Healing ARC Newsletter
EqualHealth’s Campaign Against Racism Celebrates 5 Years of Advancing Antiracist Action Globally
Five years ago, EqualHealth launched the Campaign Against Racism (CAR) to dismantle structural racism and its effects on health around the world by supporting local actions, efforts, and networks that aim to improve the health and lives of those most affected by racism. CAR is a network of chapters that declare a strategic goal for their direct communities and commit to be a part of a collective campaign. Chapters engage together, while sharing success stories and challenges, participating in community organizing training, and building relationships with other organizers around the world. Recently, the Healing ARC Newsletter talked with some of the key organizers about their accomplishments and what they see in the future for the organization. Participating were:
Tianashe Goronga
Tianashe Goronga is a medical doctor from Zimbabwe who specializes in Public Health. He is one of the Global Coordinators for CAR and an alumnus of EqualHealth’s social medicine courses.
Courtni Alexis Andrews
Is a health practitioner and behavioral scientist in Atlanta. Working with academic institutions, non-profits, and governance, Courtni is a thinker at her core. She often bridges gaps between visions and actions for better health systems and a future that centers nature, organisms and technology in harmony and alignment in solidarity with communities both locally and beyond. Andrews participated in the interview in her personal capacity. The views expressed are her own and do not represent the views of the Centers of Disease Control and Prevention or the United States government.
Nabirye Peruth
Is a CAR organizer who is an artist and digital visual communicator in health. She leads the cancel the debt subgroup that focuses on improving access to vaccines, therapeutics and diagnostics in Uganda and Zambia communities. She uses artistic skills and oral poetry to address social, economic and political challenges embedded in systems and structures of governance at the global and local level.
Anne Marie Collins
Is an experienced organizer with a focus on advocacy and influencing/reimagining public policy. Based in Spain, she has worked at the intersection of public health and community organizing internationally from Colombia to Liberia and in harm reduction with the EU.
Yeukai Chikwenhere
Is an organizer who is a pharmacist and global health researcher. She is co-founder of the Centre For Health Equity Zimbabwe, and is a community organizer for CAR.
Why Was CAR Started?
Tinashe: Equal Health´s Campaign Against Racism was co-founded by Michelle Morse and Camara Jones with support from myself and Tanvi Avasthi in 2018. Michelle was an existing partner in the global coalition of the social medicine consortium and decided to use this platform to organize to dismantle structural racism and racial capitalism. Now across 14 Chapters around the world, CAR is organizing members to uncover the historical connections between racism and capitalism to radically imagine a future in which the sociocultural, political, and economic systems work towards health equity, rather than against it. I remember also Camara Jones presentation about racism and the different levels of racism which formed part of the path to move to a global campaign. Camara Jones made a presentation in 2017 about racism and the different levels of racism. During that presentation at a social medicine consortium conference, people realized that racism impacts countries around the world and not just the United States of America. But it was a global phenomenon. And at that time, there was a National Campaign Against Racism going on. And the campaign, the Global Campaign Against Racism, was then started as a global component of that national effort to engage a global conversation about the intersection of racism and health equity. We want to bring racism prominently into the health space as a structural determinant of health. And we also wanted to highlight the different manifestations of racism in a different context, in a global context, considering the unique historical context of racism in every country or region. We thought it was necessary to uplift those conversations and to build solidarity, globally, in order to dismantle the racism affecting health globally.
What Were Your Initial Goals And Objectives When You Started?
Anne Marie: Our initial goals, the main goals, remain. We want to dismantle structural racism and its impact on health globally. There are more specific goals at the chapter level. We have 14 chapters, but we always have that one principal goal. The local goals address how structural racism operates in specific locations. And vary from country to country. In Spain, we are more focused on the migration industrial complex. In Atlanta, we are focused on the prison industrial complex. We understand that this is a generational struggle. This is not something that is going to be over in our lifetime. And I think that the campaign, apart from having this goal of dismantling structural racism, understands that we are building an infrastructure that will eliminate the racism that engulfs systems in countries all over the globe, and reduces the quality of health, particularly for people of color.
What Have Been Some The Organization’s Accomplishments Towards Jettisoning Racism?
Yeukai: In terms of accomplishments over the first five years, we have established 14 operating chapters in nine countries. That is a big accomplishment. Each chapter establishes working groups that design strategic goals and tactics for their communities. Having those chapters setting up strategy goals and tactics are accomplishments. For instance, the Uganda and Zimbabwe chapters work together to address the remnants of the colonial legacies in those countries. Those collaborations and sharing of stories and experiences is a big accomplishment for us. One of our CAR organizers from Uganda was quoted in an article in the Guardian about inequities with COVID vaccines because of racism rooted in slavery and colonialism. Having our work cited on international platforms helps amplify what we are striving to accomplish. We have also been on the airwaves talking about racism, colonialism, feminism, and other issues. These are all accomplishments because each opportunity shines a spotlight on the need to eliminate racism. We also partnered with Harvard in a webinar on global perspectives of anti-racism. Our organizers and community members actively participate in sharing their perspectives on anti-racism work. Lastly, our Vanderbilt Chapter, led a powerful organizing strategy to end the use of race as a variable in the calculation of eGFR (equations for calculating estimated glomerular filtration rate) at Vanderbilt University Medical Center and in 2020 won, with race now eliminated as a variable.
What Are Some Specific Strategic Actions Over The Last Five Years?
Anne Marie: I can talk about Spain. The country declared racism a public health crisis at the onset of the COVID pandemic. This was the first place in Europe that declared racism a public health crisis. It was a huge achievement led by migrant collectives. It was a multiracial platform and amounted to communities taking back spaces of power. And in that declaration, we had demands linked to de-colonizing political institutions and dismantling the current migration industrial complex. We are still struggling for funding, which will be critical to establishing material change. That is the next frontier. Another achievement has been that we hosted our first de-colonialized feminism school in November. That created our own community space, again, led by migrant collectives from Spain to across the Americas. And we will start addressing the negative narratives that are embedded in the White supremacist policies that impact the daily conditions in our communities, especially migrant communities here in Spain.
