Local health departments have a shared understanding that the conditions in which people are born, grow, live, work, and age impact their health. But often, the root causes of these social determinants of health are not addressed in all programs or policies. In an effort to bring about action toward a “stronger, more healthful, and more productive society,” the Health and Medicine Division Roundtable on Population Health convened a workshop on February 4, 2016 to explore one of these systematic forces that perpetuates health inequity: racism. The workshop, Framing the Dialogue on Race and Ethnicity to Advance Health Equity, informed participants on the ways that racism affects health equity and provided communication strategies for health officials to use in their communities to aid in tackling these inequities. Some of the strategies that were discussed include:

• When presenting disparities data, provide a clear explanation for how social determinants lead to these outcomes. Public health practitioners often rely solely on disparities data to discuss health equity. But Frameworks Institute Vice President Julie Sweetland explained that the public often is not aware of the systems that create and reinforce racial inequity. As a result, people often fill gaps of knowledge with mental shortcuts. For example, they may blame disparities on poor decision-making. The Frameworks Institute suggests explaining first why something is a collective issue. Then provide an explanation for the problem by connecting social determinants and root causes to health outcomes.Sweetland suggested that it is important to provide the meaning first and then the data. For example, a classic public health message may be: “Infant mortality is higher among black women as compared to white women.” The message could be modified to: “Unfair housing policy creates conditions that prevent women of color from owning a home. Housing insecurity creates stress. This stress is associated with a higher rate of infant mortality among black women as compared to white women.”In addition, health officials can garner greater public support by emphasizing that these systemic problems are unsustainable and that improvements are not only necessary, but possible and beneficial for all.
• Use framing to change perspectives. CommonHealth Action, an organization that frequently works across sectors, emphasized the importance of making the topic meaningful and relevant for everyone involved. By using competencies such as common language, historical context, and equity lens, they have helped several organizations on their paths towards achieving more equitable communities. CommonHealth Action recommends assessing the readiness of a group before starting capacity building towards health equity. They maintain that people need to be realistic about the risk and expectations they are taking on. They begin with a conversation about privilege and oppression. They find this to be a helpful place to start, because understand that it is less about who are you as an individual, but how you experience the world as an individual.
• Establish a shared language and health equity lens. The New York City Department of Health and Mental Hygiene described how they use several strategies to make racial equity a priority, including conducting research, coordinating internal reform, and engaging in public advocacy. They have also partnered with other government agencies and community advocates to invest in key neighborhoods, as well as make injustice visible through data and storytelling. The presenters explained how crucial it was to establish a shared language, lens, and plan amongst staff before taking external action.

The strategies mentioned above are just a brief glimpse of the work featured at Framing the Dialogue on Race and Ethnicity to Advance Health Equity Workshop. To view the workshop presentations on the history of racial inequity, the policies that perpetuate it, and the strategies that can be used to combat it, please visit the IOM website. You can also visit NACCHO’s website for more Health Equity and Social Justice resources.