Race, Religion and Healing in American Healthcare
February 19, 2021
Can interfaith leadership foster greater equity for the health of communities of color? Four leaders in healthcare, Janice D’souza, Shaunesse’ Jacobs, Kamilah A. Pickett, and Dr. Kimberly Arnold came together to discuss racial health disparities in our nation and how interfaith leadership can be implemented in order to solve these disparities. A recurring point in the conversation was that disparities cannot be solved without a community-centered approach first and foremost. If interfaith institutions desire to be a part of the solution, it is imperative that they recognize Black and brown communities at the heart of American healthcare inequalities have a voice.
12:53 “I like thinking of interfaith leadership also as physical assets and resources and I feel that’s missing from the conversation sometimes too.” -Janice D’Souza
20:25 “Often times in healthcare spaces, patients’ voices are excluded completely, because there is this diagnostic approach that says ‘Western healthcare knows what’s best for you so we’re going to do it to you diagnostically’…so when we think about restorative healing, I second very much dialogue, What does it mean to have a patient-centered approach? What does it mean to have a person-centered approach? Which then, expands to a community-centered approach, where the needs of these people and these communities are actually at the forefront.” -Shaunesse’ Jacobs
32:15 “It takes a rethinking of how we have conversations. That means that faith communities have to have really hard conversations about how they operate and take really hard looks at their processes and who they’re reaching…so it takes those really hard conversations about how our institutions are just structured and what they feel their responsibility is and how they best do that. Like Kimberly said, it can’t be them deciding what interventions are best, it can’t be a religious institution taking funds from the government to do outreach if that’s not what the folks in that community have not decided they’re necessarily cool with, right?” -Kamilah A. Pickett
38:49 “We have not moved the needle when it comes to health disparities because there has been a lack of cross-sector collaboration, interfaith collaboration, just a lack of collaboration in general. There have been some examples and there are examples of successful collaborations to address disparities, but it hasn’t been widespread enough for us to actually see meaningful change and meaningful outcomes as it relates to health disparities and actually trying to achieve health equity.” -Dr. Kimberly Arnold
>>BECCA HARTMAN-PICKERILL: I am now particularly thrilled to introduce Janice D’Souza, the moderator of today’s conversation. And a note to Janice and to all of our speakers, these are people working at the intersection of racial equity, interfaith leadership, health and healthcare, health in communities. We know that now, and this last year, and all of your working lives, but especially now has been a profound time of the need for your work. We are really grateful that in the midst of it all you have taken one hour out for this conversation. You will see Janice and all of the speakers’ bios in the chat box shortly but let me introduce Janice before I hand things over to her.
Janice D’Souza is a policy and qualitative researcher with a focus on sexual reproductive health and religion. She’s an Evaluation Coordinator with the New York City Department of Health. Her prior experience includes conducting policy reviews at the CDC, training abortion refers in Kentucky and across Appalachia, as well as conducting field research for Mahindra’s CSR Girls Education Project. She has a Master of Public Health from Emory University and a BA from Berea College. Janice, we are so proud, is an alumni of IFYC. I will turn things over to you.
>>JANICE D’SOUZA: Thank you so much, Becca. We have a great group of panelists here. I would like them to introduce themselves. Kamilah, would you like to go first?
>>KAMILAH PICKETT: Good afternoon. My name is Kamilah Pickett. I’m a public health practitioner, lawyer, artist, writer, abolitionist, and a racial equity trainer. My work focuses on the intersections of race, justice, and health, and is most pointedly concerned with getting folks free. I do work with incarcerated Muslims to provide bail relief, and I make sure I help organizations craft policy that is focused not only on folks’ physical and mental well-being, but also their social well-being.
>>JANICE D’SOUZA: So exciting. Let’s go, Kimberly.
>>KIMBERLY ARNOLD: Good afternoon, everyone. My name is Doctor Kimberly Arnold, I’m a Postdoctoral Fellow at mental health at the department of psychiatry at the University of Pennsylvania, Perelman School of Medicine in Philadelphia. I am also a board member of the Black Church Food Security Network which seeks to dismantle racism in the food system through the creation of a system anchored by Black churches in partnership with Black farmers. My work focuses on the intersections of race, religion, health equity, and social justice.
>>JANICE D’SOUZA: Okay. Shaunessee’.