Tinashe: Collaborations have expanded as more institutions become aware of the work that CAR is doing and see the need to join in these conversations. When we started the campaign, we sought to expand the intersectionality between racism, and health equity on a global level. Take the Harvard webinar that we cohosted. It was a platform where these conversations were not among us but reached academic spaces and broader audiences. That is so important. Then on the academic side, members of the Campaign Against Racism are contributing to papers published in major journals that discuss some of the critical issues about structural racism and its impact on health. Many papers were published when the pandemic started, highlighting the continued impact of structural racism on health. These papers serve as a foundation for academic work and conversations on the impact of structural racism. For CAR members, being in those spaces and contributing to the body of knowledge that’s trying to eliminate structural racism globally, is very powerful.
Courtni: It was very significant when CAR collaborated with others, such as Southern Kindred Healing Justice Collective, to shut down the Irwin County Detention Center in Ocilla, Ga. While there is a legacy of atrocities throughout history, at Irwin, there were unwanted procedures on detained immigrant women and people that jeopardize their ability to have children or health generally. We stood in solidarity with a nurse named Don Wooten, who blew the whistle on what was going on. Because of that campaign, a group of us wrote a statement to spread the word and build power with the communities already mobilizing about what was going on. We got 800 people throughout the world to sign a statement, denouncing the actions, and started building a powerful letter to support the coalition to shut down migrant detention centers. This conversation also included conversations about conditions at prisons. Taken together, this shows that there is a real underground network of health practitioners, community organizers and activists who have and can come together during the pandemic in solidarity as a community to say when you harm one of us, you harm all of us. It has been powerful to see.
Yeukai: Our organizing space recently adopted a language justice framework, which is based on the understanding that language has been used as a tool to oppress, and among other things, to marginalize communities. We have established this framework to enable our communities to express themselves in the most influential ways. We support interpretation and translation as well as, making sure we are not English dominant and give space to other languages and other community members. That is a big achievement for us.
What Will It Take To Eliminate Racism?
Tinashe: We have to realize that ending racism is not something that we can do alone; it’s something that really needs a collective effort globally. That’s the motivation of the global nature of our work. We want to put racism in a different context. We focus on the intersectional approach, and bringing the intersectionality that comes with different forms of oppression. We are building solidarity to fight it. I have mentioned it is very important that we bring to the fight the impact of racism on health because a healthy population is every society’s core, and it reflects on the status of that society. But at the same time, our economic systems, our social systems and structures are all influenced by racism. Thus, we need to get everyone from all these systems involved in the conversation. The solidarity that we build is a very important element for us towards achieving our goal of eliminating racism. Most importantly, one of the things that we have also learned from our partners and other movements is to start actually envisioning where we want to go, re-imagining a future that we want to see without racism. We have learned from different movements. That has been powerful in helping us shape a clear picture of what we want the world to look like without racism. It is what motivates us and give us something to work towards. It is important for us to have these conversations in different countries in different contexts, answering questions like ‘What would the world look like? ‘ It helps us work towards creating new systems and structures that are not based on structural racism and racial capitalism.
Anne Marie: When I think about this question. I think about our beloved mentor, Dr. Camera Jones. She eloquently frames the denial of the history of upholding structural racism. Globally, we are recovering and confronting that history. We are especially doing that in this campaign. We are constantly providing an education, and consciousness, of what took place and how countries have arrived at this moment that we are in right now. It starts with a historical context of how we got here.
To Make Progress, Do Those Who Sustain Structural Racism Have to First Acknowledge that Racism Exists Before Progress Can Be Made?
Courtni: Often with these types of questions, I think about what Malcolm X said about when you replace I with we, illness becomes wellness. One part of movement building is recognizing the historical context and seeing that these things are cyclical. Look at what happened after the 1918 influenza pandemic. Many have said, but after pandemics, there is a rise in eugenics and fascism. We are seeing some of that repeated today after the COVID pandemic. That’s been a historical precedent. There are communities that have been harmed multiple times – indigenous populations, Black and Brown communities, disabled communities, and more. In regard to those who have been oppressed, I don’t think it is really for them to acknowledge the harm because these are people who don’t have the lived experience and will never truly understand how it feels to watch family members go through violence, harm, and oppression. The people who do have positions of power, who historically have been in positions where they have wealth, land, resources, food, they need to understand the impact of structural racism and other isms. But these are sensitive conversations. It can placate people and not actually move the needle forward. Racial healing should be in the conversation because there is a mental health piece that is critical here as generational harm, health and healing justice co-exist together. The psychology of constantly being oppressed, constantly having to coddle people and constantly having to prove your humanity to somebody is dangerous. It’s a dangerous conversation, but a much needed one.
Anne Marie: I will answer as the white person in this space. We had this discussion when organizing the de-colonialized feminism school. There was an attempt to bring in feminist organizations that didn’t have a de-colonialized lens. It was at the point where we were building connections with local people from community organizations who had been around for a long time. For White people there is always a discussion about your role in the movement. For five years, I’ve been a White person in a global campaign against racism. We are dismantling White supremacy, yet it is White people who benefit from the racism. I like to name the damage that White privilege has done. We use narratives, and unconscious bias training, to put an individual lens on this struggle. And honestly, I see the capitalism lens, too. I put my body in the struggle to shift resources and shift power. In Spain, we had examples of White people protecting young migrants by letting them in their homes during police raids. There were young migrants during the pandemic living in houses that belonged to banks. I don’t call it occupied housing; it was empty houses that belonged to banks. And it was White people who put their bodies on the line for this to happen. It should be White people, right? Putting our bodies on the line. It is White people that displaced the migrant communities in the first place.
