Racial Equity in Public Policy
Those who advised in the development of this guide imagined the following responses to the messages. You can use the answers below to help bring the conversation back to the need for targeting policies where the need is greatest, especially in communities experiencing structural racism.
And/or “What about people with low incomes who are white and also struggling?” Or “We are all struggling right now as we face the COVID-19 pandemic.”
Response: “We need to do a better job for all people who don’t have what they need to reach their best health and well-being, and we’re working on that, too. But with this policy we have to focus on the needs of (insert specific community) because of the disproportionate impact that policies (and/or structural racism) have on the community, as evidenced by (insert health outcome you are trying to address).”
Response: “Many of us are struggling right now. The reality is that we may all be weathering the same storm, but the boats we are in—and the tools we have to fix those boats—are dramatically different.  Communities experiencing structural racism have, for generations, received less investment and less opportunity for social, economic and financial security and advancement. (Offer an example from your area.) We need to prioritize action in those communities, then expand.”
The link between racism and health has been documented over time and now stares us squarely in the face.
The COVID-19 pandemic provides a stark example; there is overwhelming evidence that some racial and ethnic communities are being disproportionately affected due to structural issues that put people at greater risk. This includes working in frontline jobs that don’t offer time off, living in more dense conditions, exposure to higher levels of air pollution, barriers to health care access, lack of insurance and more.
Across income levels, there are racial differences in health outcomes. One of the most stark examples is in pregnancy: Black women with a graduate education are still at higher risk for maternal mortality than white women with high school educations. This is often the result of persistent discrimination and unequal treatment, which causes stress and limits opportunity.
And/or "I believe everyone should get equal treatment.”
Response: “Some communities have faced structural racism through disinvestment and a lack of opportunities for generations. This has led to disparities in health such as (insert a statistic about health disparity related to your policy). Eliminating oppression and reversing negative health outcomes requires that we invest where we haven’t invested before.”
Response: “Not every community is starting from the same place; the barriers that each community faces are unique. Therefore, when every community is given the same solution (or level of investment), we run the risk of not meeting the needs of the people who need the solution the most—once again creating unequal outcomes. Not only does this not solve the issue at hand, it’s an inefficient way to apply the policy. For example (share an example about how the policy you’re discussing, if applied in a blanket way, would continue to leave some communities behind). That’s why we are asking you to prioritize this policy where the need is greatest, and shape the solution with the community. If we get this right where the need is greatest, we’re likely to have a solution that could work in other places, too.”
Response: “By focusing policies where the need is greatest (in places that are experiencing worse health outcomes and/or places that have had less attention/investment and/or places that are experiencing structural racism, as shown by concrete data and evidence) we can ensure that people have what they need. Then, we can expand the policy to benefit everyone.”
And/or “Adding this language into this policy does not apply to me.”
Here it is important to walk into the conversation equipped with data on the population you’re advocating with.
Response: Although (insert specific community) may not be visible to you, there are (insert population size of specific community) living in (insert location). Because this population is so often invisible, being considered in this policy is especially important to address the health challenges reflected in their community.
If you’re in a rural area you might share the following, as applicable:
About 21% of rural America is nonwhite, according to the Pew Research Center. In some rural counties, people of color are the majority, such as Black people in the Southeast, Latinos in the Southwest and American Indians in the Great Plains.
Some rural parts of the country have growing populations of people of color. In the rural West, 203 of 278 counties have grown in population since 1980. All the population growth in 39 of the 203 growing counties was from people of color.
Fifty-four percent of American Indian and Alaska Native peoples live in rural and small-town areas, and 68 percent live on or near their tribal homelands. Understand which tribal nations are located in your area (see National Congress of American Indians for a directory).
Response: “It may be appealing to adopt a more general policy now with the intention of working on racial equity later. But we’ve found that it’s much harder to build specifics into a policy after the fact, and those changes tend to be easier to dismiss or delete than direct policy language. Let’s take the extra step to secure this language now, so this policy does what we intend it to do.”
You might add: “Taking a strong stand now may lead to more support/make you a champion/help build the legacy you’re pursuing.”
And/or "We don't have an adequate sample size, we can’t take the time for the inclusive process communities are asking for etc."