>>SHAUNESSE’ JACOBS: Hi everyone. My name is Shaunessee’ Jacobs. I’m a third-year PhD student at Boston University School of Theology focused on theology and ethics. My research looks at how Black working communities use religious practices to make sense of the injustices in the healthcare system. I am most specifically engaged in holding churches accountable to actually being on the ground to be activists for Black working communities.
>>JANICE D’SOUZA: Thank you, everyone. This is such a great group of people. I am excited to learn from you all.
One of the questions that kept coming up when I saw the title was how can interfaith leadership foster greater equity for the health of communities of color? For me, interfaith leadership is building across deep difference, looking for points of connection and commonality.
When we think about that, what comes up for you? We can start with whoever is open to sharing.
>>KAMILAH PICKETT: I will go first. When we were talking about the topic, my initial reaction was, I am not an interfaith leader. I don’t have a particular position in the clergy. I don’t minister to a population in any sort of way. But I am often in spaces where I am the sole representative of people who sit at my particular intersection of being Black and Muslim.
And so, if we are asking if interfaith leadership can foster greater equity, I would say, insofar as you assume most folks are connected to a faith community, yes. But if faith leaders are looking beyond the confines of their particular community, absolutely yes. I am Muslim. My faith practice is one of liberation theology. While being Muslim is an individual decision, and it is an individual relationship that I have with my creator, being a Muslim means I am part of a community.
I believe my actions are weighed as an individual of how I comport myself and how I do things my faith asks of me. Some of those things are my actions towards others, right? It doesn’t stop at sort of individual… deeds. I am responsible to a community of folks, and not just folks who worship as I do, but anybody that’s around me.
There is kind of a saying that you can’t be well if your neighbor is unwell. There is no indication of who that neighbor might be. They don’t have to look the same. They don’t have to pray the same. Just their proximity to me means I have some level of responsibility over them.
And so, I think of it in those terms. What I may want for my particular community, what well, happy, healthy, and whole looks like for me, might be different for other folks. But, at a very basic level, we are all here together. We have a responsibility to each other to make sure the things that we do bode well for the least of us. That if the very least of us is good, we are probably all good. And so, I think that takes some cross communication. That takes people actually talking to each other outside of their differences, and making those connections where they can, to make sure that everybody is good. Even if people aren’t connected to a particular faith community, or if they are, but they are unchurched or not in mosques, that they don’t get left out. That is something I don’t think we talk about enough. I just told you I’m not an interfaith leader, and now I’m putting myself smack in the middle of the conversation, but I don’t think interfaith spaces talk about that enough, people who are not connected to a particular congregation, and the work that needs to be done in order to make sure those folks are well.
So, yeah. I think probably yes and no.
>>JANICE D’SOUZA: This is exciting. Thank you so much, Kamilah.
Kimberly, what are your thoughts?
>>KIMBERLY ARNOLD: I have a lot of similar thoughts as Kamilah. First, I predominantly work with Christian churches, but as I was thinking more about my experiences, not only as a researcher, but just in my personal life, I thought of other types of spiritual systems that we sometimes don’t think about or talk about that are outside of the predominant denominations and religions that people are more familiar with.
In my case, I went through a Rights of Passage program when I was doing my PhD, and that gave me the opportunity to gain more exposure to traditional African spiritual systems, and how there are a lot of assets that exist within these traditional systems that are connected to my ancestors. A lot of practices that we did, and a lot of rituals that we did during that process, are relative to things that we do even outside the context of religion. Even when it comes to health, for instance, going into the Rights of Passage, I didn’t think health was really going to be a major component, but it was. It was throughout the entire experience. The focus was not only on spirituality, but my health as well.
It brought me to a place of thinking more of what holistic healing is, and also the ways in which we can exchange this knowledge and information across different faiths. At the end of the day, we have similar goals. Even when Kamilah mentioned having the liberation theology perspective, that is the same perspective that we have within the church I attend, the Pleasant Hill Baptist Church, where we practice and study Black liberation theology as well as Black Christian nationalism. We really have the focus not only on social justice and spirituality, but also the health and well-being of not only our members, but community members as well.
I think another thing that’s important to point out is that places of worship are located in almost every community that you can think of. I have had the opportunity to live in different places. I’m originally from South Carolina, a very rural town. I grew up on a small farm, but there was a church located in my community. When I moved to Philadelphia for the first time to pursue my master’s in public health, I actually started working with Black churches across the city and implemented different interventions that were focused on diabetes prevention, obesity prevention, and other chronic diseases.