Tinashe: In Zimbabwe, there was a very controversial land reform program that was meant to address land ownership and land distribution. And in South Africa there are still historic issues around land ownership where White privilege persists. When the conversation focuses on the individuals, they feel attacked and tend to resist. But if there is an appreciation of the broader issues, like the power dynamics, it really helps. That appreciation is very important because some of the systems put in place to address structural racism have perpetuated it. A lot of people talk about democracy and constitutionalism. In some countries, the constitutions cite ‘equality for all’, which on paper is great because you are recognizing freedoms for everyone, but it doesn’t acknowledge the historic inequities. It just assumes that when the constitutions passed, everyone from that day forward is equal as if it magically erases the inequalities and assumes everyone is now equal and starting from the same position. But actually those with privilege and power continue having their privilege and power and that privilege and power is actually protected. It makes it harder to have authentic conversations about dismantling White privilege. Each country has a different context. Look at Australia, South Africa, Zimbabwe. But in all these countries, racism persists, but it manifests in different ways because it has different roots in each location. We have institutions like the United Nations, which are supposed to address some of these issues, but again, those in control are people who protect those with the power and the privilege. The important conversation that must happen is probably about awareness of the power and the privilege, and the willingness to create spaces for those disadvantaged by the privileged to center their voices and lead efforts to oppose it.
What Do You Envision For The Next Five Years? What Are Some Strategic Actions That You Hope To Engage In?
Tinashe: When we started the campaign, we thought it was going to be one year initially, but now it has grown, and we are excited about the growth. With the growth, there is also increased need for resources. In the next five years, we must reflect in terms of how do we turn the growth that we are experiencing into meaningful change? How do we support and sustain that growth, because that’s very important. We are having meaningful conversations about opposing rising right-wing movements around the globe. There is more work to be done and we need to think about how we can continue de-colonizing. And another topic we must bring into the conversation is climate justice; this is a growing problem. We need to emphasize how racism and racial capitalism contributes to climate change. These same movements and institutions that we have been organizing against are the same ones contributing to the climate issues that we face. In the next five years, our chapters need to grow and start transforming various communities within their countries, and within neighboring countries. What I hope to see is both local growth and an increase in global solidarity and partnerships, so resistance continues rising.
Anne Marie: We are very aligned with the people. We have a powerful community, and our challenge is to deepen our relationships every single day. We want to connect the struggles and make sure that people are feeling connected to the community. We have to understand when they are feeling disconnected, and be accountable for that disconnect. We need to be ready for the moments when our incremental pressure finally leads to institutional policy changes.
Nabirye: Our chapter is going to navigate more into reflecting on how history influences our health, and will continue doing so in the future. We intend to work with the universities around health and looking into the scientific approach to diseases. As we move through this journey, there will be many opportunities to support different communities, and even the next generation.
Courtni: With eugenics and fascism, the solutions are building power and acknowledging that intersections are vital and important. I look forward to building power with disabled, and Black and Brown communities, and formally incarcerated people – people from all walks of life without a savior complex. My vision is for people to have access to care, safety and security wherever they are. I also have a vision of people who represent those communities being able to put truth to power, whether that is with public policy or with new technologies. Even with union busting in the United States, people are taking on their employers calling them out. That shows me the future will be complicated and messy, but I think, like many others, that white supremacy and capitalism are on their last stand. The momentum is there. In five years, the world is going to look very different. It already looks different, such as opportunities for clean air and building better communities that are based more on values that focus on our humanity and not on what folks have or don’t have. I’m excited even though I am wary of what is to come.
Yeukai: I envision growth and expansion of resources for the Campaign Against Racism, and also in terms of growth from the local to the global. I see some of the tactics and the frameworks that we are adopting trickling down throughout our chapters. For instance, like language justice. It will be great to see chapters incorporate that in their work, better understanding of different tribes and languages.
Where Has The Organization Grown Most Over The Last Five Years?
Tinashe: The growth has been mainly in the chapters. I remember struggling with the Uganda chapter in the early days to even have conversations, struggling for many people to understand how structural racism is manifested. Now, so many years down the line, they are one of the most active chapters and are leading in so many spaces. And they’re growing in numbers too, and in how they contribute to the conversation. Our number of chapters is growing. We now have a chapter in India, bringing in a new perspective that we did not have originally.
Anne Marie: It is very important that when we talk about growth that we talk about the evolution of our tactics. I think at the beginning, we were more stuck in a reform mentality, often organizing within the frameworks of institutions. We were not always recognizing how oppression operates to stagnate our movement dreams. Witnessing COVID-19, another pandemic fall along the fault lines of race, gender, ableism, class and other intersections along with a global uprising on Anti-Blackness was a moment of reckoning to be more radical in our demands. They more aggressively go for dismantling, reimagining, and putting declarations on the table. These are like roadmaps in their asking for resources and funding for courageous actions and tactics to change the flawed systems. We are engaging in one of our most courageous actions – hosting a global trial on anti-blackness in the migration industrial complex. We have a proper legal format with witnesses, a jury, and we’ll have a verdict. This is not a tactic we could have done in year one. The trial, which was held on March 1, can be viewed here:
https://www.youtube.com/watch?v=T-x2mwf9fRU
Dr. Bram P. Wispelwey: Championing Health Equity Around the Globe
In 2015, Dr. Bram P. Wispelwey worked with Dr. Michelle Morse and other colleagues at Brigham and Women’s Hospital (BWH) in Boston, who found that over a 10-year period, Black and Hispanic patients diagnosed with heart failure in the emergency department were less likely than White patients to be admitted to the hospital’s specialty cardiology unit, where patients had better outcomes. Dr. Wispelwey helped create the Healing ARC, a race-conscious framework based on the reparations work of William Darity and E. Kirsten Mullen, that aims to redress racial inequities in medicine, improve patient outcomes and enhance accountability. Today, under a pilot program at BWH, when the emergency room treats a person of color with heart failure, a new, more equitable, process is in place. When physicians select admission to the general medicine service for a patient, rather than the specialty cardiology service, they receive a “best practice advisory” from the electronic health record system. The physician can either change their decision and admit to cardiology or override the best practice advisory and continue admission to general medicine. Implementation of the Healing ARC stirred a backlash among critics. Dr. Wispelwey, Dr. Morse and others were the targets of threats and a neo-Nazi protest at the hospital. Dr. Wispelwey recently talked with the Healing ARC Newsletter about this experience and his commitment to racial justice and health equity.
Where did you complete your medical training and what led you to a health equity focus?
