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Addressing Racism and Its Deeply Entrenched Dynamics: A 21st Century Imperative

2023; Mary Ann Liebert, Inc.; Volume: 7; Issue: 1 Linguagem: Inglês

10.1089/heq.2022.29019.rtd

2473-1242

Gail C. Christopher, Algernon Austin, Mindy Thompson Fullilove, Alan Jenkins, Charmaine Royal, Lisa Sockabasin,

Racial and Ethnic Identity Research

Health EquityVol. 7, No. 1 Roundtable and Briefing PapersOpen AccessCreative Commons licenseAddressing Racism and Its Deeply Entrenched Dynamics: A 21st Century ImperativeModerator: Gail C. Christopher, Participants: Algernon Austin, Mindy Thompson Fullilove, Alan Jenkins, Charmaine D.M. Royal, and Lisa SockabasinModerator: Gail C. ChristopherExecutive Director, National Collaborative for Health Equity, Washington, District of Columbia, USA.Search for more papers by this author, Participants: Algernon AustinDirector, Race and Economic Justice, Washington, District of Columbia, USA.Search for more papers by this author, Mindy Thompson FulliloveThe New School, New York, New York, USA.Search for more papers by this author, Alan JenkinsProfessor of Practice, Harvard Law School, Cambridge, Massachusetts, USA.Search for more papers by this author, Charmaine D.M. RoyalRobert O. Keohane Professor of African & African American Studies, Biology, Global Health, and Family Medicine & Community Health, Duke University, Durham, North Carolina, USA.Search for more papers by this author, and Lisa SockabasinWabanaki Public Health and Wellness, Bangor, Maine, USA.Search for more papers by this authorPublished Online:13 Jan 2023https://doi.org/10.1089/heq.2022.29019.rtdAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Dr. Christopher: Hello, everyone. I am Gail Christopher, executive director of the National Collaborative for Health Equity (NCHE), and I am just so humbled and honored that you as our senior scholars have written these wonderful articles for us and are going to engage now in a roundtable discussion of these critical issues. I want to begin by saying that the issue of racism, the grounding I call it meme and ethos of our culture has been danced around for too long by far too many people and our politics, our governance infrastructure, our investments, and certainly, the opportunity structures to be healthy are all shaped by this organizing theme of our society, which is hierarchy of human value, or racism.I am really excited to be engaging in this very frank discussion with each of you who are such scholars and who can help to shed light in a way that, as I say, calls people into the conversation more so than calls people out because we need as many people as possible in this discussion and willing to make a stand for us to transform our country. I am honored that the Robert Wood Johnson Foundation has funded our leadership work, and that the W.K. Kellogg Foundation while I was there had the courage to launch a National Truth Racial Healing and Transformation Initiative.We, unlike many other countries in the world, have failed to really face the truth of our past and to embed a commitment to facing that, redressing it, and moving forward. So, the truth, racial healing, and transformation are the organizing comprehensive framework for our work at the National Collaborative, and many places around the country are doing this work, and it has five pillars.Each of you has written a beautiful article that explores one of those pillars. The first one is narrative. And it is certainly the issue of the stories that we tell about our country, about ourselves, and the significance of that, particularly in driving our perceptions and our scientific middle view, as it were. We were so pleased that Dr. Charmaine Royal took on this narrative change conversation for this particular effort.I am going to invite Charmaine Royal to tell us why narrative change for health is so critical to achieving health equity.Dr. Royal: Thank you, Gail. It is such a pleasure to be part of this conversation today; I appreciate the invitation to engage with this group. I am a professor of African and African American studies and biology at Duke University, also working in global health and family medicine. I am trained in human genetics and bioethics, and bring those disciplines together in my research, scholarship, and teaching. My work focuses on the ethical and social implications of human genetics research, particularly issues at the intersection of race and genetics. The narrative change pillar is directly related to my work. As Gail alluded to earlier, the stories we tell and who tells those stories, shape our historical and current realities. The narratives that I focus on in my research and in my brief have to do with what race is, what it is not, and how it is related to racism and adverse outcomes.For centuries, the dominant narrative has been that humans are naturally divided into distinct biological races, and that there is a hierarchy among these races, with people of primarily European ancestry being superior to everyone else. My work and the brief that I prepared are focused on helping to change that narrative, helping people understand that we made up this story. Science has long confirmed that regardless of our diverse physical characteristics, we as humans are one species—Homo sapiens. Unlike some organisms, there are no biological divisions within our species that can be defined as subspecies or races.Although biological human races do not exist, racialized human groups do, and it is important to understand the differences between these concepts. The invention of race, racial classifications, and racial hierarchies in humans were driven by a need to justify economic, political, and social domination of groups deemed to be inferior based primarily on physical features. Racism created race and is the root cause of the associated inequities and disparities we see today. This narrative must replace inaccurate narratives about the relationship between race and racism and the