I noticed in these various places of worship, regardless of what denomination it was, there is a church in almost every neighborhood. Once I returned back to South Carolina to work at the prevention research Center at University of South Carolina, I was working with a program called fate, activity, and nutrition. Again, I had the opportunity to travel to some parts of the state that I had never been to before. I noticed even in places where there wasn’t a grocery store there was a church. And so, the presence of God being in different communities that sometimes think maybe they don’t have a lot resources, there are a lot of resources. I really think that by taking a more asset-based approach and really thinking across different faiths we all have assets.
We have not only people who have different talents and skills within our places of worship, we also have space, money, land in many cases. And so, there are lots of assets we can leverage, especially assets as it relates to improving health. We can leverage those assets across different faiths and really come together and think about those commonalities that we have, and especially addressing common issues, such as health disparities, or social injustices. We have the people, the skills, as well as the resources to really address these issues.
>>JANICE D’SOUZA: That’s really interesting. I like thinking of interfaith leadership is also physical assets and resources. I think that is missing from the conversation sometimes, too.
Shaunessee’, what do you have to say?
>>SHAUNESSE’ JACOBS: Thank you very much, Janice. I am agreeing with Kamilah and Kimberly as well. I would never consider myself an interfaith person and I feel I have all these different interests and then people put a title on me and Oh, Ok, that works. Sure. I am doing this work. It makes sense that the answer could be yes. So, to answer the question of whether or not interfaith leadership can foster greater equity for communities of color, absolutely.
I think one of the fascinating things I have seen in my work is in healthcare settings, or within communities, is that people come together because they are desiring to achieve justice, especially around health equity. They are concerned with making sure people get proper care. They are concerned with making sure public health infrastructure is in place so communities can thrive, and then it just so happens they also bring their religious identities to those conversations.
When we are engaging in these conversations, religion isn’t the first thing that happens to come up. I am a Doula, or a PhD student, or health advocate, or public health official, and I also attend this place of worship, or I also believe these things. That theological framework informs the way I go about justice, and the way I go about justice happens to be sitting in the space with you all so we can collaboratively think of ways to bring our communities into the room because they have been left out many times.
If we want to look at the ways that religion is in that room, we will see interfaith leadership is happening, but our faith informs the way we go about justice, and I think that is no different for me. Getting to sit in these rooms with people, to listen to the work they are doing, and see the ways they represent their communities, who are often excluded from the conversations, means that a liberation theological perspective is being used to see how we can achieve equity.
>>JANICE D’SOUZA: That is so interesting. Something else I thought of when I was looking at the title is restorative healing. I know a lot of our participants have had a lot of thought about it, too. I would love to know what is restorative healing for you all, and where you see that kind of healing in your work right now?
Let’s let Kamilah start.
>>KAMILAH PICKETT: I’ll start. I want to say one quick thing to follow up on Shaunessee’s point. I actually do wear my faith quite in-your-face. You know that I’m Muslim when you look at me because of how I choose to dress. I don’t have the option of not bringing it into spaces with me. Even if I am not there to do that, other people would often try to do that for me. They usually get it wrong, but they try anyway.
Part of me being in spaces sometimes is pushing back on notions that people have about what they expect of me, or what they expect of people that they assume sit in my space. There is that. I am thankful for all the participants for answering the question of what restorative healing might look like for them, and I will admit that to me it is one of those kind of crunchy terms people use. I think people who are practitioners of it have a really well-rounded idea of what it is, and other people not so much.
I think of it in terms of restorative justice and transformative justice. To me those are about communication. Restorative healing is kind of about a dialogue because you are looking at a whole system’s sort of healing. You can’t bring any sort of effective change without having a strategy for resolving conflict, repairing harm, or building relationships. It is grounded in a sort of mindfulness approach that is nonjudgmental and is seeking to humanize both folks who have been harmed, and people who might have inflicted harm.
When you think about that, it is clearly not the approach our system in the United States or anywhere else uses. It’s not the basis of it. In terms of healthcare, and health equity, it’s about the dialogue, and figuring out where harm has occurred. For me, also realizing that everybody has the… everybody can harm and be harmed, and those things are not necessarily separate. You can inflict harm and be harmed all at the same time and carry both of those things.