I attended medical school at Ben Gurion-University of the Negev. I learned about the program through my master’s advisor at Columbia University who was a co-founder. The design was focused on global health and social medicine. It’s in the desert in the south of Israel. I moved to Boston to complete my internship in residency at Brigham and Women’s. During my residency in Global Health Equity, I met Dr. Michelle Morse, and we began working together.
What did you learn from being in Israel?
Israel is a country the size of New Jersey established in the wake of rampant antisemitism in Europe. Yet the creation of the state was a disaster for the Palestinian population living on the same land, displaced either to nearby areas like refugee camps in Gaza or the West Bank, or in surrounding countries. I became acutely aware of this situation in July 2010. In the desert, Palestinian communities were being displaced and I came to know the people in one community. The village was demolished in the summer of 2010. Two families kept rebuilding it. It’s been demolished like 200 times. In this time, I gained a real sense of the pain and suffering of that community. That experience and those relationships allowed me to better understand the impact of racism and displacement in the US, once I returned.
My interest in going into medicine was always focused on global health and social medicine and helping solve big problems. Some people are getting sicker and dying younger than others, and we have the tools, we have the resources, to stop that. Palestinians in Gaza and in the West Bank live 10 years shorter than Israeli Jews. I’m less interested in the newest, latest technology that might help a few well-off people. I am more interested in trying to eliminate disparities in care and outcomes.
Is there anyone who sparked your passion for health equity?
Marshall Ganz is a long-time organizer currently at the Harvard Kennedy School. He began organizing in the 1960s working in the deep south during the Civil Rights movement. He later went to work with Cesar Chavez in his home state of California. In this work, he saw injustices in a new light, and what he had normalized growing up there no longer seemed normal at all. He called it looking through his “Mississippi eyes” because of the racism he had seen and experienced working in the Civil Rights movement. I use a similar analogy. I have what I call my ‘Palestinian eyes.’ Now I see racism and injustices more clearly in my home context, which I was socialized to miss or ignore as a white person growing up in the US. Returning to the US after four years of medical school, I observed elements in our society differently. Injustices became much more apparent. This was part of how I noticed the initial heart failure inequities; It was apparent Black and Hispanic patients were receiving different care than white patients right in the hospital where I worked.
How did you recognize an inequity in heart failure care?
Brigham and Women’s has two clinical services where patients with heart failure are admitted: general medicine and specialty cardiology. The attending doctors work in silos by service, so they each only see one set of patients. Residents work in two-week rotations with each service. I had just been in cardiology and saw all the resources at their disposal to help patients. I noticed they were predominantly white patients and they received the best cardiology care possible. Over in general medicine, we would have patients with heart failure—some cases were severe forms of heart failure – and even though we had a specialty cardiology service specifically for patients with these problems, they were treated in general medicine. I observed that they were predominantly patients of color, mostly Black and Hispanic. That is what set off the Healing ARC research and initiative.
What steps did you take to address the disparity?
I discussed my observations with other residents including those in the Division of Global Health Equity and presented my observations to faculty at the Harvard TH Chan School of Public Health where I was completing my masters. Among faculty some of the responses were, “Even if we are segregating care, it doesn’t really matter because the outcomes are what matter.” This thinking sounded to me like “separate but equal is ok, right?” And it didn’t sit well. So, we then worked with Jen Goldsmith, the program director in the Division of Global Health Equity, who helped to get data on admission and discharge patterns. This was a real departure in use of patient data and required working with hospital administrators to understand our question was not theoretical, it had meaningful immediate impact on patient care.
When we finally analyzed the data, it essentially confirmed that this segregation of patients had been impacting care for at least ten years. This led myself and fellow residents to open the conversation with other departments. Predictably, these conversations with emergency medicine and cardiology became quite tense. We learned a lesson from not having worked together across departments earlier in our analysis. From there, we shared the data with everyone involved: clinicians and statisticians alike. Dr. Morse had studied organizing strategies and began building a coalition movement internally. Eventually, that included department chairs who emerged as big champions of the work. A large part of the work over the years was winning people over to the urgency of this issue. That took time, but it paid off. We were able to build a shared understanding of what the data showed and commit to making changes in care.
Has the hospital committed to the Healing ARC for the long-term?
Our pilot program has been funded by the highest level at the hospital and has significant institutional support. There is also a broader campaign within the Mass General Brigham Health System to address racism. Yet our race conscious approach has required building critical consciousness of past harm and commitment to redress. That’s an evolving process.
How did BWH handle the potential legal issues Healing ARC presented?
We first published our research in 2018 and the Department of Medicine funded several health equity improvement pilots before we launched Healing ARC. Yet, many people were not aware of the inequities in care until the attacks against implementing the Healing ARC as an intervention. We had conversations with the interim president of the hospital as well as working with the hospital’s general counsel recognizing real risks and backlash the institution could face [related to implementing Healing ARC]. A number of conservative organizations threatened to sue the hospital if we went forward with it. Some claimed that Healing ARC was essentially racism against Whites, and that it violated the 1964 Civil Rights Act.
I am not a lawyer, but my interpretation is that, increasingly, in order to prove discrimination, intent matters. You must prove there was an intention to discriminate. Once we documented the disparities, it wasn’t like there was some smoking gun where you could say, ‘Oh, there is this bad actor or this bad part of the system.’ It’s built into the system. So where we landed was that because we had documented the disparities so thoroughly, we had the legal argument to say that we had to do something about it. Even if we didn’t intend to have this racial inequity in care for heart failure, we knew about it because of our research, and if we didn’t attempt to fix it, we could be liable. But most important to us was finding a new way to way to address examples like this, something reparative.
How did the backlash affect you personally?
It was a frightening time beginning in the spring of 2021. I received numerous threatening emails. Dr. Morse received messages that were full of cruel, racist, and gendered slurs. The backlash wasn’t aimed just towards us, it was also aimed at the hospital. It created questions like, “Is this the right thing?” “What are we doing?”
Is the Healing ARC approach being used in other institutions?
