1

Introduction¹

The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Population Health Improvement convenes workshops for its members, its stakeholders, and the public to discuss matters of importance to improving the nation’s health. On February 4, 2016, the roundtable held a workshop titled Framing the Dialogue on Race and Ethnicity to Advance Health Equity in which speakers shared strategies for individuals, organizations, and communities to advance racial and health equity. Topics included increasing awareness about the role of historical contexts and dominant narratives in interpreting data and information about different racial and ethnic groups; framing messages for different social and political outcomes; and readying people to institutionalize practices, policies, and partnerships that advance racial and health equity.

In her introductory comments, planning committee co-chair Phyllis Meadows of the University of Michigan and The Kresge Foundation said that although the characteristics of the populations served by the health sector may be different, the groups that most need interventions are

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¹ This workshop was organized by an independent planning committee whose role was limited to identification of topics and speakers. This Proceedings of a Workshop was prepared by the rapporteur as a factual synopsis of the presentations and discussion that took place at the workshop. Statements, recommendations, and opinions expressed are those of the individual presenters and participants, and have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine or the roundtable, and they should not be construed as reflecting any group consensus.

fundamentally the same. These are the groups that determine the extent to which health can be achieved. These beliefs, conditions, policies, and practices that have adversely influenced groups include people of color living in marginalized communities devoid of resources and voices, such as Flint, Michigan. Though resilient, these communities have historically been predisposed to social, economic, and environmental conditions that have resulted in persistently poor health outcomes over the decades, so much so that race, culture, ethnicity, and zip code have become proxies for poor health.

This workshop, Meadows said, sets the stage for an important dialogue about structural, institutional, and individual beliefs, conditions, policies, and practices that have adversely influenced health and limited the ability of this nation to achieve health equity. In 1988, in one of the most widely cited reports by the Institute of Medicine (IOM), public health was defined as “what we as a society do collectively to assure the conditions in which people can be healthy” (IOM, 1988, p. 1). This definition applies to all people all of the time—not to some people, not to all people some of the time, and not to some people more than others. This definition, Meadows said, implies that health is achieved through the actions we take as a society. This workshop, she said, is designed to raise awareness and inspire the audience to actively participate in finding solutions to persistent health inequities in the United States (see Box 1-1).

WORKSHOP OBJECTIVES

The title of this workshop was Framing the Dialogue on Race and Ethnicity to Achieve Health Equity. Some may ask, “Why this? Why now?” It has been nearly 30 years since the publication of the earlier IOM report, and many other reports on how to improve population health have appeared during that time, Meadows said, but the nation still has not moved the needle far enough. The nation has failed to meet this charge, Meadows said. It still has health disparities, and there are even growing disparities and growing inequities for some groups.

Meadows said that she and the other members of the planning committee charged with developing the workshop—co-chair Lourdes Rodríguez, Gillian Barclay, Marthe Gold, Sarah Linde, Sanne Magnan, and Vish Viswanath—believe that a part of changing the national narrative about health will be defining and elevating narratives that promote health equity. This workshop was intended as an early step in that direction with the goal of having a dialogue about race and ethnicity in a way that will prepare the roundtable and others in population health to “reframe our thinking, deepen our understanding, and build more grounded solutions,” Meadows said.

This reframing will require, Meadows said, “that we not only look at race, but we look at racism, that we not only look at culture, but we must look at cultural elitism, and we cannot just describe problems based on ethnicity.” It is necessary to look at racial and ethnic bias and the role these current realities play in shaping the resources, policies, and practices that limit the nation’s capacity to achieve health equity for all.

This is the beginning of what will be a long and difficult journey, Meadows said. It is easy to talk about the facts. It is hard to talk about how these facts play out in reality. This workshop started with these objectives in mind: to explore and share a framework for applying the lens of race and ethnicity to promoting health equity; to explore some of the policies that affect the production of health inequalities; to explore best practices for communicating about racial and health equity; and, hopefully, to leave the audience with the capacity to be more conscious about applying a racial equity lens to the promotion of health equity for all population groups.

ORGANIZATION OF THE WORKSHOP AND PROCEEDINGS

The workshop consisted of a keynote presentation on racism and health inequities over the life course (see Chapter 2), followed by presentations on the policies of urban renewal and the production of inequities (see Chapter 3); building individual and institutional readiness for equity, diversity, and inclusion (see Chapter 4); framing messages to advance

racial and health equity (see Chapter 5); and a case study of institutionalizing racial equity in the New York City Department of Health and Mental Hygiene (see Chapter 6).

In accordance with the policies of the National Academies of Sciences, Engineering, and Medicine, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants. In addition, the organizing committee’s role was limited to planning the workshop. This Proceedings of a Workshop has been prepared by the workshop rapporteur Darla Thompson as a factual synopsis of what occurred at the workshop.