Professors from the Milken Institute School of Public Health developed a framework for local public health systems to reduce the impacts of historically racist economic policies in a report published late last month.
The model of community resilience – a community’s ability to provide necessary resources to respond to adverse events like natural disasters and terrorist attacks – calls for city public health leaders to create policies that can reduce the effects of structural racism. The digital framework will help cities keep track of solutions for social issues like homelessness and high arrest rates, according to the report.
Wendy Ellis – the lead researcher and the director of Milken’s Center for Community Resilience, which provides policy guidance and solutions to increase racial equity – said the team observed the social health determinants that led to the financial exclusion, concentrated areas of poverty and increased policing of communities of color.
She said the team analyzed sectors, like housing and law enforcement, which operate independently but combine to demonstrate how social policies can fail to address factors that drive the racial oppression of communities of color.
“This paper is very much highlighting the issue but also presenting solutions to the field,” she said. “One of which is using group modeling and systems dynamic modeling to pinpoint specific policies, the outcomes that they’re associated with and then how we get to a solution space remedy.”
Ellis said researchers can use the model to assign public health leaders to become chief health strategists in hopes of understanding and addressing the root causes of systematically racist policies. She said chief health strategists analyze data from multiple sectors related to public health disparities, like law enforcement and poverty, to produce policies that address various issues impacting a specific sector.
Ellis said the model is allowing communities within Louisville, Kentucky to focus on which disproportionate outcomes, like evictions, need policy support at the legislative level.
She said community leaders are identifying additional factors, like public transportation infrastructure, that can benefit residents in poorer areas who need access to an efficient public transportation system.
She added that federal- and state-level funding can support synthesizing the data from multiple sectors to increase the capabilities of local health departments in locating the causes of adversities like homelessness in minority communities.
“I don’t understand why there seems to be such a confusion about recognizing trauma, real trauma that we should not have to sit here and defend,” she said. “You can see the harmful effects and all of our health disparities, our economic disparities, our social disparities. It’s clear, so why is it still a question of whether or not we have to address racism as a health issue?”
Daniel Chen, one of the co-contributors of the report and the center’s associate director, said the model uses a systems dynamics framework – which organizes policy design and ideas within a computer system – to implement a role model-building approach where local health departments work with community members and experts in fields like social service and health. He said these groups then decide which issues require prioritization and create policies to address adversities, which are all compiled in a computer system to keep track and check on their progress of change.
“We’re not saying racism and all these effects can be resolved in the next three to five years,” Chen said. “It’s long-term work, but we are so glad that we have been able to help these health departments to have a plan to start working at it.”
Community health science experts said the model urges public health officials to unite community leaders and social workers and create policies that can expand communities of color’s access to public health resources.
Leslie Carnahan, a research assistant professor of community health sciences at the University of Illinois Chicago, said the report highlighted how housing policies like redlining – a New Deal policy where banks only provided housing loans to white communities – forced minorities to live near industrial sites with low air quality and high asthma rates.
Carnahan said policymakers need to be educated on issues that impact people’s health, like housing and public education access, to create policy change. She said academic researchers in public health are responsible for disseminating that information.
“Once we document issues that impact health, we understand how to better intervene,” she said.
Tahlia Gousse – a consulting specialist for the National Association of County and City Health Officials, a group of public health practitioners – said the model provides social and health care workers the opportunity to consistently observe aspects of community resilience, like criminal justice, and build a shared understanding of the “vicious cycles” that perpetuate racial inequities.
She said communities like Louisville, Kentucky and Leon County, Florida are using the model to investigate which health disparities impact minority communities the most and work toward issues like handling the disproportionate number of people of color who are homeless.
“This really provides a framework from which local public health can start to meaningfully move upstream to address root causes of inequity that influence access and resources and exposure to conditions that lead to inequities at an individual level,” Gousse said.