The University of Virginia Medical Center is implementing a Healing ARC model to address racial disparity in the heart failure patients assigned to general medicine versus the cardiology unit, much like we did at BWH. Also, the Institute for Healthcare Improvement has launched a campaign called Rise to Health, which will include the Healing ARC as one of the remedies they will cite in their health equity campaign.
Can the Healing ARC approach be used more broadly to address other inequities in health care?
That’s an important question. We haven’t yet fully explored the scale up from Healing ARC in the treatment of heart failure patients to broader Healing ARC interventions applied to a wide range of scenarios to address racism.
Our commitment is to reparative and restorative justice for harms that have been perpetrated. Clearly, this framework can be utilized to address many inequities that are discovered and documented. The goal is to engage communities and patients during the process of repair.
Disparities are pervasive across our health care system. For example a race-based modifier applied to kidney function showing that Black people are less likely to be put on kidney transplant lists. That is a direct harm. There are other well-documented race based algorithms in pulmonary function and bone density testing, for example. And there are other documented disparities in patient care like around access to pain management and hospital security responses. The Healing ARC process could be adopted to find ways to redress these inequities and others. We hope to share this model to right past harms where they exist. I hope as a clinician to sustain my commitment and work with communities who have long been misserved by engaging models like Healing ARC that offer these essential elements of acknowledgment, redress and closure of past harm.
New ‘Rise to Health’ Coalition Emerges to Advance Racial Justice in Health Care
Health care and equity advocates have launched a new coalition, Rise to Health: A National Coalition for Equity in Health Care, created to bring together individuals and organizations engaged in health equity work but currently operating in silos. The coalition’s objective is to forward a cohesive national strategy that advances equity and embeds racial justice in health care.
Announced in early December at the Institute for Healthcare Improvement Forum 2022, IHI’s president, Kedar Mate, MD, said, “The time has come for a system-wide approach—where health care organizations, individual practitioners, payers, professional societies and pharmaceutical, research and biotech organizations come together and align activities to make the whole ecosystem of health care more equitable. By doing this together we will change the story on equity from one of confusion and competition to one of hope, possibility, collaboration, and alignment.”
The organizations in the coalition include: AHIP (American Health Insurance Plans), American Hospital Association, American Medical Association, Council of Medical Specialty Societies The Commonwealth Fund, Genetech, Groundwater Institute, Health Begins, Institute for Healthcare Improvement, National Association of Community Health Centers, PolicyLink and Race Forward.
The coalition will unite people and organizations toward action and shared solutions for systemic change and structural impact, with a vision for a transformed health care ecosystem in which all people have the power, circumstances and resources to achieve optimal health.
The coalitionalso includes a number of advisor organizations: American Public Health Association, Asian/Pacific Islander Domestic Violence Project, Kaiser Permanente, National Association of Hispanic Nurses, National League for Nursing, National Quality Forum, Robert Wood Johnson Foundation, The Trevor Project, Treehouse, A Vision of Change, Urban Indian Health Institute, WE in the World and others.
To realize its vision, the coalition will have several areas of action – mobilizing and equipping individuals, health care organizations, and health care industry actors with concrete skills and tools. They hope to change mindsets and narratives within health care and influence and fundamentally change policy, payment, education, standards and practices.
“Hospital and health system quality improvement and equity are inseparable in order to improve health outcomes for all,” said Leon D. Caldwell, senior director of health equity strategies and innovation for the American Hospital Association’s Institute for Diversity and Health Equity.
The coalition embodies five critical values, including: an interdependence in which cooperation and collective action are needed to transform inequitable systems; a sense of belonging, with the belief that improving health for individuals and communities that experience health inequities benefits everyone; a belief that an abundance exists with enough resources to achieve optimal health for everyone; a faith in the inherent dignity, worth and value of all people; and, finally, a strength in which the coalition honors community knowledge and practices, while acknowledging the structural inequities that lead to disparate health outcomes.
To achieve its goals, the coalition will engage health care sector audiences in health care organizations, individual practitioners, payer organizations, pharmaceutical, research, and biotech organizations and professional societies.
The coalition has organized its foundational set of actions and associated activities into six categories or steps: committing to acting for equity, getting grounded in history and local context, identifying opportunities for improvement, making equity a strategic priority, taking initiative with others and aligning, investing and advocating for thriving communities.
In recent years, the growing need for healthcare equity has become headline news with a growing recognition that inequity in healthcare leads to poor patient outcomes, often resulting in tragic consequences, including shorter lifespans, untreated illnesses and lost lifetime potential, not to mention billions of dollars in costs to the U.S. health system.
To achieve its long-term vision, the coalition will focus on four areas of emphasis. Firstly, the coalition will seek to build access, ensuring that every individual and community has health care that is inclusively designed to reach them.
Secondly, the coalition will build and sustain a diverse, inclusive and thriving health care workforce that advances racial justice and health equity for patients, communities and staff. Thirdly, the coalition will work together to leverage its collective strengths, resources and power to address structural and social drivers of health inequities, creating social and structural drivers of equity.
Finally, the coalition will redesign health care systems to reliably deliver equitable, high-quality and safe care for every single individual and community, with the goal of eliminating unjust differential harms and ultimately improving care for all.
For more information, please visit the coalition’s official website at http://www.risetohealthequity.org.
Race-Based Equations Delayed Black Patients From Getting Onto Kidney Transplant Lists—An Unprecedented New Policy Seeks to Undo the Damage
Dr. Michelle Morse, a National Leader in the Fight for Health Equity, Seeks to Jettison Racism from Medicine and Patient Care
A native of West Philadelphia, Dr. Michelle E. Morse is an accomplished innovator of health policy, practices and procedures that target structural racism in medicine. She is committed to achieving health equity through global solidarity, social medicine and anti-racism education, and activism. Working with other physicians at Brigham and Women’s Hospital in Boston, Dr. Morse spearheaded a study determining that Black and Hispanic heart failure patients treated in the hospital’s emergency department were disproportionately sent to general admissions rather than the specialty cardiology unit where there are better patient outcomes. In response, her leadership led to the creation of the Healing ARC intervention and framework, a blueprint for race-conscious interventions that can eliminate racism in patient care. In February 2021, Dr. Morse became Chief Medical Officer and a Deputy Commissioner at New York City Department of Health and Mental Hygiene. Among her other duties, Dr Morse coordinates a coalition of NYC health care providers examining the use of race and ethnicity in clinical algorithms that can play central roles in patient care decisions, even though their race modifiers are frequently based on debunked, racist theories that leave patients with delayed and compromised treatment. A co-founder of EqualHealth, and an Assistant Professor at Harvard Medical School, Dr. Morse co-led creation of the Healing ARC campaign, which is raising awareness of race-conscious interventions in Massachusetts and across the country. Dr. Morse recently conducted a candid interview the Healing ARC Campaign newsletter.
