RAPHC Research Agenda

RACISM AS A PUBLIC HEALTH CRISIS

CLEVELAND Research Agenda

Prepared by ThirdSpace Action Lab Photograph: Mike Segar/Reuters

HOW RAPHC MAY ADAPT A COLLECTIVE IMPACT MODEL TO CLEVELAND’S LOCAL CONTEXT Adapting the collective impact (CI) model to Cleveland’s Racism as a Public Health Crisis (RAPHC) coalition represents a tremendous opportunity. CI coalitions have a common agenda, shared measurement systems, mutually reinforcing activities, continuous communication, and a backbone support organization.

CI inspires clear strategy that leads to dedicated partners, organizations well-suited to executing the initiative, and a culture of accountability.

- What is RAPHC’s specific goal?

- Who is RAPHC trying to persuade and/or motivate?

High impact coalitions have low barriers to entry, strong moral leadership, prioritize building trust among participants, and focus on solutions.

- What are the products of RAPHC’s work?

- What value do Cleveland residents derive from RAPHC?

TIPS FOR SUCCESS: develop A theory of change identifying a small number of clear metrics with accompanying goals.

Avoid CI devolving into fish-fixing, bureaucratic stalemate, and political conflict at the expense of our most marginalized neighbors.

members can continue developing into a high impact coalition by evaluating the effort with the Collective Impact Forum’s readiness assessment.

raphc Peer city model Since 2019, more than 200 local government entities across the United States have declared racism to be a public health crisis. While these declarations have inherent value in identifying racism as a structural issue instead of an individual issue, many communities have struggled with translating these declarations from words on paper to real, meaningful change.

What lessons can the Cleveland RAPHC coalition take from how peer cities have approached RAPHC declarations and initiatives?

In March 2019, Milwaukee County was the first community to pass a RAPHC declaration, and the City of Milwaukee soon followed in July 2019.

In Milwaukee County, the implementation of the declaration was mostly internal to county government, focusing on creating racial equity indicators and applying GARE best practices around racial equity budgeting.

At the city level, there was a focus on creating racial equity action plans for each city department and working on diversity in hiring.

Still, in both cases, the work of implementing RAPHC was challenged by entrenched racial power dynamics. In the City of Milwaukee, the original draft ordinance mentioned racial segregation in housing as a challenge, but this was removed because the mayor did not want to focus on this point.

At their best, [RAPHC declarations] can “shepherd meaningful anti-racism policy forward and bridge long standing divisions…” but “at their worst, the declarations poison or sedate grassroots momentum towards anti-racism structural change by delivering politicians unearned publicity and slowing progress on health equity.” - Lilliann Paine, Director of the Wisconsin Public Health Association

In Milwaukee and other communities, the fact that there was such a race-conscious approach to policy and an understanding that data should be disaggregated by race meant that their response to COVID-19 was very quick to identify and respond to disparities in race. The important components of RAPHC initiatives include specific action steps and accountability mechanisms, meaningful community input, and adequate funding.

did you

know?

RAPHC initiatives that operate as public-private partnerships are the exception, not the norm, and present challenges to implementation due to the complexity of collective impact work.

RAPHC initiatives risk creating harm if they provide cover for politicians without meaningfully addressing structural issues.

RAPHC efforts that build a race-conscious approach to all policies will help communities respond quickly to disparities in emergent issues, as occurred with COVID-19 in Milwaukee.

NOW THAT YOU KNOW Emphasize community engagement, such as strengthening partnerships between organizations to address racism.

Include detailed action steps, meaningful community input, and adequate funding successful RAPHC initiatives

Focus on data and accountability, like developing methods for collecting data and disaggregating it by race, as well as creating racial equity action plans

PUBLIC HEALTH

& racism

"What does it mean for racism to be a public health crisis?"

Public health aims to prevent disease and promote wellness rather than the diagnosis and treatment of diseases. Prevention refers to the various efforts individuals, local and state governments can pursue to reduce social determinant of health (SDOH) related illness and disease. SDOH are the conditions that have a significant influence on people's health and quality of life, and include a range of social and physical variables that contextualize the reality of a population’s health outcomes. They include but are not limited to language and literacy, social cohesion, employment, and crime and violence. Racism is both one of the social determinants, and a structural inequity that prepares the conditions for all other social determinants.