Response: “This is an opportunity. It may not be simple but it is doable and it can make our policies so much more effective. Our coalition has relationships in (the community) and can help organize some community conversations to learn how residents are experiencing (the problem) and how they propose we use policy to address it. "
Response: “I know we are asking for this policy to be crafted differently than the way we usually work. The system we have isn’t working for everyone, and it’s time to rebuild it. What could we try differently this time to move in the right direction? What will it take to make this possible?”
Response: “We cannot continue to make communities invisible. We have an obligation to address the needs of all your constituents, no matter the size of the community. If we don’t have the ideal process or data, let’s at least get a start by doing (propose a first step).”
And/or “This is about personal behavior and the choices people make, not policies.”
Response: “A growing number of communities encounter barriers to opportunity that cannot be overcome through hard work or perseverance alone. In many instances, it isn’t just one barrier people face, but many—and these barriers have been in place for generations.”
Response: "Today we live in tough times. Despite playing by the rules, far too many of us are struggling to find work and make ends meet. It hurts to lose a home or job—whether we are white or Black, a single parent or a two-parent family.”
Response: “The choices we make depend upon the resources we have available to us. Limited resources lead to limited choices. Most of the things that determine our health are far beyond individual control. For example, (use the evidence points included in the messages and point to specific, localized examples of existing policies that restrict options, such as limited access to parks or fresh food). These conditions are shaped by policies.”
It is critical to have people from the communities experiencing structural racism accompany you to meetings with decision-makers. If you hear this perspective, together you might respond like this:
Response: “Could we explore that further together? Do you know why it didn’t work? Was the community part of designing the policy/program/action or evaluating how it worked? What insights did they have about what could be changed to increase use?”
Response: “We’ve been working with our community to explore the problem and design a solution the community wants. Here are some details …”
Response: “There are many examples of how addressing the immediate need can have a positive impact on the underlying cause. For example, (offer examples of improvements leading to more pride in the area, boosting school outcomes, etc.).”
-  Based on a quote by Damien Barr, https://www.damianbarr.com/latest/https/we-are-not-all-in-the-same-boat.
-  New York City Department of Health and Mental Hygiene, “Severe Maternal Morbidity in New York City, 2008–2012,” (2016), http://www1.nyc.gov/assets/doh/downloads/pdf/data/maternal-morbidity-report-08-12.pdf.
-  Kanetha B. Wilson, Roland J. Thorpe, Jr, and Thomas A. LaVeist, “Dollar for Dollar: Racial and Ethnic Inequalities in Health and Health-Related Outcomes Among Persons with very High Income,” Science Direct, Preventive Medicine 96 (March 2017): 149-153, https://www.sciencedirect.com/science/article/abs/pii/S0091743516302444?via%3Dihub.
-  Kim Parker, Juliana Menasce Horowitz, Anna Brown, et al., “Demographic and Economic Trends in Urban, Suburban and Rural Communities, (May 2018), Pew Research Center, Social and Demographic Trends, http://pewsocialtrends.org/2018/05/22/demographic-and-economic-trends-in-urban-suburban-and-rural-communities/.
-  Olugbenga Ajilore and Zoe Willingham, “Redefining Rural America,” Center for American Progress (July 2019). http://www.americanprogress.org/issues/economy/reports/2019/07/17/471877/redefining-rural-america/.
-  Kelly Pohl, “Minority Populations Driving County Growth in the Rural West,” Headwater Economics (August 2017), https://headwaterseconomics.org/economic-development/minority-populations-driving-county-growth/.
-  Sarah Dewees and Benjamin Marks, Research note: “Twice Invisible: Understanding Rural Native America,” First Nations Development Institute (April 2017), http://www.usetinc.org/wp-content/uploads/bvenuti/WWS/2017/May%202017/May%208/Twice%20Invisible%20-%20Research%20Note.pdf.
-  Brian Smedley and Loren Siegel, “American Opportunity: A Communications Toolkit,” The Opportunity Agenda (2009). https://www.scribd.com/document/36969975/American-Opportunity.
-  Jessica Kang, “Let’s Talk About Race: How Racially Explicit Messages Can Advance Equity,” Center for Social Inclusion (2015) 56, https://www.centerforsocialinclusion.org/wp-content/uploads/2015/08/Lets-Talk-About-Race-1.pdf.