Why did you become a doctor?
I love that question. It’s one of my favorite questions and for me it wasn’t a life altering experience necessarily. A big part of it is the fact that my mother, Debbie, is a public school teacher and always ensured that we were raised not only to be proud of being Black, but also being very, very community engaged and civically engaged and very conscious of the needs in our community. So those values were there from the beginning. And my mom is very much a people person, which is why I also love being around people. And, I just love, absolutely love, math, science, chemistry, calculus…all of the super wonky, nerdy topics that end up being a gateway to becoming a physician. Growing up, I had a Black woman, pediatrician. And so being a doctor always felt within the realm of possibility. As I started to shadow doctors and understand the reality of it, I absolutely loved it.
Where did you grow up?
I grew up in Philadelphia. West Philly. I went to public schools from kindergarten to 12th grade. My mom is a public school teacher, and it was important to her that I went to public schools. I was raised by my mom, but I am also connected to my Dad’s side of the family. His family runs funeral homes. My Dad’s a third generation running a family funeral home business.
Where did you go to college?
For undergraduate, I went to the University of Virginia and majored in French. As a Black student at a predominantly white university, it was quite an experience. I always loved French. I took a lot of French classes in high school, and I loved my French teacher. So, I was very engaged in French and languages in general. I majored in French thinking I would become a physician who would work in Francophone West Africa. I’ve never ended up doing that. But instead, I spent considerable time living in, and working in Haiti between 2009 and 2020. I lived in Haiti from 2012 until 2015.
What was it like in medical school?
For medical school, I went to the University of Pennsylvania, which is in West Philly. And I was the only med student from West Philly out of 600 med students. That says a lot about Penn and its problems with diversity, equity, and inclusion. At times, it was very painful because many of my classmates and the faculty, the teachers and even nurses and doctors in the hospital, all harbored nasty negative beliefs, discriminatory beliefs, about the people of West Philly, which has a large Black population. They usually did not know that I was from West Philly. I can’t repeat the nasty things that were said. I’ve always felt that if Penn had more medical students from West Philly as it should have had, maybe the health outcomes for people there wouldn’t be so bad. You can barely find a Black primary care doctor in West Philly, which is a huge problem. I have a lot of complex feelings about Penn. On the one hand, it was my entree into global health. I got to take a year off between my second and third year of medical school to live in Botswana for the year. And that’s when I became a student activist in the AIDS movement. That’s when I really set my path towards global health equity.
When did you first encounter racism in medicine?
Definitely as a first-year medical student at Penn. I was twenty-one and went straight from undergrad to medical school. There was this very memorable moment when some of the nurses in the emergency department at Penn disparaged a patient, saying, “Oh, this one has West Philadelphia wig syndrome.” That was just disgusting. It was just one of those nasty, derogatory, racist things that they would say. The health workers struggled with their own secondary trauma from the challenges and hard works. Unfortunately, their frustrations manifest in racist comments directed at Black and Brown patients. It’s definitely hard work, but it’s obviously quite racist and pretty nasty. Another troubling thing was hearing patients derided as having “poor protoplasm” or patient with “PPP.” This is the way that doctors and nurses used racist framing to denigrate Black or Hispanic patients struggling with addiction or complex medical problems. It was their way of blaming and stigmatizing the patients.
How did this impact you?
It had an enormous impact. It became very clear, very quickly that to be a Black woman doctor is just a very unique thing. And it’s in a way both a gift and a curse. I am incredibly honored to be able to serve Black people in particular, but all marginalized communities. This is the honor of a lifetime. And it’s definitely my calling. This is the job I was born to do. So, I feel very strongly about that. The curse, of course, is that the darts that come my way are pretty ugly. It is the experience of being undervalued, assumed to not be as competent, assumed to be less than, assumed not to be the doctor. I think the undervalued, underappreciated thing is really probably one of the most challenging parts. It’s been a journey and you really need community to be able to navigate it. Because otherwise it becomes just too much. Just too painful. I have several friends that I’ve known since I was 10 years old in Philly that I went to public school with, but most of my other friends are Black women physicians. We just understand each other in a way that I think helps us all get through the challenges.
Has this driven you to create “safe” communities for yourself?
Definitely. I think it’s a big part of the reason I loved working in Haiti so much. I went to Haiti in 2009 for the first time as a second year internal medicine resident with Partners in Health, and I absolutely fell in love with working there. I was in clinics in rural Haiti with hundreds of patients who had never seen a doctor. I was able to speak French with a lot of colleagues while collaborating with the Black community, health workers, Black nurses, Black doctors. It was so affirming. That was such an important experience for me. It’s probably part of the reason I was so drawn to Haiti in addition to having studied the Haitian Revolution in college and knowing the history of Haiti. And, in 2010 Equal Health was launched after the earthquake in Haiti to be part of the solution to rebuilding the healthcare and medical education system in the country for the long term. My experiences definitely led me to finding power and strength through the communities we build. I associate with people who see the power of community and a shared analysis. We’re all dissatisfied with systems as they are, whether the system is healthcare, social services or something else – it’s infected with structural racism. We keep each other hopeful and on fire and inspired, about the fact that change is possible because we have this shared analysis, this shared dissatisfaction, and more than anything, our relationships and community.
When did you first start thinking about the healing arc?
