Originally published on The Medical Care Blog, May 4, 2023. Reprinted with permission.
Racial justice reframing is the process of shifting our attention from individual choices to the many structural and societal factors that contribute to health inequities. This framing allows us to picture a world where values of equity, shared responsibility, and community care are paramount. We see a world where everyone - regardless of their identities and experiences - has equitable access to services and resources. In this world, everyone has the opportunity to achieve their best health.
FRAMING INFORMS HOW WE SEE THE WORLD
That picture described above is a frame. Framing is essential to the way we view, design, and communicate public health information and theories. Framing is also critical to the way we perceive information and how we make meaning and sense of the world. Public messages and concepts can be intentionally and strategically designed to amplify ideas to help achieve better health outcomes. The way the public receives a message can reinforce or contradict concepts that already lie in our minds.
Racial justice and health equity are central to our work in public health and, increasingly, in healthcare. Racial justice reframing is useful for public health professionals and healthcare providers because it refocuses attention on the root causes of health disparities. These include systemic racism and the many social determinants of health, including poverty and violence. The racial justice approach also recognizes and redresses the historical and ongoing impact of race and racism on health outcomes for Black, Indigenous, and People of Color (BIPOC) communities in the United States.
MOVING TO A RACIAL JUSTICE APPROACH
As public health and healthcare professionals, we have a responsibility to reframe our work and support equity-focused policies. We can broaden our thinking beyond a traditional approach, which has emphasized individual behavior, lifestyle, and personal responsibility. And we can move to a racial justice approach, which centers equity, and emphasizes the conditions in people's lives that impact their health. The CDC argues that interventions with the greatest impact on health are the ones that prioritize the social determinants of health, not individual behavior change.
Everyone is harmed by racism and other systems of oppression. But people of color experience the burden of these systems, in part, via chronic stress, sometimes referred to as weathering. We also know that adverse childhood experiences (ACEs) are significant contributors to poor health later in life. Moreover, generational embodiment and historical trauma impact our health before we’re even born. Due to centuries of enslavement, displacement, and cultural genocide, BIPOC communities are disproportionately impacted by historical trauma.
FROM INDIVIDUAL BEHAVIOR CHANGE TO SYSTEMS CHANGE
Given our knowledge about how trauma and systems impact health, it's essential to expand our thinking and design interventions that encompass more than solely individual behavior change. Let’s use diabetes as an example. In a traditional public health approach, we define the problem as a high rate of diabetes, and we focus our interventions on individual behavior change. We view the causes as poor nutrition, lack of exercise, and the resulting obesity. While these behaviors, as well as genetics, are certainly connected to diabetes, they are symptoms of larger structural issues at play.
Now let’s take a racial justice approach. In this zoomed out analysis, structural, social, and political forces are responsible for the persistent racial inequities in diabetes rates. Outcomes of these forces look like food deserts, income inequity, and racial redlining in transit. Brought to the forefront are housing, walkability, and zoning for green space. Disinvestment in communities of color become the focus of the intervention. The solutions and actions are vastly different, as are the values that are highlighted, with each approach.
For diabetes, there are many successful racial justice approaches. One example is Boston's StreetCaster Program. This initiative creates new networks of sidewalks in areas that need them most, improving walkability in historically underserved neighborhoods. In Washington's King County, the Local Food Initiative is increasing access to healthy, affordable foods in underserved areas. By increasing the number of culturally relevant grocery stores in priority areas, Seattle is supporting racial equity in geographic and financial access to healthy food.
REFRAMING COMMON QUESTIONS USING A RACIAL JUSTICE APPROACH
Moving to a racial justice approach is not an abandonment of the way we work. Instead, it helps change the way we think about our work. The chart below offers an exercise in defining health problems and solutions using a racial justice approach. It is intended to help you see how linkages and intersections affect lives. It is based on answering the following 5 questions differently, and can be used with any health issue:
By centering racial justice and health equity in our work, we can work together to create programs, policies, and systems that prioritize the health and well-being of all communities.