Written by Sindhia Colburn
This piece originally published in The Community Psychologist (TCP)
Fall 2022 Volume 55 Number 4. All TCP columns are available online, at https://www.scra27.org/publications/tcp/
What does “anti-racism” look like in practice? As institutional efforts to proclaim a stance on racism have grown more and more widespread across the healthcare sector, I have wrestled with this question across multiple spheres of practice. While Black families in the US continue to be disproportionately affected by adverse childhood experiences (ACEs), heart disease, mental health and substance use problems, pregnancy-related deaths, and increasing gun and other violence exposure (Centers for Disease Control and Prevention; Martin et al., 2022; Sheats et al., 2018), we simply cannot afford to continue prioritizing diversity statements and theoretical debates on colonization while postponing the ACTION that we desperately need to rectify ongoing harms and to secure the safety and health of our future generations. Racialized disparities exist, and we need solutions to eliminate them. Full stop.
To this end, CERA (the Council on Cultural, Ethnic, and Racial Affairs) is launching the Action for Racial Justice and Equity Fund (ARJEF) to support action through intervention and policy advancement that directly addresses health disparities at any of the sociocultural sectors where they exist, including but not limited to: housing, employment, education, criminal justice, career advancement, economic stability, community resource allocation, and access to care. The goal of the ARJEF is to support action projects that are co-created or led by, and center the experiences of Black, Indigenous, and People of Color (BIPOC). If you or your organization is engaged in action for racial equity, be on the lookout for more information about applying for the ARJEF through the SCRA listserv, and consider submitting a proposal.
To build on this opportunity, I want to highlight some critical considerations for designing anti-racist care within the healthcare sector in particular, whether through practice or advocacy:
1. Anti-racist care is early intervention. Profound racialized disparities in health and development emerge in young children before they even make it to kindergarten, and these disparities become more pronounced as they move further along in school (Halle et al., 2009; The Annie E. Casey Foundation, 2022). Health equity cannot be achieved until quality care and prevention strategies are accessible during early childhood, before children start school.
2. Anti-racist care is affordable. Racial and ethnic background are significant predictors of a family’s access to health insurance and likelihood of residing in areas of concentrated poverty, where fewer employment and education opportunities are available to support families’ economic stability (The Annie E. Casey Foundation, 2022). Race-related discrimination in hiring, retaining, and compensating employees further contributes to wealth disparities, making rising healthcare costs especially prohibitive for BIPOC families. Thus, even a high-quality and culturally responsive program cannot constitute as anti-racist care until it guarantees equitable access for low-income, uninsured, and under-insured families.
3. Anti-racist care is integrated. Despite a higher prevalence of mental health problems, BIPOC families are less likely to utilize behavioral health services (Merikangas et al., 2011). To remove barriers to accessing care, behavioral health services should be integrated into systems and contexts relevant to the well-being of BIPOC families, including primary care, schools, workplace, and religious and cultural institutions. Integrated services also facilitate interdisciplinary approaches to addressing health problems, which has the potential to produce better and more sustainable outcomes for families.
4. Anti-racist care is trauma-informed. Not only is the social construction of race associated with the likelihood of exposure to ACEs, violence, and other traumatic events, but racism itself is a traumatic stressor that has a profound impact on physiological and mental health (Berger & Sarnyai, 2015; Brody et al., 2014). Exposure to trauma is associated with chronic illness even in the absence of persistent mental health effects (Mock & Arai, 2010; Norman et al., 2006). As such, trauma-informed training and practices should not be confined to the realm of mental health, but instead need to be integrated into the design of any health-related program to ensure equitable access and effectiveness.
5. Anti-racist care is strengths-based. In contrast with the pathology-centered medical model, strengths-based approaches consider the whole person. Such approaches seek to learn and capitalize on what is working and functioning well, and what resources are available to the person that can help them move toward health and wellness. Utilizing strengths-based approaches requires reconceptualizing health to center the personhood and humanity of every person—seeing their faces, their uniqueness, and their strengths, rather than only their diseases or problems. It allows professionals in health care to gain a fuller appreciation of people who need care, and their families and communities, by situating their concerns in context, championing their “stories,” and following their lead in all aspects of their journeys. It requires a new orientation (Gottlieb & Gottlieb, 2012).
Whether or not you are directly involved in the healthcare sector, there are ways you can advocate for equitable access to behavioral healthcare for all families. Visit https://www.votervoice.net/APAAdvocacy/BlogPosts/3538 to find out how you can join efforts to reduce structural barriers to quality, integrated, and affordable behavioral healthcare. For more information about the health impact of racial trauma, as well as self-care tools and resources, visit https://www.mhanational.org/racial-trauma. To join CERA in its ongoing mission to support BIPOC communities, please contact firstname.lastname@example.org or sign up for the CERA listserv.
Berger, M., & Sarnyai, Z. (2015). “More than skin deep”: Stress neurobiology and mental health consequences of racial discrimination. Stress, 18, 1-10.
Brody, G.H., Lei, M., Chae, D.H., Yu, T., Kogan, S.M., & Beach, S.R.H. (2014). Perceived discrimination among African American adolescents and allostatic load: A longitudinal analysis with buffering effects. Child Development, 85, 989–1002.
Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System. Retrieved from https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm
Gottlieb, L.N. & Gottlieb, B. (2012). Strengths-based nursing care: Health and healing for person and family. Springer Publishing.
Halle, T., Forry, N., Hair, E., Perper, K., Wandner, L., Wessel, J., & Vick, J. (2009). Disparities in Early Learning and Development: Lessons from the Early Childhood Longitudinal Study – Birth Cohort (ECLS-B). Washington, DC: Child Trends. Retrieved from https://rhyclearinghouse.acf.hhs.gov/.
Martin, R., Rajan, S., Shareef, F., Xie, K.C., Allen, K.A., Zimmerman, M., & Jay, J. (2022). Racial disparities in child exposure to firearm violence before and during COVID-19. American Journal of Preventive Medicine, 63, 204-212. doi: https://doi.org/10.1016/j.amepre.2022.02.007.
Merikangas, K.R., He, J., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., Georgiades, K., Heaton, L., Swaonson, S., & Olfson, M. (2011). Service utilization for lifetime mental disorders in US adolescents: results of the National Comorbidity Survey–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 50, 32-45. doi: https://doi.org/10.1016/j.jaac.2010.10.006.
Mock, S.E., & Arai, S.M. (2011). Childhood trauma and chronic illness in adulthood: Mental health and socioeconomic status as explanatory factors and buffers. Frontiers in Psychology, 1(246), 1-6. doi: https://doi.org/10.3389/fpsyg.2010.00246.
Norman, S. B., Means‐Christensen, A. J., Craske, M. G., Sherbourne, C. D., Roy‐Byrne, P. P., & Stein, M. B. (2006). Associations between psychological trauma and physical illness in primary care. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 19, 461-470.
Sheats, K.J., Irving, S.M., Mercy, J.A., Merrick, M.T., Annor, F.B., Morgan, R.E. (2018). Violence-related disparities experienced by Black youth and young adults: Opportunities for prevention. American Journal of Preventive Medicine, 55, 462-469. doi: https://doi.org/10.1016/j.amepre.2018.05.017.
The Annie E. Casey Foundation. (2022). KIDS COUNT Data Book. Baltimore, MD: Annie E. Casey Foundation. Retrieved from https://assets.aecf.org/m/resourcedoc/aecf-2022kidscountdatabook-2022.pdf.