“In the twenty-first century, the visions of J.C. Nichols and Walt Disney have come full circle and joined. “Neighborhoods” are increasingly “developments,” corporate theme parks. But corporations aren’t interested in the messy ebb and flow of humanity. They want stability and predictable rates of return. And although racial discrimination is no longer a stated policy for real estate brokers and developers, racial and social homogeneity are still firmly embedded in America’s collective idea of stability...”
-Tanner Colby
Health equity is the basic principle that all people despite race/ethnicity, gender, age, religion, geographic location, or sexual orientation have equal opportunity to lead healthy lives. The above principle is simple enough, and I would wager that there is none who could legitimately argue that in fact all people should not have equal opportunity to lead healthy lives regardless race/ethnicity, gender, age, religion, geographic location, or sexual orientation. However, despite our proclaimed value of equitable health for all peoples, the institutional policies of our nation demonstrate a very different principle.
To understand health equity, I think we first need to acknowledge inequity, as it relates to public health. It is my observation and informed conclusion that the social inequities that lead to disparities in health equity are avoidable, unfair, and unjust. It is this perspective which leads me to view disparities in health equity as a matter of social justice. The reality is that health is often determined by social factors and circumstances outside of one’s control. This is especially true for communities of color, and for people living at or below the poverty line. Statistics demonstrate that African Americans live sicker and die younger than any other ethnic group in the nation (LaVeist).
Skin color, along with residential zip code, has become a reliable predictor of a person’s risk for illness and disease, and general health outcome. If you are brown skinned, and/or poor your risk for illness and disease such as hypertension, diabetes, breast cancer, or heart dis-ease increases exponentially. You are also predicted to have a significantly shorter life span. These factors have very little to do with DNA or biology, and much more with the way that our society is organized and the social location that you have inherited and inhabit.So what causes the extreme health disparities that plague the African American community and the impoverished? Our social narrative would have us believe that the disparities are a matter of poor lifestyle choice and /or lack of ambition. However, we find that public health issues and the health of an individual are closely connected and the choice to engage in unhealthy lifestyle behaviors is not so much of a choice after all. It is argued that there are social determinants of health that either provide or deprive a person of the right to make free and informed choices about their health. These determinants are race/ethnicity, culture, education, socioeconomic status, neighborhood, and occupation.
In our capitalist society, these determinants are interdependent. The quality of education received, what neighborhood we live in, and the occupations we have are all a consequence of our inherited socio economic status. The greater your economic status,the more access you have to social resources. The more access to social resources you have, the better your health outcome. It is important for us to remember that the United States was founded on a system of slavery and despite de jure legislation, structural racism is deeply rooted in our institutions and in the public policy that these institutions generate. This means African Americans are specifically vulnerable to being deprived of access to social resources because institutions have the power to create unequal opportunities related to social status.
The social, economic, and environmental policy trends of our society create an inequitable distribution of wealth and economic oppression within the African American community, restricting and limiting access to quality education and higher paying employment opportunities. Policy makers and city planners (along with developers) determine how schools are funded, which businesses get tax breaks, the choice to invest in a neighborhood or divest, and even where a freeway or a grocery store is built. These policies are systemically generated in favor of people of higher economic status, at the expense of those of lower economic status. Poorer performing schools, lack of job opportunities, violence, abusive policing, environmental pollution, inadequate access to fresh food, and transportation barriers are trademark characteristics of low-income neighborhoods. In environments like this, where the stress of social subordination is high, resident choices are extremely restricted and limited. Maladaptive coping mechanisms must develop to survive in such an environment (Unnatural Causes). Last year, I began an in depth study into how trauma shapes the function of the brain. I was focused specifically on how complex cultural and ancestral trauma affects the brain and in turn interpersonal relationships. I was led to study interpersonal neurobiology by a deeply personal need to understand the way traumatic experiences have shaped the way that I engage with others. Personally, it was an effort to understand how lifelong conditions of poverty and the traumatic experiences associated with poverty had shaped who I was. Until this class, I had only given exploration to how trauma affects our mental health. I had not thought to ask how our physical heath is impacted by trauma. The documentary, Unnatural Causes helped me make the connections between the constant overproduction of cortisol not only on our mental health, but on our physical health outcome as well.
