Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity (2023) / Chapter Skim
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7 Social and Community Context
7 Social and Community Context
Pages 355-406
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and (2) the presence of strong social bonds," measuring "the extent of connectedness and solidarity among groups in society." A cohesive society is characterized by abundant social capital, and social cohesion and social capital are "collective, or ecological, dimensions of society, to be distinguished from the concepts of social networks and social support, which are characteristically measured at the level of the individual" (Kawachi and Berkman, 2000, p.
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, it provides policy examples that highlight how federal intervention in the social and community context can address health inequities. Specifically, the chapter explores the following policies: waiting periods for gun purchases; policies that increase accountability in policing and data collection, such as the George Floyd Justice in Policing Act; mass incarceration policies, such as long and mandatory minimum sentences; policies that acknowledge and provide redress for historical actions, practices, laws, and policies that caused enduring harm; and policies that build civic engagement and a sense of community and belonging.
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. This section discusses three interrelated dimensions of social and community context: violence, public safety, and the criminal legal system.
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.3 With these definitions in mind, this section reviews some examples of federal policies related to violence, public safety, and the criminal legal system. Gun Violence The lack of federal regulation of firearm access is one example of a policy directly related to violence and public safety impacting racial and ethnic health inequities.
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. Gun violence is a clear health equity issue and provides an opportunity for federal legislation to improve outcomes for racially and ethnically minoritized populations.
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Although research is needed, given the disproportionate impact of gun homicide on Black, Latino/a, and AIAN populations and recent increases in firearm suicide among young Black adults, a federal waiting period is one potential policy lever that may counteract the impact of gun violence in these communities. Other firearm regulation policies that have received attention in recent years and may be worth exploring as avenues to address racial and ethnic inequities in gun homicides include policies for safe storage, background checks (for private sales/gun shows)
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For example, data on policing policies, such as stop-and-frisk, and extremely punitive criminal legal policies, such as long sentences and mandatory minimums, show that such policies disproportionately impact Black, Latino/a, and AIAN people yet do little or nothing to address crime and violence (Dunn and Shames, 2019; The Educational Fund to Stop Gun Violence et al., 2022; Keating and Stevens, 2020; MacDonald, n.d.; Siegler, 2021)
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. Data suggest that officer-involved killings of individuals from racially and ethnically minoritized communities may negatively influence the educational performance of Black and Hispanic students who live nearby, and research is underway investigating how fatal police shootings might affect pregnancy-related and infant health in impacted communities (Ang, 2021; Noguchi, 2020)
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Federal policy changes related to incarceration also provide an opportunity to address the disparate impact of the criminal legal system on racially and ethnically minoritized communities. The United States has the highest rate of incarceration in the world; it accounts for almost 25 percent of the global prison population despite making up only 5 percent of the global population overall (NAACP, n.d.)
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. Re-examination of federal policies regarding mandatory minimum sentences and long sentences could address the disproportionate impact of mass incarceration on minoritized communities (NRC, 2014)
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. Federal support for community programs like these, along with broader efforts toward improving the criminal legal system, could have important impli cations for youth and for racial and ethnic inequities in violence, public safety, and public health.
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. This section explores how federal policy interventions that address the ongoing impact of historical traumas could advance health equity.
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, and criminal legal system policies, such as the convict leasing system (Equal Justice Initiative, 2013) and mandatory minimum sentences (NRC, 2014)
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. How the United States might begin to rectify these harms and therefore advance health equity is a topic of ongoing discussion.
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, which have often been perpetuated by federal actions, practices, policies, and laws. For example, in 1882, the Chinese Exclusion Act banned Chinese laborers from immigrating to the United States for 10 years.
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. Although acknowledgement of past injustice is a meaningful step, further action is needed to address the long-lasting harm of past actions and ultimately advance health equity.
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. Following the Civil War, the opportunity that the Reconstruction era provided to address structural racism and inequities, offer redress to formerly enslaved individuals, and chart a path toward racial equity went unfulfilled (Equal Justice Initiative, 2020)
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. The legacies of the Fugitive Slave Act, Black Codes, and Jim Crow laws are evident in today's inequitable policing and criminal legal policies that have disproportionately removed Black individuals from their families and communities, which has economic and physical and mental health implications for them and their children, partners, and other family and has been tied to community disempowerment (Dyer et al., 2019; Mason, 2021; Maxwell and Solomon, 2018; National Geographic, 2022; Paul, 2016)
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. Although past actions, practices, policies, and laws have inflicted lasting trauma on Black communities and undermined access to social, economic, and political resources and opportunity, this history is also characterized by Black perseverance and resistance to injustice, from slavery, to Reconstruction, to the Civil Rights Movement, to the present (American Social History Project, n.d.-a)
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Such policies may also apply to other racially and ethnically minoritized populations, who also experience inequities in wealth due to structural racism. Similar policies to redress harm caused to Black communities are being explored and implemented at the state and local levels.
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Many of them were low income or had a disability, and 40 percent were racially or ethnically minoritized (Mennel, 2014; NCDOA, 2014)
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Trauma and Healing for American Indian and Alaska Native Communities AIAN tribes have a unique legal relationship with the United States, which includes hundreds of treaties that mandate support for economic well-being, public safety, education, and health care (U.S. Commission on Civil Rights, 2018)
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In addition to this failure to honor treaty obligations, past and present federal actions, practices, policies, and laws, such as forced assimilation, territorial dispossession, extermination, and intrusion on sovereignty, have also resulted in ongoing trauma and negatively affected health and well-being for AIAN people. The legacy of Indian boarding schools is one example.