reasons for differences in health and other outcomes among racialized groups. Now, I am not naive enough to think that replacing prevailing false narratives alone is going to fix the racism problem. But it is critical to the process, because beliefs influence attitudes and attitudes influence behaviors.We have done research that has demonstrated that more than 50% of the U.S. population believes that there are biological human races. Some people also believe that there is a racial hierarchy. Furthermore, research has shown that biological race thinking influences how we do scientific research, how we provide health care, and how we live in society. To achieve health equity, we must dismantle beliefs in the existence of biological human races and racial hierarchies that underlie and perpetuate structural inequalities and health disparities. The need to promote more accurate and complete narratives about race and racism has never been greater or more urgent. And science must be part of the conversation in my view. It will take science and society working together to change narratives, minds, and hearts and lead us to transformation.Dr. Christopher: Thank you so much for that. And we are going to come back to some of the critical issues that you raised, but one of the key takeaways for me was that racism created race and that this is a joint effort, science, and all aspects of society that must commit to eliminating that fallacy. So, thank you so much for that. And the next topic we are going to discuss is racial healing. And from a practical standpoint, would you please answer the question, Lisa Sockabasin, in terms of why is racial healing such an important precursor or a necessary component to achieving equity and fairness and more optimal health outcomes?Ms. Sockabasin: Kci woliwon, Gail, for the question. My name is Lisa Sockabasin. I am a Passamaquoddy citizen from Wabanaki territory, which is what we now call the state of Maine. My work has always been centered on Indigenous people, our culture is our prevention, our culture is our medicine, and providing services and developing programs that really work in our communities. I am the co-CEO of WPHW. It is an organization here in Wabanaki territory that is growing quite fast. When I joined just a little over 4 years ago, we were less than a dozen people trying to make profound change in our community.Four years later, we are close to 200 people, 70% Indigenous, wildly enthusiastic about healing in our community. When we think about racial healing, when we think about the relationships that are needed for that, we look at the massive amount of work before us. We see a nation that is utterly divided, not just divided, aggressively divided. And we also see this deep disconnection with our land that we share, and we do not own. Our land is now poisoning us because we have poisoned her. Our relationships are deeply disconnected.What I believe is that when we heard Charmaine talk about the stories our history has told in this country, one of those stories that has been missing for far too long is that Indigenous story. Those stories in the books that describe us as uncivilized and savages when the reality is we should be measuring civilization based on how much love is present rather than what we are accomplishing based on capitalism. The racial healing that needs to happen, these relationships that need to be restored, we need so much now more than ever the people that we made invisible in this country, Indigenous people. That perspective of love first always is what is informing how we build health care for our people, how we build education and recovery programs, knowing that wellness and healing is easy when love is present and impossible with the hatred that we now are all experiencing.So, my article is very much focused on the Indigenous perspective of relationships, the knowing that the concept of race is silly. We are all connected. We all have roles, and they are different, just like the scholarly roles today, but equally as important. So, I hope what you see from my article is this charge, this calling in that you describe Gail, this calling in for censuring all of us, each other even when there is difference, finding what are those things that we can work toward, and believing that what this country tried so hard to make invisible is the very strength that can pull it together today.Dr. Christopher: Thank you so much, Lisa. And our diversity, our Indigenous values, it is our strength as a nation and as a world, I would even say, as a global family. Because each and every one of us will trace our roots back to an Indigenous people, and the decision to deny that is a lethal decision truthfully. So, I thank you so much for those comments, and we will come back to explore that in more depth as well.Our next scholar, Dr. Mindy Fullilove, is going to explore how the tool of separating and dividing has been embedded in our systems and structures, the five pillars of the THRT framework are narrative change, racial healing and relationship building, separation, the law, and the economy.Dr. Fullilove: Good morning, everybody. Nice to be with you. I am Dr. Mindy Fullilove. I am a social psychiatrist on the faculty at the New School. As of this day, we are currently on strike fighting for decent pay for our part-time faculty. The New School is behaving atrociously, so we are all trying to support the picket line. And it is one of those things that we are talking about: how you can mistreat people by giving them a special name so they are not real faculty, they are part-time faculty. With demeaning name, you can give them terrible pay and no benefits and make them perform piles of unpaid work. One of the things that I learned when we were working on a project to observe the anniversary of Jamestown in 2019—our 400 years of Inequality Project—was that just at the time that Africans were being brought over and sold into slavery, the colonists were stealing the land from all the tribes that lived in