A Jarring Health Equity Conversation Shifts Our Thinking

MCH Teams Go Home Changed by Health Equity Experience

Kristina Wint, et al.
Program Manager, Women's Health
The Association of Maternal & Child Health Programs

When I recently joined a meeting of the Infant Mortality Collaborative Improvement and Innovation Network on Social Determinants of Health (IM CoIIN SDOH), I didn't expect to feel jarred by the discussion. But Richard Hofrichter, Ph.D., walked us through a health equity experience that left me and members of the state teams thinking very differently about some basic approaches to our work.

Participants in this CoIIN are developing and implementing policy and practice changes to influence the social determinants of health impacting infant mortality in their states. State representatives convened April 24-25 in Washington, D.C., for technical assistance, capacity-building, and the health equity experience.

As a new member of the Women's and Infant Health team at AMCHP, I found the health equity session to be the most powerful part – a combination of facts, personal knowledge, and experience in tandem with present-day, historical, and political contexts. As you'll see below, the state teams felt the impact as well.

Hofrichter, senior director of health equity at the National Association of County and City Health Officials (NACCHO) led participants through a provocative and engaging presentation. He challenged attendees to rethink the narratives perpetuated by institutions and systems we have come to accept in our daily work and in our lives, and to critically think about our language and how it has come to fuel the systems of power that negatively impact health. He encouraged participants to talk about health equity and social injustice, as opposed to using circular language to address it.

For example: In academic text, terms such as "vulnerable populations" are often used to characterize a group of people, when in fact, it is arguably more accurate to say, "people made vulnerable by systems of power." Hofrichter encouraged us not to blame the individuals but to use a systemically aware approach[i] that puts the onus on the systems and policies that purposefully do not invest in communities.

Additionally, Hofrichter encouraged participants to critically examine how enacted policies can lead to disinvestment in communities, driving the very social determinants that impact health. In this discussion, he encouraged us to engage with policymakers and be critical of current policies that perpetuate poor health outcomes.

At times I felt jarred by the content, as it was a new way of approaching everyday language and experiences that opposed the norm. Eventually, however, I found myself connecting with the content and thinking of ways I could shift the narrative in my own work. I was reminded of the social justice roots of public health and felt renewed motivation to continue this legacy. Although provocative, I felt the experience was a needed jolt to center health equity in our conversations on social determinants of health and propel us from thinking about individual-level interventions to large systems change that has the potential to impact generations.

We asked state team members to provide reflections about the health equity experience and next steps for how they plan to move the work forward:

Timika Anderson Reeves, M.S.W., Illinois: "Dr. Richard Hofrichter infused us with a wealth of data and experiences to display the effectiveness in employing a social justice/political framework to develop a collective knowledge to address issues surrounding health equity. I left Day 1 rethinking how we approach policy work from a system level lens. There is a need to re-strategize how we mobilize the community voice to build health equity. To rebuild our communities, we must create a political movement wherein individuals understand the need for change in how they live, respond, and value services, which have been designed to address health disparities associated with their geographical location. 

Michaela Penix, M.P.H., North Carolina: "The North Carolina team left the meeting with a richer appreciation for including the historical context of racism and equity in our work. As a state with a sordid history of racism and inequities, North Carolina has to face some hard historical realities, but Dr. Hofrichter elevated the need for intentional language around the drivers of health inequities as a means of making the invisible visible, and addressing the root causes of health inequities.

"We ended the meeting with an exceptional conversation about being comfortable with some personal discomfort associated the challenges of health equity, as those who live in inequity are experiencing discomfort in their daily lives. Debra Frazier [CEO, National Healthy Start Association; steering committee member, AMCHP IM CoIIN SDOH] reminded us all that as public health professionals, we must fearlessly 'do' public health, even if it means abandoning the personal comforts that allow health inequities to persist"

The Massachusetts team noted that the information from the health equity experience will be used to inform the work of the state Department of Public Health's racial equity data road map. The focus of this road map is to improve the use of data to inform racial equity work so that services are delivered in a more equitable way, thus optimizing the health and well-being of all residents. Collaborating with communities is a critical piece of this work as well as framing program data within the broader historical context as well as current policies and system factors that impact the health of communities.

The Wisconsin team is working to test PRAMS (Pregnancy Risk Assessment Monitoring System) questions related to SDOH in the state. After the health equity experience, the team decided to reframe the project to reference SDOH inequities. They also plan to share the information from the meeting through a learning session for local health departments that have chosen to focus on implementing the maternal and child health equity objective at the local level.

Hofrichter's presentation was inspired by a recently created module within NACCHO's Roots of Health Inequity course (Module 6). The course is free, and we encourage those working to advance health equity in their practice to check it out at http://www.rootsofhealthinequity.org

[i] The Center for Racial Justice Innovation. (2014). Moving the Race Conversation Forward, Part I: How the Media Covers Racism, and Other Barriers to Productive Racial Discourse.