"How can a public health framework eliminate racism" Public health frameworks can address racism by permitting municipalities to influence legislative change and population health outcomes by promoting health literacy and tiered prevention models. Health literacy refers to the personal, cognitive and social skills which determine the ability of individuals to gain access to, understand, and use information to promote and maintain good health. Health and social interventions should be relevant to how racism interacts with the SDOH in communities of color. Emphasis must be given to more personal forms of communication, and community-based educational outreach, as well as the political content of health education, focused on better equipping people to overcome structural barriers to health. Health literacy is concerned with improving individual and community capacity to act independently with knowledge and influence the social norms that lead to negative health outcomes.

"What does this mean for cleveland's raphc coalition?"

The RAPHC coalition can address racism as a public health crisis by identifying opportunities for collective interventions. All of which require intersectoral cooperation involving medical institutions, government agencies, and nonprofit organizations. Social, economic, and political interventions are paramount for the success of bringing about changes that prevent or reduce environmentally-related illness and health.

1. Create tailored relevant channels of communication (social media promoted digital dashboards, information leaflets, public service announcements) raising awareness of the relationship between racism and the social determinants of health

2.Invite community members of color to lead interactive dialogues about their health. Refrain from relying on traditional community organizations to complete outreach and remember to do with not “for.”

3.Assess the RAPHC coalition’s potential impacts to the public health of Cleveland’s communities of color using a Health Impact Assessment.

actionable insights

for Cleveland

Resources

Collective Impact John Kania and Mark Kramer (2011). “Collective Impact,” Stanford Social Innovation Review, https://ssir.org/articles/entry/collective_impact Paula A. Braveman et. al (2022). “Systemic And Structural Racism: Definitions, Examples, Health Damages, And Approaches To Dismantling,” 10.1377/hlthaff.2021.01394 Health Affairs 41, NO. 2 (2022): 171–178 Paul Schmitz (2021). “10 Dangers to Collective Impact,” Stanford Social Innovation Review, https://ssir.org/articles/entry/10_dangers_to_collective_impact# Rosabeth Moss Kanter and Tuna Cem Hayirli (2022). “Creating High-Impact Coalitions,” Harvard Business Review, https://hbr.org/2022/03/creating-high-impact-coalitions West Side United (2021). “Community Impact Report,” https://westsideunited.org/wpcontent/uploads/2021/06/WSU-Impact-Report-2021.pdf Collective Impact Forum (2022). “Readiness Assessment,” https://collectiveimpactforum.org/wpcontent/uploads/2022/02/CI_Readiness_Assessment_Jan_7_2014.pdf ThirdSpace Action Lab (2022). “Draft RAPHC Logic Model,” https://docs.google.com/presentation/d/1J_WTBTPgdrowwCuvDWaM_FPzj17kI-P0VneHfI5elcw/edit? usp=sharing International Association for Public Participation (2018). “IAP2 Spectrum of Public Participation,” IAP², https://cdn.ymaws.com/www.iap2.org/resource/resmgr/pillars/Spectrum_8.5x11_Print.pdf

Peer city models for raphc American Public Health Association (2021). “Analysis: declarations of racism as a public health crisis,” https://www.apha.org/-/media/Files/PDF/topics/racism/Racism_Declarations_Analysis.ashx Harvard T.H. Chan School of Public Health (2020). “Why declaring racism a public health crisis matters,” https://www.hsph.harvard.edu/news/hsph-in-the-news/racism-public-healthcrisis-bassett/ Dr. Jeannette Kowalik, personal interview, April 22, 2022; Lilliann Paine, personal interview, April 26, 2022.

Paine L, de la Rocha P, Eyssallenne AP, Andrews CA, Loo L, Jones CP, Collins AM and Morse M (2021). “Declaring Racism a Public Health Crisis in the United States: Cure, Poison, or Both?,” https://www.readcube.com/articles/10.3389/fpubh.2021.676784

Social Determinants of Health Office Disease Prevention and Health Promotion (2020) “Social Determinants of Health,” https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health Mark Rastetter. (2021). “How racism is a structural and social determinant of health,” The Ohio State University Wexner Medical Center. https://wexnermedical.osu.edu/blog/racism-isa-social-determinant-of-health Don Nutbeam. (2006). “Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century,” Health Promotion International, https://doi.org/10.1093/heapro/15.3.259 Brian L. Cole and Jonathan E. Fielding. (2007). “Health Impact Assessment: A Tool to Help Policy Makers Understand Health Beyond Health Care,” Annual Review of Public Health. https://www.annualreviews.org/doi/pdf/10.1146/annurev.publhealth.28.083006.131942

Prepared by ThirdSpace Action Lab Image: Center for Disease Control + Prevention