that Jamestown region.People described this as, “Stolen hands working stolen lands,” that these processes of theft were happening at the same time. At that same time, they were also bringing women over to be indentured servants but really to be sex slaves. All of these forms of inequality emerge at the same time and are interwoven. Anybody can be labeled something and then situated in this hierarchy, which is then applied to the land. Lisa said we do not own the land, in fact, land owns us. But the commodification of the land in 1619 transforms the land from the source of life, the mother of us all, into something you buy or sell. The commodification of people and the commodification of the land are happening at the same time.Which leads to the first point I would like to make about separation: the importance of redlining, a policy instituted in the 1930s, but very evident to this day in the traces it has left and the impact it had on the American city. Redlining is said to be about undermining black neighborhoods, but really it authorizes the disinvestment in the whole American city. This kind of illusion is the way in which racism is used to hide the real objective, which is to make as much profit as you possibly can and to use people as you use the land without concern for long-term sustainability.The second point is that there is a paradox in separation. The more you divide people, the more tightly they become connected. This is an unexpected finding that is presented in the important ecological work of doctors Roderick Wallace and Deborah Wallace. We think we are separate, but in fact, we are one, and we are all suffering from the ways in which this stratification is imposed upon us and destroys our relationships, destroys our strengths, and destroys our health.And then the third is that racism is constantly evolving, because oppressed people are constantly fighting it. Women have fought it. Jews have fought it. Native people have fought it. African Americans have fought it. Everybody fights it. It is disassembled, but then it tries to invent new ways to assert itself, and we are certainly in this period of the new racism lifting its ugly head and tearing at us. You pick up the paper every day, and there is another incident of racial hatred, most recently in Colorado Springs. So, it means that none of us are safe at any time. This new racism, as Lisa was describing, is so angry and so aggressive and has been promoted by the top levels of the U.S. government. Part of the question we face now is, how are we going to respond to something that is all pervasive, connects all of us while we feel disconnected—so that is a terrible paradox—and it is constantly evolving?One of the things I wanted to throw into the conversation was a concept that Doctors Wallace who had done all this ecological thinking on apartheid said, look, you cannot address a problem this big with any simple solution. You have to have a solution, what they called the magic strategy, which operates at multiple levels of scale and in multiple systems. I really appreciate their proposal about magic strategies. They are trying to teach us that we have to think ecologically because we are in an ecological crisis. As Einstein said, “You can't solve the problem with the thinking that created it.” We can't solve the problem of racism with the thinking that created it, that sees people as separate. We have to see us all as in one kettle, one pot, one something.Dr. Christopher: Beautifully said, Mindy. Your article is profound in that expression and communication, and I am going to invite our next scholar, Alan Jenkins, to talk about the law, which is a broad, broad topic, and we know that in this pillar, as are all of them. But again, why is addressing this structured legal dynamics so important if we are going to achieve our ultimate goal of people having the opportunity to be healthy and to live up to their potentials?Prof. Jenkins: Thanks very much, Gail. I am Alan Jenkins. I am a professor of practice at Harvard Law School. In my previous lives, I have been a civil rights attorney, a human rights grant maker, a social justice leader at a communications lab, and now here as a scholar of the law. The law is one of the principal ways in which we organize ourselves as societies. We establish what our societal values are, how we treat each other, and how our government will interact with us and vice versa. And in the United States, the law has been both an implement for oppression and extreme discrimination and also at times, at the best of times, an instrument for greater and more equal opportunity, human rights and human dignity.In my article, I briefly traced some of that history. That our founding documents declared the remarkable proposition of equality and freedom and a government by, for, and of the people. And at the same time, it embedded the principle of human chattel slavery tied to race. It both assumed and furthered the attempted genocide of Indigenous peoples. It intentionally excluded women and many other people in our nation. And that was the case for the first century almost of our existence as a nation. I should note that the Supreme Court, to whom we will return, was most frequently an instrument in furtherance of discrimination and oppression, declaring, as Lisa noted, Indigenous people to be “savages,” unworthy of either controlling or even remaining on the land that they had inhabited since time immemorial, declaring that black people, whether enslaved or free, had no rights that whites were bound by the law to respect.And so it was for many, many decades, the fundamental change coming with the Civil War and importantly the Reconstruction amendments to our Constitution—the 13th, 14th, and 15th amendments to our Constitution—that many of us, both historians and those of us who study the law through legal academia, see as a fundamental transformation of the relationship between people, the states, and the federal government.With those amendments, we saw an