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2 The Need for a Systems Approach to Address Structural Racism
Pages 3-18

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From page 3...
... Chan School of Public Health, discussed the current disparities that exist between White Americans and people of color and the factors that perpetuate them. Brian Smedley, chief of psychology in the public interest and acting chief diversity officer at the American Psychological Association, argued for the importance of place as a way to frame race and focused his presentation on actionable opportunities to demonstrably improve conditions for health equity.
From page 4...
... . This gap is nearly identical to the income gap following the antipoverty programs and civil rights initiatives of the 1960s and 1970s, Williams said.
From page 5...
... He compared segregation to a burglar who slips in u ­ nnoticed at night and over time steals valuables such as quality schools, safe housing, transportation, and access to health care and healthy foods. ­Providing empirical evidence to support this statement, Williams noted a study that looked at 171 of the largest cities in the United States and found that because of segregation, there is not one city where White Americans live in equal conditions to Black Americans (Sampson and Wilson, 1995)
From page 6...
... 6 REIMAGINING A SYSTEM OF CARE levels of racial bias and a high presence of fathers, but fewer than 5 percent of Black children grow up in these areas. These racial inequities in SES are not reflective of a broken system, Williams stated.
From page 7...
... Consequences of Racism and Toxic Stress Research has also shown that in addition to higher levels of racial dis crimination, Black American and Hispanic American populations encounter higher levels of other economic, psychosocial, physical, and environmental stressors (Williams, 2018)
From page 8...
... Solutions to Address Racial Inequities These are all problems of systemic and structural biases, said Williams, but there are things that can be done to address them. He first highlighted ways to reduce prejudice through focusing on identifying and tackling implicit bias.
From page 9...
... As a strategy to achieve this, Williams suggested creating communities of opportunity, to "minimize, neutralize, and dismantle the systems of racism that create inequities in health." To do this, he offered several methods outlined in Box 2-1 and explored in further detail below. Invest in Early Childhood Education Williams shared an example of positive outcomes through investment in early childhood education demonstrated by the Perry Preschool Study, a preschool program designed for disadvantaged African American children in the 1960s.
From page 10...
... Researchers found that the communities that were challenging the government for increased land rights, self-governance, and control over their own education and health care services had a significantly lower risk of youth suicide (Chandler and Lalonde, 1998)
From page 11...
... Williams also called attention to a recent National Academies of ­Sciences, Engineering, and Medicine report, A Roadmap to Reducing Child Poverty, which listed several of the report's recommended strategies to reduce child poverty by 50 percent within 10 years (National Academies of Sciences, Engineer­ing, and Medicine, 2019) by a number of policy initiatives: • Earned-income tax credits • Expand housing vouchers and SNAP • Child allowances • Child and dependent care tax credit • Work-based programs • Government and tax transfers • Public health insurance The report reviews the research on linkages between child poverty and child well-being.
From page 12...
... One study found, for example, that raising the minimum wage in a state by just one dollar produces decreases in low birthweight of up to 1 to 2 percent and decreases in post-neonatal mortality of 4 percent in the United States (Komro et al., 2016)
From page 13...
... In conclusion, he said, "we need to move from a commitment of equality of giving everyone the same thing to a commitment of equity and giving everyone that which they need to thrive." SOCIAL DETERMINANTS OF HEALTH: PLACE MATTERS Smedley called attention to residential segregation, which Williams mentioned previously, and said that it set the stage for many racial inequities in other areas besides health. Segregation has faded as a key objective of racial justice work, he noted, but it is increasingly returning to the focus as a key structural determinant of racial inequality.
From page 14...
... This created a legacy of not just segregation, he explained, but d ­ eliberate economic disenfranchisement and marginalization, which explains the patterns of deep poverty often associated with segregation. To provide context for racial residential segregation in the United States, Smedley presented data comparing South Africa during the apartheid era in 1991 to several U.S.
From page 15...
... Poor Black Americans and Hispanic Americans are more likely than poor White Americans to live in medium- and high-poverty census tracts. Some might argue that these concentrations are due to income or educational differences, he said, but even controlling for income, the racial differences are stark (see Figure 2-4)
From page 16...
... He presented a report called "History Matters" in which Cuyahoga County PlaceMatters and several other partners reviewed old homeownership loan corporation redlining maps, demonstrating the sanctioned disinvestment in overwhelmingly Black neighborhoods (Reece et al., 2015)
From page 17...
... The long-term evaluation of this effort found the following results for families that moved to lower-poverty neighborhoods: BOX 2-2 Strategies to Address Structural Racism Creating Healthier Communities: • Improve food and nutritional options and provide incentives for greater numbers of farmers markets and grocery stores. • Structure land use and zoning policy, explore incentives for healthier restaurants and food establishments, and limit permits for fast food ­ stores, carryout, and the like.
From page 18...
... Instead, differences in investment and other structural inequities across the neighborhoods expose the true root of these differences. Finally, Smedley offered a quote from Mary Bassett, former commissioner of health for New York City: "Antiracism is … a collective healing without which our nation will remain painfully and inequitably divided, corroding opportunity, spirits, and bodies alike" (The Huffington Post, 2017)


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