05 / 01 / 20
KConnect is emphasizing the role that equity – or the historical absence of equity – is playing in the crisis that is currently underway, and to compel all of us – individuals, organizations, and systems – to recognize that with the present pain also comes an opportunity to reset structures and systems with authenticity and intentional design that rejects a blanket universal approach and rather takes into consideration the unique needs of populations; their situatedness and specific needs.
To gain a deeper understanding of the COVID-19 healthcare and other impacts, we convened a panel of experts in a variety of roles in our community. Micah Foster PA-C, the Executive Director of the Grand Rapids African Health Institute, is not only leading GRAAHI in their work for equity in healthcare, but he is practicing on the front lines of the pandemic. Dr. Brandy Lovelady Mitchell is the Inaugural Director of Diversity, Equity & Inclusion at Kent Intermediate School District and acts as an expert in equity in the education system. Dr. Juan Olivarez is the Distinguished Scholar in Residence for Diversity, Equity, and Inclusion at the Johnson Center for Philanthropy and has acted in a variety of roles including the former president of GRCC. Lastly, Paul Doyle is the Founder and CEO of Inclusive Performance Strategies and specializes in bringing equitable practices to organizations and businesses in our community.
The following is part one of a two-part blog; part one focuses on how we’re seeing structural inequity show up in healthcare, education, and jobs and income.
In the time of COVID-19, how are we seeing structural racism show up in…
When we think about racism, we think about restrictions; how it restricts the lives of individuals and has done so throughout history. A number of studies correlate individual experiences of racism with the greater rates of illnesses. (See article 1 and article 2 for resources.)
The consequences of racism show up on an individual level within our patients in healthcare. However, when we think about public health and the health of social groups, they are strongly affected by structural instead of individual accounts of racism. One underlying problem is that structural forms of racism and its relationship with health inequities is really an understudied topic.
The COVID-19 pandemic really highlights several forms of structural racism; for example, we see social segregation and we’ve known that it’s a structural form of racism for decades, such as redlining. When you think about it in this context, we see how it’s the concentration of poverty and people being subjected to air pollutants and in this case an infectious disease.
For me in my practice, I like to think about historical trauma as particularly important because the individual acts of racism and inequities on one generation are often felt by the next, the result being a distrust and an underutilization in healthcare services. We see this play out with many other disease states, and I think we need much more data sharing by our system partners to assess whether this is a factor in the COVID-19 pandemic as well. When we look at systemic recommendations like stay at home or when you go in public wear a face mask, there are some unintended consequences that need to be addressed with that. If you are an African American male in some communities walking around with a face mask, that could be perceived as threatening.
I would like to highlight and commend our local healthcare systems. I know they are proactively seeking solutions and proactively considering racial equity in their solutions, and that’s commendable. We’re fortunate to be in West Michigan where we have a history of collaboration.
I’m glad that KConnect is leaning in and continuing to amplify your identity – agents of justice for the marginalized. In times like this the most vulnerable can be forgotten or not centered as people default to technical strategies. I think that you all continue to help us anchor and center our thoughts and decision making around the most vulnerable and I’m happy that you’re doing it. I think that what you’re doing right now can really amplify some of the legacy cost of things like housing segregation, racial discrimination, redlining, medical discrimination as well as educational discrimination/injustices. They’re all interlocking, so the way that you put this panel together is important and a good model.
What is so abundantly clear is that COVID-19 has intensified some of the inequities we knew already existed in education. It’s the glaring understanding of the haves and have nots. We’re talking about digital devices so that families can engage in the continuity of learning which also takes us to connectivity, who has those resources in the home to really access ongoing learning and to access support. Beyond that, who has adults in the home with school-aged kids based on being deemed essential workers. The overabundance of black and brown folks in those essential positions have implications on learning as well as just the exposure to COVID-19.
We saw early-on just how reliant some folks are on schools for things like food and the social/emotional support that comes from school. We’re seeing a greater divide of those who are dependent on public services, which, to me, is a window into the inequity of wages, who has access to quality healthcare, who has access to mental health services, etc.
Illuminated in structural racism is how certain schools have access to resources or funding; those who were able to pass out devices and hot spots, how some were able to right away just continue learning because of how they’re set up, and who had staff that was even equipped to pivot like that. The level of trauma to the adults in the building was magnified in some areas as opposed to others.
We like to talk about achievement gaps and opportunity gaps – if kids are not growing the cognitive skills to be independent learners and self-directed, it has future implications on their quality of life and the choices that they have. COVID-19 has intensified who will continue to make progress in meaningful ways… who has opportunities and who will be left behind; this is Educational Debt.