In order for us to really get at the heart of how our healthcare system is set up, and make sure it is transforming the way that it approaches illness, requires conversation, honest conversation. That has to happen between folks who have been harmed, and people who inflict that harm. Those are not conversations we are used to having in this country in any context. If that were the case, we wouldn’t be having this conversation.
It really comes down to an individual level of practitioners, and what they are going to do with the people who come to them for healing. What type of conversations are you going to have to make sure you are getting to the root of why somebody is ill? What things are you going to recommend so you’re not taking them out of the context of their family or community when you talk about how to restore anything that has been taken away from them?
That is the context that I use when thinking about this.
>>JANICE D’SOUZA: That’s good. For now, let’s just talk about what does even restorative healing mean for us.
>>SHAUNESSE’ JACOBS: I agree with Kamilah. Depending on who is using the term it can be very iffy or full of depth. I approach this conversation as a Bioethicist. I feel like I’m Public Health adjacent and that I’m a Public Health advocate but trained very much in bioethics. Thinking about these conversations of harm and beneficence, there are four consequences of bioethics, justice, autonomy, non-maleficence and beneficence, because we are trying to do the most good, the least amount of harm, but centered patient needs.
When I come into the conversation, I’m often focused on any sort of patient-centered approach. When I think about the communities in which I’m engaging, whether that is Black working communities or Asian communities to figure out how we can come together to reduce anti-Asian violence, their voices need to be heard. Oftentimes, within healthcare systems, patient voices are excluded completely because there is this parentalist approach that says, Western healthcare knows what’s best for you, so we are going to kind of do it diagnostically. There are no preventative measures or aspect of holistic healing, and I’m being overly simplistic here, because those things do exist, but more often than not, people don’t feel that this is the care that they’re given. So, when we think about restorative healing… dialogue, what does it mean to have a patient-centered approach? What does it mean to have a person-centered approach, which expands to a community-centered approach where the needs of these people in these communities are actually…? We are understanding what the real issues are. We are understanding what resources are actually needed and understanding how to implement those sources in a way where the communities feel their needs are being met. Myself, as a researcher, or as a student, I am not just asking a question and using someone as a case study as has often happened within the history of U.S. healthcare to say, great, I got what I needed, and you probably won’t be able to have access to these resources for another 50 years. I very much agree that patient and community voice has to be centered in order for any sort of restoration to be made.
>>KIMBERLY ARNOLD: I agree with what has been said so far. I think that is one of the issues I have just noticed along the years of working in the field of public health. There are so many people that want to do the “right thing.” They want to do well and good, but the way they go about doing it is not an asset-based way or a way that honors cultural traditions and practices. Sometimes it’s straight up like a paternalistic approach, just saying, I have the answers to your problems, and I have the answers for how you should heal, but we really need to flip that paradigm.
I know that in many cases approaches such as community based participatory research are used where promoted, but it shouldn’t be that the community is participating. The community should be leading these efforts, and really be seen as equal partners in addressing issues that they have identified as problems, and not necessarily researchers or scientists, or policymakers, or whoever else, coming in and saying, I know what your problem is, and I have the answer to fix it.
We really have to take the approach of taking the step back and really focusing on relationship building, which does not happen a lot in the space of healthcare or within the space of Public Health. It’s really important for us if we are going to move to a place restorative healing that we really have to take that approach and really focus on relationships and really listening, and not just doing it as a checkbox saying, okay, we had a couple community conversations, and we are still going to proceed with doing what we want to do.
For me, restorative healing really is about taking the trauma-informed and holistic approach at multiple levels to really address the harms that have been done, and to also take the approach of understanding that health is not in a vacuum and there are so many different factors that influence health. If we are going to heal, we have to think of all of those different elements and factors that contribute to health disparities, and adverse health outcomes, that are disproportionately experienced by people of color.
Another thing I just wanted to mention in terms of the work that I do, not only with the Black Church Food Security Network, but within my research, I’m really having that multilevel approach because we can’t also just only focus on the individual because the individual, again, is not in a vacuum. We live inside of families. We live in communities. We have multiple communities that we are part of. So really acknowledging that intersection of those various identities and communities in which we live, and in which we operate in, and also thinking about even other levels outside of the individual, the community, but also at the policy level as well, because policies create a lot of these issues. There are ways that we can now undo some of those policies and pass new policies that are more equitable in the criminal justice, not only for various races that have been done wrong before, but also for different socioeconomic statuses, diverse religions, etc.