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. Although data on the mental and physical health impacts of territorial dispossession and forced migration have been limited, studies suggest that AIAN people think regularly about broken treaties and historical loss of land, language, culture, traditional spiritual ways, and family ties from relocation or boarding schools and experience associated sadness, anger, anxiety, and shame (Urban Indian Health Institute, 2018b; Whitbeck et al., 2004)
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. In addition to restoration of land, ensuring access for AIAN communities to federal lands and waters for traditional hunting, fishing, and gathering activities and costewardship is another avenue to address ongoing historical trauma and emotional distress related to loss of land and traditional ways (Gordon, 2022; Whitbeck et al., 2004)
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Despite overwhelming odds, tribal communities have survived and, in many instances, thrived when given the opportunity and resources to apply Indigenous knowledge systems to address inequities. For example, diabetes has long been an issue within AIAN communities; however, despite a disproportionately high diabetes prevalence, that rate has not increased since 2011.
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In addition to the policies covered above, other avenues to address historical trauma and improve health equity for AIAN communities include permanently providing advanced appropriations to IHS (National Indian Health Board, n.d.) (see Chapters 5 and 8)
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. More accurate and complete data allowed a clearer picture of the health inequities experienced by Native Hawaiians, ranging from chronic conditions to mental illness (Liu and Alameda, 2011)
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. Conclusion 7-4: Generations of Black, American Indian, Alaska Native, Native Hawaiian, Pacific Islander, Latino/a, and Asian communities have been negatively affected by past actions, prac tices, policies, and laws that inflicted lasting harm and undermined access to social, economic, and political resources and opportuni ties, contributing to current racial and ethnic health inequities.
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. Similarly, civic capacity and civic muscle relate to health equity and community well-being through individual, social, and institutional capacities,
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describes the importance of belonging and civic muscle by explaining that "people are healthier when they are connected to others" -- social networks confer resilience, support mental and emotional well-being, and encourage positive health behaviors (Norris, 2019, p.
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. Likewise, communities facing fewer barriers to civic engagement are more likely to have their needs met than those with limited access or greater barriers (Ballard, 2019; Center for Social Innovation and University of Wisconsin Population Health Institute, 2021)
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. Sustained Investments to Strengthen Shared Power and Build a Unifying Movement for Equitable Health and Well-being Can Generate Significant Results After investing more than $1 billion into one of the most extensive initiatives for health equity, leaders at The California Endowment concluded that improving democracy, especially by building community power and funding power-building organizations, is essential for achieving health equity (Iton et al., 2022; UCLA Center for Health Policy Research, n.d.)
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Potential levers to enhance health and well-being -- specifically opportunities to improve belonging and civic muscle -- are outlined in the recently released federal interagency plan for ELTRR (ELTRR Interagency Workgroup, 2022)
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Civic Association • Expand federal agency partnerships with federal civic engagement programs, including Citizens Corps and AmeriCorps, to support locally driven community development and resilience programs. Collective Efficacy • Establish a Center of Excellence in Cultivating Community Well-Being to provide technical assistance and training focused on increasing connections between federal agencies and communities working to improve the vital condi tions for health and well-being, prioritizing supports for groups that have been economically and socially marginalized and underresourced communities.
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Opportunities for Civic Engagement • Increase federal program approaches to meaningfully engage youth who have been marginalized to identify local issues, prioritize needs, and design, imple ment, and monitor strategies to strengthen the vital conditions. • Allow states to leverage federal funds to support initiatives that meaningfully engage individuals, families, and communities in the design and oversight of service delivery systems.
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However, many past National Academies reports have evidence-based and promising recommendations for federal action to advance health equity in the area of social and community context (including and beyond the federal policies reviewed in this chapter) that have not been implemented and are still relevant today (see Box 7-5 for examples)
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Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity (NASEM, 2019b) Recommendation 4-4: Policy makers at the federal, state, local, territorial, and tribal levels and philanthropic organizations should support the creation and implementation of programs that ensure families have access to high-quality, cost-effective, local community-based programs that support the psychosocial well-being of the primary adult caregivers and contribute to building resilience and reducing family stress.
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Evidence also suggests that federal efforts to integrate community voice by articulating elements that build belonging, community inclusion, and civic engagement into agency policy development processes can also improve health equity. It is also important to recognize and consider the work being done at the community level to promote safety and well-being, promote healing from historical trauma, and build civic muscle and a sense of belonging.
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2021. Compendium on civic engagement and population health.
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2008. Closing the gap in a generation: Health equity through action on the social determinants of health.
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2012. Indian boarding school experience, substance use, and mental health among urban two-spirit American Indian/Alaska Natives.
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2020. Healthy People 2030: Social and Community Context.
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2021. White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders Interagency Working Group.
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2011. Social determinants of health for Native Hawaiian children and adolescents.
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2016. Preventable death rates fell where com munities expanded population health activities through multisector networks.
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2023. Civic engagement and civic infrastructure to advance health equity.
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In The psychology of citizenship and civic engagement. New York: Oxford University Press.
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https://www.rand.org/research/gun-policy/analysis/firearm-safety-training-requirements. html (accessed June 1, 2023)
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2022. Advancing health equity through the federal trust responsibility: Full mandatory funding for the Indian health service and strength ening nation-to-nation relationships.
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Madison, WI: University of Wisconsin Population Health Institute. Urban Indian Health Institute.
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White River Junction, VT: National Center for PTSD, Department of Veterans Affairs. Wilmington Race Riot Commission.
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