “navigating a settler colonial state” and that they need to ensure their efforts are not leading to unjust practices. She also noted the need to reflect on how philanthropic practices and processes can be adapted or changed to be less burdensome to grantees, especially as they deal with crises like the pandemic and climate change. Hernandez also discussed how funders should leverage both their own and other funders’ investments to get money to communities on the ground and on the front lines, “listening to their intelligence, listening to their leadership.” Tsosie responded that within the context of her work on climate change and health research in Indigenous communities, there is a need to provide workforce training—including so individuals can work within their own community—and to see how they can use the data to benefit the community. She said there is also a need for funders to recognize these communities are always seeking funding, and to consider how that can be used to benefit the community moving forward. “It’s developing the

Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×

recognition also that we are still here, the Indigenous people, and that we are still working very hard to move forward and try to adapt to the current changes,” Tsosie concluded.

Rodriguez then shared her thoughts on these comments, beginning with the role of philanthropy, which is where she is currently. She said she could see coming to philanthropic work “with two lenses—one of trust and one of strengths-based approaches.” She noted that when philanthropic partners come with trust, they can understand that their grant partners and community colleagues’ understanding of the world is just as valid as their own. She also said that the mechanisms of philanthropy used for documentation and validation are not necessarily based on trust. Rodriguez added that the strengths-based approach is about understanding that while a foundation may have a strategic plan and goals they set for themselves, “our grantees are the hands and feet and the heart and the brain that is going to allow us to get to that strategy,” which “means that we need to think about them as coming with strengths and assets that we don’t have.”

Then, in terms of research evidence, Rodriguez said she feels there is already enough data to inform policies and practices, and “if we know the data, then we need to muster the political will to use that data to inform our policies and practices, so that any new evidence contributes to our understanding of how all the evidence we already have has informed policies and practices.” In terms of training or workforce needs, Rodriguez said that there is need for shared understanding of how knowledge generated in one discipline can inform work in another (e.g., knowledge generated in sociology informing public health, knowledge generated in public health informing planning, knowledge generated in planning informing law). She added that this requires “creating spaces for shared scholarship across disciplines,” and that when that is done, everyone can come to their work “with more strength and with a better understanding of what is ours to do to improve population health.” Alley added that with respect to Rodriguez’s comments about research evidence, it is also important to consider communication research and public engagement research, especially around how “we engage with people at scale on these issues.” She noted earlier conversations touched on the “amazing work” that happens when people are brought together to look at maps and to share their thoughts so community perspectives are heard. However, Alley noted, “those are really on-the-ground, labor-intensive ways to create change.” She said earlier conversations also touched on things like state-level policy change, and asked, “How do we bridge those gaps?”

Tsosie then noted that with respect to gaps in research and data for Indigenous tribes, there are several steps—tribes, counties, and then states—and that it is important to consider how to bridge those divides

Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×

and use data to benefit the community, especially given the history of research within American Indian communities. Hernandez added that “with training and workforce, we need more people that are from the community that are getting the training and the resources to build the communities they want to live, work, and play in [and to build] the world that is more just, more equitable, and more community oriented.”

Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×
Page 67
Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×
Page 68
Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×
Page 69
Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×
Page 70
Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×
Page 71
Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×
Page 72
Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×
Page 73
Suggested Citation:"6 Bringing It Together with Applications for Different Practice Communities, Collaboration, and Policy." National Academies of Sciences, Engineering, and Medicine. 2023. Spatial Justice as a Driver of Health in the Context of Societal Emergencies: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26858.
×
Page 74
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Spatial justice is about equitable access to parks, housing, and more. During societal emergencies, including pandemics and climate change, the relationship between people and places requires greater attention and action to integrate the knowledge of people with lived experience, especially historically marginalized communities. On September 20 and 21, 2021, the National Academies Roundtable on Population Health Improvement hosted a virtual workshop to explore the nature, use, design of, threats, and changes to places as a resource for health and public spaces as a shared resource. This Proceedings document summarizes workshop discussions.

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