One of the things, especially when it comes to different faith communities as it relates to restorative healing from my perspective of being a Black woman, a Black Christian woman, some of the things that we do is we provide health education like in collaboration with various community members. Addressing social determinants of health. When it comes to food, for instance, everyone has to eat. That is why one of our main goals for the Black Church Food Security Network is to connect Black churches with Black farmers, and really build upon those assets that we have within our own community to address food insecurity and food apartheid.
And then when it comes to even delivering health prevention and promotion programs, these programs should be chosen and selected by community members who are experiencing these conditions. That was one of the things I used to go through a lot when I was starting out in my career and I didn’t really know a whole lot about the ways that we should go about delivering interventions. Again, it shouldn’t be like I’m coming to you saying, I have this intervention that’s going to be beneficial. It should first start out with the relationship building and seeing you may already be doing something to address these issues. Many times, that is the case, in which communities are already doing something to address problems that they have identified.
Sometimes when outsiders are coming in, it makes it seem as the communities aren’t doing anything, and that is not the case at all. That does take the relationship building step as well as working together to figure out what are the assets, and then what are the gaps, and how can we work together to fill in those gaps.
>>JANICE D’SOUZA: Thank you for starting the conversation of what restorative healing looks like in your work, Kimberly. Kamilah and Shaunessee’, how do you see that playing out in what you do?
>>KAMILAH PICKETT: I think I want to take a step or two back and say something that… I would not be me if I didn’t say. I have been on both sides of Health Policy. I have been a person who has helped write it. I have been a person to help implement it. Obviously, I have been a person who has borne the effects of policy written way before I was born.
What I notice is that a lot of policy directed towards Black communities, other communities of color, policymakers tend to focus on the thing that worked. Like the big thing that worked. And so, 60 years ago it was the Black church for Black folks. That was the hub of the community. That is where all programs funneled through at some point or another, whether it was a food program, vaccines, any public health intervention you can think of that has been targeted to Black people has run through Black churches.
What I will say is this. It is 2021, and that model no longer works, because Black people are not just Christian. They’re Muslim, they’re Jewish, they are all manner of faith and no faith. And so, if your model of addressing health inequities centers on running through one model, you’re going to fail, because you are not going to reach everybody.
While I take Kimberly’s point that a church in every community may be a sign of people’s relationship of God and a good thing, and I’m not saying it’s a bad thing… If there are churches in communities and no grocery stores, that is not good. That’s not a good thing. That means that, at some point, people had to decide between the building fund and food, and they chose the building fund, right? Or that means that, at some point, things that were supposed to be funneled directly to people didn’t get there.
Those are reasons why people pull back from institutions. It happens where people go for help. They don’t get the help that they need, or they don’t get enough of it, and they look at it not as a public health intervention failing, but as a failing of the religious institution in and of itself.
So, then they separate themselves from it. It’s hard to convince people that, you know, what you are doing is research-based, that it may close racial equity gaps, that it may be good for them. Like Kimberly mentioned, it’s hard to convince people of stuff if you have not made those bonds with them, but it’s even harder to convince them if you have done it once and failed. It’s harder to come back the second time and say, this thing is definitely going to be the one that works.
And so, people end up siloing their issues and concerns. They go to church, to be in that place for their spiritual well-being, and they look somewhere else for everything else. That’s fine if that’s what people want to do, but that’s not liberation theology. That is not making sure that you are taking care of your whole community, and that is not where equity conversations are going to happen, or where racial equity gaps are going to be closed.
It takes a rethinking of how we have conversations. That means that faith communities have to have really hard conversations about how they operate. And take really hard looks at their internal processes and who they are reaching.
I am in Atlanta. This is the home of the big church. This is what we do. We do big churches. We do big spaces that are really beautiful architecturally, and they have amenities that people love, but folks are still hungry. Folks still don’t have healthcare. It still takes these institutions a while to reach as many people as they could. And it’s not indicative of everybody.
I wouldn’t be me if I didn’t point out that that happens more often than you’d like to admit. That is a hurdle to true equity. If you’re going to have restorative healing, you have to have these internal conversations. I don’t think a lot of communities are set up to do that. They’re not set up to challenge folks that you have imbued with some sort of safeguarding of your spiritual well-being. We are not socialized to do that necessarily. And so, it takes those really hard conversations about how our faith institutions are structured, and what they feel their responsibility is, and how they best do that.