Regarding K-12 students, I’m really concerned about what we’re going to see next – this deficit that we’ve always known about of the educational gap; it often gets pushed under the rug, but now we see that it is a big deal. Schools are part of our democracy, where students learn and prepare for careers and vocations. To lose time in this educational process will affect our black and brown students the most. This is going to be very, very impactful on students. Think about the learning every single day that they’re not getting. This is going to be devastating, and we haven’t seen anything yet in terms of the ramifications for our K-12 kids. The harm is going to be everywhere, but it’s going to be toughest on the youngest kids because they are losing out on the most.
Then there are many parents who are not equipped; they don’t have the skills to teach their children at home. Teachers are also not equipped to be teaching totally online – even on the college level. It takes a lot of work, preparation, training, and support that they really haven’t had. The faculty I’ve talked to at different colleges are really struggling with what to do and how to do it, and basically they’re all lowering their standards. For our kids, it’s going to really matter when we talk months of this.
I also want to reflect on higher-ed with students having to leave campuses. For many of our students, the dilemma is that they may not have anywhere to go and that’s been a struggle for colleges to maintain some semblance of dormitory life. Students are needing to go home, but home isn’t necessarily conducive to a learning environment perhaps due to lack of space, technology, etc. The stress on the college kids is enormous. Graduates are missing out on career fairs – our students of color rely on those because they don’t have the networks that other students have through family, acquaintances, parents’ jobs, and so forth. Those that are in the sciences or technical fields where you need to fulfill practicum requirements by the accrediting agencies, once again, it’s great to relieve all of those requirements but it’s scary. What do you do when you haven’t had the full training yet? It’s a tough situation and very stressful for our students who need to graduate and move on.
The big realization in all of this is the digital divide – access to equipment at home and lack of wifi. We should have wifi in our neighborhoods.
If anything, this pandemic has really illuminated the issue of structural racism and societal racism. 80% of our citizens go from check to check; they have nothing to fall back on, no safety net. A large portion of that 80% are African American, Latinx, Native Americans, and so on that are struggling every single day. They didn’t need a pandemic to realize the problems of accessing jobs and earning livable wages or the difficulty of actualizing prosperity.
In addition, the fear and emotional stress that undocumented workers are going through is unimaginable. The fear is not just the disease – if they have to end up in a hospital, what does that mean? They worry whether the authorities will find out about them. People are afraid that they’re going to be discovered and teams are going to come and start taking them away. This fear is always there, but this is far worse – it is really making people fall apart emotionally.
That fear is what we see prevents early access to healthcare – most frequently fear of discovery. When I practice clinically, I have to be careful with patients that I’m able to address their concerns both physically and emotionally while connecting them with resources.
We have been looking at the African American Health Institute because our default status, like other organizations, is English for all the documents we put out. If you’re not cognizant of the other populations and proactively including them, it’s easy for them to be excluded. Our friends at the Hispanic Center have done a phenomenal job of rallying to translate documents to make sure that learning is out there for all communities so that the language barrier is dropped.
Culturally, the other big things that I wanted to highlight – many times there are multiple generations in the same household. If you get one person with a cough and shortness of breath, how are they going to quarantine themselves? The rapid spread of this infectious disease is that much more amplified in that environment. Breaking down language barriers and knowledge gaps around are we using PPE and social distancing is vitally important for our community.
Also, the little piece of aid or support that some people may have may not be available to un-documented or under-documented populations. They don’t have access to that which serves as bandaid for some, so that’s another way they get pushed to the margins. Schools have done a better job but it’s basic, critical information that must be translated to reach all in our community
Jobs & Income?
When I look at these three areas, healthcare, education, and jobs, they are so inter-reliant with each other when it comes to quality of life. We cannot just look at them as separate areas.
What we’re experiencing in regard to structural racism and inequities in regard to COVID-19 is like a pressure cooker. We’ve had this slow pressure cooker boiling and all of a sudden the lid has flown off and people are saying “wow, I didn’t know what was in the cooker!” The inequities have been “cooking” for quite a while; for generations, in fact, and the current crisis has blown the lid off!
There are going to be businesses who will be totally wiped out by this crisis and people who will not be able to get their jobs back if we are not able to soften the impact. We’ve had an uptick in lifestyle business ownership within the African American and Hispanic community over the last year – those businesses could be wiped out. They had just so much financial cushion to even establish themselves. If and when this opens up, how quickly will their consumer base come back to help them re-establish themselves?
The tension that arises when we discuss structural racism is that there are some people who believe we have existing systems that are equitable and you just need to “pull yourself up by your bootstraps.” This crisis has exposed the inequities within our systems. The question is going to be who really cares? Unless it’s totally hitting their pocketbooks or their financial base, they’ll care at that level, but from an empathetic standpoint, that’s going to be a question and a reality for us to face.
I heard that we are living a tragedy where perception and opinions are overriding facts – if we continue to let that happen, and that’s the behavior we embrace, then what are we to expect in regards to change?
Part two is available here and focuses on how these issues are impacting children and how the system needs to respond and adapt in the future to create more equitable outcomes in our community.