We started thinking about a solution right from the beginning after recognizing there was a problem with Black and Hispanic heart failure patients not being admitted to cardiology unit at Brigham’s. Once we looked at the data over the prior decade, it was very clear we were seeing institutional racism at work. One of the challenges is that solutions to inequities almost never actually center the community that was harmed. We were committed to changing that. We wanted the Black and Hispanic communities centered in the solution. We were also doing this at the height of the Black Lives Matter movement when conversations about restorative justice and race consciousness were a major part of the public discourse. I was engaged with the Lancet Commission for Reparations and Redistributive Justice so we were thinking about reparations, about restorative justice, about public health, critical race practices and all these things were centered on race consciousness.
Why are race-conscious approaches necessary?
The empirical evidence shows that the strategies and approaches we have used to counter structural racism in medicine and other fields is not working. And what has been tried are colorblind approaches. It is the 20th anniversary of the Institute of Medicine’s groundbreaking report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. In more than 700 pages, every inequity, racial and otherwise, are documented. And, 20 years later, almost nothing has changed. What has happened is a lot of studying of racial and other health inequities and almost no real action. No targeted action to ensure that the communities being disinvested and marginalized for generations actually get some restitution and the inequities are addressed. A race conscious approach is grounded in history. It is critical to understanding the racist history of this country and know the policies, practices and procedures create the social inequities. A hierarchy of human value has been embedded in this country since its origin. We need to ensure that solutions are focused on redressing the racism that has long existed. Let’s not waste time, energy, and resources on general approaches. For instance, in a field like housing. We cannot just increase general access to housing. We must look at the fact that Black people are significantly more likely to be homeless. So, focus on the Black community! We must focus on the demographics that have been historically marginalized. And there is evidence that this works. The American Association of Medical Colleges launched a bold initiative in the 1990s and early 2000s to increase Black and Hispanic medical school students. They weren’t able to continue it longer because of the backlash against affirmative action, but their efforts made a huge difference. Focusing on affirmative action was a race-conscious approach to a longstanding inequity with medical schools. We know it works. There are modeling studies on the impact that race-conscious approaches can have on longstanding inequities. New Zealand is a global model for utilizing reparations to redress historically harmed communities. The New Zealand government admitted harm and fault for atrocities towards the Indigenous population during colonialism. The ensuing reparations have spurred considerable progress.
Can racism be eliminated from patient care in the U.S.?
Yes and no. Sometimes I think we cannot have health equity and racial equity in healthcare in a society, country, state or city that is still socially inequitable. Those two things cannot co-exist. Think of it this way: we can’t achieve racial justice in healthcare that is independent of the rest of society. Health equity is predicated on social justice at large. There is really no way to achieve health equity without a full societal transformation. So, can we eliminate racism in medical care? It will require us to essentially eliminate racism across society. Healthcare does not happen in the bubble. It is subject to the perceived hierarchy of human value that puts those with white skin ahead of those who are Black and the allocation of resources throughout society. That is the framing from the social determinants of health. Our health outcomes are shaped by factors such as socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. These impact health outcomes and people of color are impacted way more than everyone else.
What role will you be playing in the fight for health equity?
Dr. Morse: I really strive to be into both the theory and into the practice. I consider myself someone who is really oriented towards the practice. It comes from Paulo Freire’s work, which argues that oppressed people can only regain their humanity in a struggle for liberation, and only if they lead the fight. We should be constantly educating ourselves and then framing all of our actions based on that education, and then going back to the education and acting again, and learning, and then changing and constantly iterating. So my role is to do just that. We have not figured this out. We do not yet know how to fix this. So, if anyone tells you they have the silver bullet, they are lying. My role is to be constantly creating spaces for progress to happen. It’s living and embodying the practice of constant learning and then action. So, I believe that is the only way for us to break the cycle.
Benjamin Perkins: Enduring the pain from health inequities, while striving to create a better health environment for others
BOSTON, MA – Benjamin Perkins recalls his father taking a stress test and collapsing on a treadmill in Los Angeles in 1995. His dad, also Benjamin, had suffered symptoms pointing to heart trouble, but doctors repeatedly insisted everything was fine. Three days after the heart attack on the treadmill, he was being transferred to another hospital, one with better cardiology care, when the 56-year-old went into cardiac arrest in the ambulance and died.
Fast forward to today. His son is a prominent social-justice and health equity advocate who has spent more than two decades in the public health field, including as Vice President of Health Strategies for the region’s American Heart Association/American Stroke Association. He was CEO of Wholesome Wave, a national nonprofit that enables under-resourced communities to make healthier food choices. Currently, he leads their equity-centered work as the creator of the FED (Fidelity, Equity, and Dignity) Principle and chairs the board’s FED Committee.
Perkins has learned that racism in medicine creates environments where patients of color too often, like his dad, do not receive the best medical care and the patients, and their families, suffer because of it. For Perkins, a recent civic engagement resonates even more, reminding him of the pain of losing a father – when it just shouldn’t have happened.
Perkins is on the “Wisdom Council” at Brigham and Women’s Hospital (BWH), where the group plays a critical role in channeling community insights and recommendations to the hospital’s Healing ARC initiative. Why is it needed? In 2015, a study by BWH physicians found, on average, that fewer Black and Hispanic patients diagnosed with heart failure in the emergency department were admitted to the specialty cardiology unit. More frequently, patients of color were sent to general admissions, where outcomes weren’t as positive. In response to this blatant pattern of structural racism, the Healing ARC framework was created to develop a practical care delivery model that can save lives and has already paved the way for better treatment for Black and Hispanic heart failure patients.
“My father’s story is certainly something that I think a lot about in relationship to the work of the Wisdom Council and understanding that there’s a differential in patient care,” Perkins says, noting that what happened to his father is the precise situation that the BWH Healing ARC intervention seeks to prevent. “Healthcare systems produce disparate health outcomes. I am very interested in supporting work that engages residents in addressing issues related to health inequities. For me, this is a very personal story.”