The reading material we've been covering in this class, along with the in class documentary, as well as the guest speakers have all broadened my understanding of the effects of trauma. I am finding a ton of overlap between my studies of complex cultural trauma, interpersonal neurobiology, and racial justice. Just one example of the way that this overlap has become evident during this course came during our visit with Lisa Bates and our brief discussion on Root Shock theory. This was my first introduction to the terminology used to explain the trauma associated with gentrification and displacement caused by urban renewal policies. To learn more about root shock, I found Mindy Thompson Fullilove's book Root Shock: How Tearing Up City Neighborhoods Hurts America and What We Can Do About It. Picking up this book following the reading of Bleeding Albina could not have been more perfectly timed. Looking at gentrification through a contracted then broadened lens helped me remember to see gentrification as the patriarchal tool for the structuring and restructuring of society that it is. When forgotten, I have a tendency to blame individual developers, city council members, and even the new people moving into the neighborhood. Already my brief read into this book is weaving together my knowledge of trauma, racial inequality, shock doctrine politics, and tactics for developing community resiliency. I believe that this weaving of knowledge will help me in the work that I do in the community.
Policies for Change
The discussion on how to create policies for change is a conversation that I have only halfheartedly engaged in because I do not believe that small and incremental policy reform can bring about adequate and timely change. My politics were radicalized in my early twenties and while my activism has been forced to acquiesce to the political reality, my social and political perspectives are what some may consider radical. While I do understand and can value the work of policy reform, I feel that we cannot rely solely on reform measures to do the revolutionary work of shifting the paradigm of state and corporate collusion that we currently find our self subjected to. Corporations have zero interest in the human element and will continue as they have, aggressively pursuing profit despite the social or ecological impacts. Because government is and always has been bent to the will of the business elite, it is naïve to believe that we can find relief through the façade of a democratic system that they would have us work though. If we want to see timely health equity, there must be an informed and enduring social movement of the masses which can swiftly intervene to dismantle the system that makes it possible for some people to have restricted and limited access to resources, and others to have unfettered access at their expense. There must be a movement that refuses to allow the continued exploitation of The People and our Mother. This I Believe.
Though I also am a realist and have come up against the state institutions that keep such a movement from becoming too effective, as well as the fears and consequences that come with being a part of such a movement. Not to mention the divisive tendencies that are so prevalent in activist circles, which have a way of turning us against each other. I must admit that colonization of the People and The Land was a very clever and efficient design. I have come to accept that the kind of radical social change that would render corporate interests benign may not be imminent. What then can be done under such circumstances? For those using the strategy of policy reform, there are infinite polices that can be used to address the current health disparities in health equity. I do not think that it is an issue of what policies would help, but rather and issue of how to get these policies implemented and/or funded. Nevertheless, here are a handful of policies/ strategies for change that I think are within political reality:
At the federal and state level, we could as a first priority, add an amendment to our constitution that clearly separates business and state. Make a national acknowledgement and apology to the injustices committed against indigenous peoples of this land, as well as an acknowledgement and apology to the practice of chattel slavery. Make corporations and the business elite pay taxes on the money they make. Dissolve all contracts between private corporations and state agencies; letting them be replaced by entities such as state banks, small-scale businesses with fair practices, and collectives. Pass adequate federal funding quality health care, childcare, and affordable housing and food programs along with free pre-k-PhD education. See to the implementation of a national stipend for all peoples with the only requirement being that you are a living breathing human being. Pass national police reform and regulation that addresses the racial and economic inequities within the criminal justice system including the decriminalization of poverty. Require training to officers and evaluation of their practices to ensure that they understand that being black or brown is not a crime. Hold individuals who abuse their institutional power accountable.
