Since 2018, more than 200 US states and localities have declared racism a public health crisis through resolutions, executive orders, and other mechanisms.1 In April 2021, the Centers for Disease Control and Prevention also issued a statement citing racism as a serious threat to public health.2
In the wake of a growing movement for racial justice, local elected officials and community leaders understand that policy and practice change is critical to dismantling systems of oppression that explicitly and implicitly impact the health of people of color. Communities seeking to build upon this momentum need to know what is effective in creating systemic change.
To help meet that need, the American Public Health Association, the de Beaumont Foundation, and the National Collaborative for Health Equity partnered to create Healing Through Policy: Creating Pathways to Racial Justice, a new resource for local leaders with tested, evidence-based policies and practice options to promote health, racial equity, and justice. The initiative offers local leaders a curated suite of pragmatic and achievable, yet aspirational and innovative policies and practices that can align with local priorities. To be included in the suite, policies and practices must have met the following criteria:
- Significant impact on health and racial equity, supported by independent evidence or expert opinion;
- Acknowledgment and addressing historic racial injustices and meaningful engagement of impacted communities;
- Feasibility under local jurisdiction;
- Successful implementation and support in at least one US city or county; and
- Recommendation and approval by a panel of advisors.
Using these criteria and the Truth, Racial Healing, & Transformation (TRHT) framework, which offers an overarching and comprehensive strategy for adaptation by communities and organizations to support progress toward societal transformation,3 we analyzed peer-reviewed and gray literature to identify policies and practices in alignment with the TRHT pillars of Narrative Change, Racial Healing and Relationship Building, Separation, Law, and Economy.
As public health agencies seek to promote action to achieve health and racial justice, Healing Through Policy provides critical options that go beyond mediating issues to addressing root causes. Healing Through Policy seeks to help local leaders to move along the continuum from commitment to action for health, racial equity, and justice while providing the space for innovation and new practice generation. The fight for health and racial justice may appear monumental, but Healing Through Policy offers pathways for those who will pursue these goals incrementally to those who will pursue them more progressively.
In the area of narrative change, public health agencies may consider deliberately engaging in mapping, data collection, and analysis efforts to understand and address inequities; embracing data-driven storytelling that highlights the impact of inequities; and implementing racial impact assessments, frameworks, and other systems for accountability toward achieving racial equity goals. These practices can disrupt dominant narratives that normalize inequity and uphold oppression while advancing new narratives from communities and individuals from historically marginalized groups to imagine a different future.
Racial healing and relationship building involves, focusing on ways for all of us to heal from the wounds of the past, to build mutually respectful relationships across racial and ethnic lines that honor and value each person’s humanity, and to build trusting intergenerational and diverse community relationships that better reflect our common humanity. Public health agencies can develop partnerships with community leaders to promote racial healing and relationship building by creating resolutions or participating in dialogue models, racial healing circles, and restorative justice practices aimed at understanding historical harms and repairing relationships within their communities. They can also engage in training and capacity-building activities that prepare leaders, practitioners, educators, and service providers at all levels to contribute to creating an environment that recognizes and confronts implicit bias and understanding of the harm created by negative stereotypes. Public health agencies are not the only governmental organizations in need of such training, but they can lead the charge and be the first to demonstrate the impact.
Housing, transportation, and education have been used consistently to reinforce separation by race and ethnicity. Public health agencies can partner with other governmental agencies and communities to deconstruct the legal and regulatory barriers that reinforce this separation rather than repair it. These are key systemic barriers that will require progressive government solutions to solve that will require deliberate planning, policy and regulatory decisions, and financing. Public health agencies must educate other government agencies and articulate how existing policies in these 3 critical areas harm efforts to achieve health and racial justice.
A transformed legal and public policy system honors the dignity of all people, upholds the civil and human rights of all, and encourages full civic participation from all communities. Many public health agencies are already engaged in reforming existing laws that promote bias and injustice, such as leading conversations about reframing policing or decriminalizing behaviors such as marijuana use.
Finally, inequity is baked into our economy through policies and practices that sustain a false belief in hierarchy. Wealth, income, and other economic indicators are positively associated with health. Improving health outcomes and achieving racial justice require investments in neighborhoods and communities systemically starved for resources. Public health agencies should consider how to use their existing funds to promote economic opportunities and make the necessary investments that build on existing community assets.
The policies and practices identified in Healing Through Policy demonstrate what is possible when communities make meaningful investments in both health and racial equity. Healing Through Policy lays out the pathways, and it is up to local leaders to take the next steps.
For more information about the initiative and to view the full policy and practice suite, visit www.debeaumont.org/healing-through-policy.
1. American Public Health Association. Racism is a public health crisis. https://www.apha.org/topics-and-issues/health-equity/racism-and-health/racism-declarations. Accessed September 28, 2021.
2. Centers for Disease Control and Prevention. Media statement from CDC Director Rochelle P. Walensky, MD, MPH, on racism and health. https://www.cdc.gov/media/releases/2021/s0408-racism-health.html. Published April 8, 2021. Accessed October 18, 2021.
3. W.K. Kellogg Foundation. Truth, racial healing & transformation implementation guidebook. https://healourcommunities.org/wp-content/uploads/2018/02/TRHTImplementationGuide.pdf. Published December 2016. Accessed October 18, 2021.