By Nisa Hussain
Program Associate, Workforce and Leadership Development; AMCHP
A day before the official kickoff of the Annual Conference, nearly 60 health professionals gathered at the conference site to attend the Leadership Lab Launch Meeting. Since 2015, AMCHP has hosted Leadership Lab as an innovative developmental activity for state and territorial Title V staff, who aim to increase leadership skills by utilizing mentorship, coaching, and both formal and informal learning opportunities. The Leadership Lab facilitates cohorts across teams, including Family Leaders, Next Generation, New Directors, MCH Epi Peer-to-Peer and Leadership Institute for CYSHCN Directors.
All five cohorts came together for the Leadership Lab's key speaker, Dr. Joia Crear-Perry (pictured below). As founder and president of the National Birth Equity Collaborative (NBEC), Dr. Crear-Perry has dedicated her career to maternal and child health by improving access to affordable health care and directing services for health care facilities. She offered a presentation on health equity to properly embrace the conference theme of "Engaging with Intention: Diversity and Inclusion." Her work for NBEC structured the main concepts of her presentation, "You are the Equity Leaders We Seek." Attendees learned more about the factors and the history behind black maternal and infant mortality in the United States.
Dr. Crear-Perry defined birth equity as "the assurance of the conditions of optimal births for all people, with a willingness to address racial and social inequalities in a sustained effort." She recognized that the common, albeit misguided, belief that the high black maternal and infant mortality rates are impossible to change keep health outcomes between racial groups unbalanced.
She explained that social factors (built environment, stress, segregation), dimensions of power (decisions, political agenda and worldview) and the levels of racism (internalized, personally mediated and institutional) all contribute to the larger system that exacerbates poor health outcomes in minority groups. A stark look at the history of the African-American experience reminded attendees of the ongoing social determinants of health inequities that Dr. Crear-Perry says "account for a greater amount of the variance in poor outcomes than well-understood clinical risk factors."
Practices such as "redlining" continue to leave lasting effects, even 70 years after a time when banks infamously denied loans and mortgages to specific neighborhoods because of their minority populations and/or low-income status. The blatantly discriminatory practices of the 1930s led to disinvestment in redlined neighborhoods and created low opportunity, which helps to explain the poor health outcomes that we see today. An entire range of historical events has had an impact on the African-American experience and their health outcomes, which should be considered in our public health efforts.
What can the MCH workforce do to advance equity and inclusion? Dr. Crear-Perry explored that question in a follow-up interview.
What can the MCH workforce do?
The history is there and the data is there, but what can the MCH workforce do to combat inequities within our work and among our populations?
Particularly in health departments, Dr. Crear-Perry acknowledges that the first step is helping the workforce adjust to a "common language," since it's often a big leap to learn the new vocabulary addressing this topic. Understanding the birth equity approaches will lead to equity in your work.
Dr. Crear-Perry suggests identifying and acting on our "choice points" – decision-making opportunities that influence outcomes. "If there are situations that require us to make active decisions to engage, take the chance to make a change," she emphasizes. When we are conscious of choice points and their impacts, we are less likely to replicate implicit bias and the status quo.
For example, a choice point occurs in your personal life when you select charities to donate to: Why did you choose to support one over the other? Another choice point can be within your leadership during a planning session: What is your work plan, and why are you prioritizing certain programs over others? Whether you are new to your career or are in a position of influence, both small and large changes can help create equitable change.
Dr. Crear-Perry cites three main areas of choice points as most important for the MCH workforce to focus on.
"How we give out contracts is inherently unequal," she says. There are stipulations about who can receive contracts and support, such as the number of years of experience, and they are barriers for young organizations that want to implement equitable concepts. "If we want to make change," she says, "we have to value equity over the desire for capacity or image of capacity."
Assess your current workforce demographics. Having a staff that is majority white and majority female is not always helpful to your organization's goals, for example, if you are aiming to increase fatherhood engagement. If your goal is to assist a certain community, but you haven't hired anyone from that community, there lies an opportunity to hire a diverse, necessary perspective. This mindset is necessary not just for community outreach staff, she says, but also for leadership.
Crear-Perry encourages the tension that emerges from the hiring process: "Think through our choices of hiring and doing what we think is uncomfortable. Because it is going to be uncomfortable. Inequality is our natural tendency, and that's often the natural choice."
Data Collection and Dissemination
Remember that the context of a person's health is essential in public health. She notes that looking at data shows only the surface, because medicalized information about smoking habits and weight says nothing about the context of a person's life. Interviewing families and listening to the full story is the most important part. "How we collect data really matters and how it's sent out really matters," she emphasizes, "because policies are consequentially shaped by that data collection and dissemination."
Tackling health inequality may feel overwhelming. However, Dr. Crear-Perry is excited by how many professionals are interested. She believes this is a critical moment to talk about racism and not run from it. She wants to highlight that lifting stigmatized groups and people of color means we also lift non-stigmatized groups. Everyone benefits when we confront racism.
For more information on birth equity, please visit the National Birth Equity Collaborative's website.