At the city/ county level we could start by equitably investing in all neighborhoods. Change the way that public schools are funded to be more equitable and just. See to the equitable redistribution of all public land that is being held for “future development”. Create a free public transportation system, and offer free classes to youth on how to get around via public transit. Donate vacant buildings or land to neighborhood associations and offer lucrative neighborhood grants for the development of Community health centers, community gardens, and community recreation centers. Change city code to make it easier to establish an urban homestead. Reestablish the commons, areas that are held in land trusts for use by The People. Pay parents to be active in their children’s schools. Hire grassroots organizing groups to capture and represent the concerns and needs of the community. Let the minimum wage reflect the cost of living. Cap the salary of all city and county officials to be not more than 20% above minimum wage. Regulate the number of convenience stores, pawnshops, and fast food stores that are allowed to operate within a given radius. Free recreational sports leagues in low-income neighborhoods along with free music and art classes. Make police accountable to the community. Abolish police unions and standardized testing in our schools. These ideas for policy reform may seem like a tall order, but I am convinced that these are not radical ideas though they may seem radical in contrast to our capitalist society. If we were to somehow address and sever the toxic relationship between business and state,
I believe that we would be able to use policy reform to make ground on the numerous social issues that we have discussed this term. Though I came to this class with a knowledge base already in place, and felt aware and informed of the deep disparities in racial equity. My decision to take this class was based off of a desire to engage with people outside of my normal social circle about issues of racial inequality. I wanted to explore these conversations with people who did not necessarily share my worldview, social perspective, or skin color. The majority of the people I organize with come from an academic background, and identify as white. Most of the people of my circles also come from a background of socioeconomic privilege.
In organizing for the Black Lives Matter campaign, I was offered the opportunity to work with organizers who were not white and whose activism was not inspired by books, on principle, or political philosophy. I found that more than anything I wanted to support and empower my co-organizers to shape the work we were doing to address their lived experience and concerns with racism. What I saw was many of the white organizers I had worked with over the years stepping into leadership roles to tell these “new” black organizers how to organize. I am familiar enough with these people to know that they would not see themselves as oppressive to work with, nor would they want to be. However there it was. Racially oppressive tendencies and a paternalistic approach to organizing with black activists. This was crushing because we all had an opportunity to align frontlines across movements and connect as allies. Not to mention the opportunity to create the kind of culture that we were demanding of the state, a culture in which black lives matter.
I think that part of the reason these oppressive tendencies came up is due to our neglecting to really understand the black experience in depth and how those experiences have shaped contemporary conditions. From my own experience, I can understand and resonate with economic oppression but I cannot share the intimate understandings and feelings of what it is like to be a brown or black person in a society steeped in white supremacy. Our oppressions are not the same and I cannot presume to know how to organize a campaign to address racial inequity but I can do the work of making sure that I am as informed as is possible to the ways in which as a white skinned person, I am afforded privileges at the expense of black and brown lives so as to not replicate in our movements the systems which we oppose.
The material in the class has given me the opportunity to move from just being aware of the consequences of Portland’s Urban Renewal projects to becoming informed about the long history of intentional disinvestment in and displacement of the black community. I am also appreciating my new understanding of the economic life cycle of a neighborhood and Planned Abandonment, which Bleeding Albina offered.
Works Cited
Dr. Thomas LaVeist. 2013. The Skin You're In.
Adelman, L., Baynard, J., Chisolm, R., Fortier, J. M., Garcia, R. P., Herbes-Sommers, C.,
Krause, D., ... Pacific Islanders in Communications. (2008). Unnatural causes: Is
inequality making us sick? San Francisco, Calif.: California Newsreel.
Fullilove, Mindy Thompson. 2004. Root shock: how tearing up city neighborhoods
hurts America, and what we can do about it. New York: One World/Ballantine
Books.
Karen J. Gibson. 2008. Bleeding Albina: A History of Community Disinvestment,
1940-2000.