attempt at a transformative multicultural democracy. At the end of a bloody Civil War and centuries of slavery, we saw the Reconstruction Congress, the radical Republican Reconstruction Congress, grant and protect the right to vote for, at that time, black men; declare that equal protection under the law is the law of the land; and abolish not only slavery but also its incidences and things relating to it. We saw it briefly for about 12 years, a transformation of African American men elected to Congress and to state legislatures, of real attempts—often through the use of federal troops—to ensure the right to vote and other aspects of equality.Then, the nation lost interest, and troops were withdrawn with the Compromise of 1877. Jim Crow discrimination was installed. Throughout that period, the displacement, the disrespect, the persecution of Native and Indigenous peoples continued. The period of around the turn of the century between the 1800s and the 1900s was considered the nadir of human rights in our country, with that transformative vision resurrected in the 1950s and 1960s and into the 1970s with civil rights laws passed.Activism was always driven by the people, driven by people of color, driven by women of all races, and later in the century, gay and lesbian, LGBTQ+ Americans. And now we are in a period in which the nation has again lost interest in that progress, and it is really up to all of us to reignite that spark.In my article, I talk about some things in the short term, in the medium term, and in the long term that all of us can do to promote greater equity and inclusion and respect for human rights—which are, of course, deeply tied to health and health equity for everyone.Many of the short-term items relate to things that this current Biden administration is doing in terms of a very important executive order that requires the spending of trillions of dollars of federal funds in a way that advances equity, of the Interior Department under the leadership of Deb Haaland, the first Native American Cabinet Secretary in the modern era, to include tribal voices and input and guidance in Interior Department decision-making, to examine our shameful legacy of boarding schools and the trauma that has caused, to advance and lift up tribal government solutions to addressing climate change—both from a resilience standpoint and from a prevention standpoint. These are all short term, meaning that they live and may expire with this administration, but present remarkable opportunities for all of us to engage and move the ball.The article touches briefly on the rise of reparative laws. Evanston, Illinois, most remarkably, has passed what we believe is the nation's first reparations ordinance tied to housing opportunity, in particular, and derived from taxes on the cannabis industry.And then a call finally for long-term transformative change, finishing the business of the original Reconstruction through what many of us call a “Third Reconstruction,” the second one being in the 1950s and 1960s, which is going to be a long-term enterprise, but is really going to be about that realignment of the people's narrative, as Peggy Cooper Davis and colleagues have called it, rather than a Confederate narrative of states' rights. Rooted in anti-subordination, rooted in full and equal opportunity, equality, and human rights. And I fully believe that we can get there as a nation given our social movements and leaders of the day.Dr. Christopher: Thank you, Alan. And thank you so much for having hope and belief that we can get there. I think that is a very important segue to hear from our final scholar, Dr. Algernon Austin. And we know that the engine for this culture that we all live in, the engine is an economic one, and so that is the final pillar of this framework, this comprehensive approach to eliminating racism and its consequences.Dr. Austin: I am Algernon Austin, the director for Race and Economic Justice at the Center for Economic and Policy Research. Although we talk about the pillars separately, every time I think about them, and it is reflected in my work, they are all connected. As Dr. Fullilove talked about, there are no small policies that are going to address this. We really need all the pillars working simultaneously. They are all intertwined with each other. So right now, in terms of thinking about the economy and its impact on health equity, I want to really drill down a little bit on one of the points in my article.The article was structured on certain principles in terms of understanding racial inequality and racial equity. One of the points that I put forth was that economic inequality contributes to racial inequality. I want to talk about that now more explicitly in terms of health equity. Our public health researchers know and have informed us that the social determinants of health can be more important than actual health care in determining the health outcomes of a population. Among the social determinants that these public health researchers examine include income and poverty, unemployment and job security, working conditions, and other economic factors. The public health researchers are telling us that economic factors are critically important to understanding the health outcomes of a population. I am not a public health researcher, but I can imagine the mechanisms working in ways such as the following.For example, many Americans are constantly stressed because they do not know how they are going to pay their bills. About half of all renters are in what we call unaffordable housing because they are paying more than 30% of their income on housing. About a quarter of these renters are paying more than 50% of their income on housing. If you are paying more than 50% of your income on housing, you are likely struggling to stay afloat. You are worrying about being evicted, worrying about being homeless, juggling bills from day to day. There is a lot of day-to-day stress in your life. And we know that chronic stress leads to negative health