Perkins continues: “We felt my father didn’t get the best treatment. But this was 1995, we didn’t necessarily connect it to race, disparities, or inequities. But it just felt like this shouldn’t have happened. It was two years ago when that was really hammered home. I was on a panel at Harvard Medical School with a Latino friend who is a doctor. And when I told him my father’s story, he said every indication suggested my father should have immediately been triaged into cardiology. They shouldn’t have waited so long before doing something. And that was the first time anybody put it to me that bluntly. He was a victim of racism in medicine.”
In some ways, Perkins sees himself a child of the struggle for racial equity. He was born in Los Angeles in 1965, the year of the Watts riots. He graduated from UCLA with a degree in geography and the scholar has advanced degrees from Harvard Divinity School and Antioch University in Los Angeles. While working in public health, he has been a leader in disease prevention and working on preventing HIV infections. Along the way, he has led a community advisory board, directed a CDC-funded HIV-prevention and wellness center, led an NIH-funded HIV-prevention feasibility study. Perkins is an ordained minister in the Christian Church (Disciples of Christ) and serves a congregation in the Boston area. By 2014, his focus turned to issues closer to home – health disparities and inequities in cardiovascular disease and stroke rates among communities of color and other under resourced populations. Not only did Perkins lose his father, but he had two uncles also die of heart-related causes.
Perkins believes that racist systems and structures bare the fault for inequities in patient care. “Some people may have ill will, don’t get me wrong,” he says. “But I think the systems produce these outcomes independent of bad actors. It’s absolutely essential to have these kinds of initiatives, like the Healing ARC, that work at the systems level. That is so foundational. If you don’t do the systems level work, bad outcomes will continue to be produced.”
In accenting that point, Perkins compares systems-level interventions in healthcare to the Boston Globe’s award-winning investigation of sex abuse in the Catholic church. In the movie, “Spotlight,” which focuses on the Spotlight Team investigation, Perkins recalls that the editor tells the team’s leader not to focus on the individual priests, but on the system that tolerated their behavior. “It was really fascinating because in talking about their approach, the editor said there had to be a laser-like focus. He understood that it was much more about the system than ‘individual bad actors.’ That just confirms that systems must be the target if you want real change.”
Perkins expanded on that reasoning, saying that he has spent decades in public health and engaging both individual and system level initiatives. “But if you don’t understand that it’s the structural weakness causing the problem, and that is where you must intervene, your resources and time will just be squandered.”
He notes the role that the Wisdom Council plays in the Healing ARC framework, as the intervention addresses the structural racism that facilitated Black and Hispanic patients not receiving the best available treatment for serious heart ailments at BWH. The “ARC “stands for acknowledge, redress and closure. In Healing ARC models, stage one requires providers and institutions to acknowledge that racism contributes to inequitable health outcomes. Stage two must redress the harm by providing restitution to the harmed population, including opening access to services and care historically denied. Stage three is to facilitate closure through reconciliation and agreement that the harm has been redressed.
When Drs. Michelle E. Morse and Bram P. Wispelwey led the development of the Healing ARC, they created a more equitable process at the hospital. Today, if an emergency physician selects admission to the general medical service, rather than cardiology, for a patient of color suffering heart failure, the clinician receives a “Best Practice Advisory” through an electronic health record system. It reminds physicians that patients of color have fewer admissions to the cardiology unit. The physician then can either change their decision and admit to cardiology or override the advisory and continue admission to general medicine. Regardless, there is now accountability for what can be life altering decisions.
Perkins sees the Healing ARC approach as a branch of Truth and Reconciliation Commissions (TRCs), which have been instrumental in resolving deeply rooted conflicts around the world. The TRCs identify human rights violations, impacts of racism and tragedies, and then lead populations on a healing process that restores dignity and respect, paving the way for the transformation of societies. The approach has been deployed to address historic wrongs in Australia, Canada and a few communities in the United States.
“My fond hope and desire is that the Healing ARC can become a success similar to those derived from truth and reconciliation frameworks,” Perkins says, noting the reluctance of America to provide reparations for the racist policies and practices that have harmed people of color since the birth of the nation. “It’s like the story we hear all the time about the only reparations ever given went to slave owners, who lost their slaves after emancipation.”
Yet, Perkins sees real progress, especially in what the Healing ARC has accomplished.
“As an individual who has experienced losing family members because of inequities in healthcare, I see real power in the hospital acknowledging their wrong. It’s like the first step in an exorcism is to name the demon, ‘What’s your name?’ “Perkins says. “In this case, the hospital has acknowledged the wrong. The study documented that Black and Hispanic patients were mistreated for at least 10 years, and we know it was longer. The hospital did not run from it. Like with my father, he didn’t have to die. And we all know it. There is a power that comes with the validation of your claim. What was suspected, is what actually happening. There’s something really powerful about the hospital acknowledgement of what happened.”
Moreover, Perkins says that African Americans aren’t used to unconditional acknowledgements of wrongs, and committed efforts to redress the harms. “The hospital says they are committed to doing things differently, the redress,” he adds, noting the Healing ARC intervention has been implemented as pilot program since earlier this year. Still, he cautioned, “the harmed community must help set the terms of what the redress and closure look like.”
That is where the importance of the Wisdom Council emerges.
“The offending institution’s role is to acknowledge and then listen,” Perkins says. “If this is done well, the community voices will be in the forefront for the final stages. We want to be in a relationship where the community and the hospital mutually agreed to the course of redress and we need to define together what closure is.”
This experience demonstrates the true power of structural interventions, Perkins says. “We are changing ingrained habits that privileged a specific group of patients. It was built into the system. But now that system has changed, it’s fairer, it’s more equitable. I often think about my father and what would have happened if he showed up at Brigham’s emergency room with the same symptoms. The way this system now works, he would have been sent to cardiology and not had to wait three days for the proper care. He could have lived more of his life.”
“Too often we get trapped in our sense that inequities are impervious to change, that racism, sexism, and homophobia are so structurally embedded that to tackle them is beyond our collective room…it is crucial for us to change the narrative around inequities. To understand them not as inevitabilities, but as things that we can in fact improve.”
Dr. Kedar Mate, President and Chief Executive Officer at the Institute for Healthcare Improvement (IHI), gives a powerful address at IHI’s annual forum.