outcomes. People with chronic stress are more likely to gain weight. They have high blood pressure. They suffer from heart disease. They have immune system problems. They suffer from insomnia, experience anxiety and depression, and have other health problems.So, America's failure to have an effective affordable rental housing policy is likely subjecting anywhere from a quarter to a half of the rental population to chronic stress and increasing this population's likelihood of having negative health outcomes. This failure in affordable rental housing policy has inequitable outcomes from a racial perspective. So here, the class inequality that is reflected in our housing policy then contributes to the racial inequality in health outcomes. For example, although only a minority of white households are renters, a majority of black households are renters. So, this failure of affordable rental housing policy has a disproportionate negative impact on black households. The stress and negative health consequences of not being able to afford rental housing falls disproportionately on black households. So, here we can see the racial inequity effects of this economic policy failure.Dr. Christopher: Thank you so much. Thank you to each of you. And in this next question, I am going to ask you to sort of step back. And if you had a moment—and the power—to bring about a change in our society that would disrupt this pattern—and Alan, you spoke so vividly about how that one period in history would seem to be the nadir for the efforts toward equity and fairness and justice. And Mindy, you described how it has to be a holistic essentially approach. There is no simple thing. And we were reminded by Lisa of the Indigenous power, the culture is the medicine, so to speak. And of course, Charmaine reminded us of the embedded nature of this fallacy of a belief in a hierarchy of human value that it is embedded in the science, which we pride ourselves, as Western minds. We pride ourselves that the science is objective, and it drives.And of course, Algernon, your illustration of the housing is absolutely relevant, particularly in this post-COVID era. And thank you for reminding us that although we have a framework that has pillars, it is all interconnected. But for each of you, could you think about what do you think is the prescription? What do you think we could do that would put in place the infrastructure for disrupting this episodic dynamic that we have had? What could we put in place that would make this a sustainable, continuous, focused, passionate effort? Knowing our two-party system, knowing the level of polarization that we have right now, if you could call for something that would be transformational, but most importantly, would not be subject to the ebbs and flows of political will, is there a thing? What do you think that could be? And I invite all of you to respond to that one.Dr. Austin: So, in my thinking, we have to get the American people of all races to get beyond a zero sum framework. People are constantly assuming that if something has a benefit for another group, it is going to harm their group. And that really prevents us from creating policies that lift up and benefit the common good. This zero sum framework is deep within our culture. Unfortunately, there are people who are invested in fostering it. But if we can somehow get people to stop seeing the other group as the enemy, as us versus them, then we can work on solving our problems collectively. But it is a real challenge. But the benefit is also real. And we must communicate this. This must be part of the narrative change.For example, just recently this year, the consulting firm McKinsey and Company estimated that closing the black/white wealth gap could grow the economy by 1 to $1.5 trillion. So that $1.5 trillion would benefit people of all races. But when we enact the policies to improve the outcomes of African Americans, unfortunately, we know that many people will say, well, if that is benefiting African Americans, it is taking something away from me. And I am going to oppose it, not being able to see that closing this gap will actually lead a 1 to $1.5 trillion benefit for people of all races. It is a lot of work to get people to see the big picture, the long-term picture and not be stuck in this us versus them zero sum framework.Dr. Christopher: Thank you very much, Algernon. Anybody else want to weigh in on that?Dr. Royal: Algernon said pretty much what I was going to say. It is the mind and heart work, getting people to truly embrace our common humanity, interconnectedness, and interdependence, realizing that what benefits you benefits me and what hurts you hurts me. And separation is one of the most powerful tools of racism. The more we separate people, keeping them from interacting with others who we have racialized and who we think are so different, the less likely it is that we are going to get to know, understand, and become empathetic toward one another. We are one human family, with a beautiful tapestry of diverse physical features and cultural values and experiences. The variation in our physical characteristics is part of our humanness. It is important for people to understand that at so many levels, we need each other.Dr. Christopher: I appreciate both of your perspectives. Anybody else want to weigh in on that question in terms of what is it going to take?Dr. Fullilove: I would like to weigh in. I do not know that there is anything that is a permanent change. Racism is like COVID, right?Dr. Christopher: It adapts, right.Dr. Fullilove: COVID is getting out from under the vaccines and our natural immunity. We are in a cloud of COVID variants. The pandemic is over, but we have COVID. Racism is like that. We get into the same kind of crazy binds because we are so ambivalent—not all of us, but the powers that be are so ambivalent about letting go of any of the power that they get from keeping us divided. But you know, Abraham Lincoln said, “You can fool all the people some of