Like Kimberly said, it can’t be them even deciding what interventions are best. It can’t be a religious institution taking funds from the government to do outreach if the folks in that community have not decided they are cool with it. It can’t be them taking CBE money saying, we are helping the Muslim community. No, you are not. You are being part of the surveillance, but you’re not helping folks eat.
How do you balance those things? Until we have those conversations, we are always going to fall short of the type of healing and equity we need from our systems.
>>KIMBERLY ARNOLD: I definitely agree with what you said. I want to be clear that when I mentioned there are certain communities where there isn’t a grocery store there’s a church. I was mentioning that as an opportunity that there are assets that exist within the church that could be used to then create a grocery store, or in the case of the work that we do with the Black Church Food Security Network, in addition to making those connections between Black churches and Black farmers, we also have two other programs. One of them is operation higher ground, in which we work with Black churches interested in creating community gardens, or if they have a community garden, helping them to scale it up so they can grow more produce, learn more about different ways to grow different types of produce, and also storing it afterwards.
We also have the Black church supported agriculture program, where we provide the opportunity for different churches and individuals to order directly from Black farmers that are within the network, so we are distributing and circulating the Black dollar as well as providing food at an affordable rate. We also of course give away food as well.
It really comes back to the self-sufficiency and not just having the charity model because that’s not what we believe in, and that’s what has failed us. Just giving handouts saying, I’m going to come in as a nonprofit organization to determine what your needs are and just give it to you.
We really focus on skill building and capacity building, so it’s not a situation where we are just another food justice organization that’s giving away food.
We are not only providing those skills for churches, but individuals as well. Having webinars, especially during the pandemic. We have done a lot of virtual meetings and workshops and webinars teaching people how to garden even at home. We’re really focusing on some things that didn’t work in the past when it came to the Black church, and what are some of the ways we can change that moving forward so we are more focused on self-sufficiency, and not even having to depend on existing systems who have failed us time and time again.
Also, I meant to mention this earlier, when it comes to this conversation around race and restorative healing, and all of this, we cannot have these conversations without acknowledging the role that racism and white supremacy has played in creating these inequities.
And so, we have discussed already there have been a lot of failures from the healthcare system, from the public health system, from the healthcare system having the attitude or model of, let me just do something to you because I am the expert and I have answers, and then experimenting on us, excluding us from access to care, access to high-quality care, but also, on the other side, within the system of public health, there have also been these injustices when it comes to doing research studies that are unethical, and having those situations in which, again, they were taking the model of, I have an intervention I think works based off of evidence that we weren’t even part of creating, and then coming into communities and saying, I have the answers to the problems. As we can see, in most situations, when these research studies occur, it’s like, Ok, I go in, collect the data, and then I’m gone, and there’s no focus on sustainability. No focus on scalability or self-sufficiency. Those are the reasons why these interventions and programs have failed, and we have not moved the needle when it comes to health disparities because there has been a lack of prospector collaboration, lack of interfaith collaboration, lack of collaboration in general.
There have been some examples, and there are examples of successful collaboration to address disparities, but it just hasn’t been widespread enough for us to actually see meaningful change and meaningful outcomes as it relates to health disparities and actually trying to achieve health equity.
>>JANICE D’SOUZA: That is really good. I was like, what needs to happen even before restorative healing? And the conversation has to open up. How do we acknowledge all the damage that has been done? Shaunessee’, I would be interested to hear your thoughts.
>>SHAUNESSE’ JACOBS: I don’t think there is much more I can add. I think Kimberly and Kamilah both have essential points to any model for restorative healing, especially for communities of color. The only thing I can do is speak from my own work. One of the things I often see, and I am often encouraged by, is the collaboration that comes, first and foremost, from being participants in communities of color because I have seen the step back where I’m doing this only within my religious organization. I’m Baptist, so the Baptist Church, they have one seminar a year on what restorative healing may look like, and how it hopefully can be achieved… Kind of like Kamilah was saying, understand that the conversations needed weren’t happening within the church and so I went elsewhere. I’m in these grassroots organizations where people understand that across communities of color there are concerns, and we need to have conversations of why we need to come to this space to have this conversation, because our religious institutions haven’t provided the space and cultivated the skills that we needed, and so we are here now as representatives. And as representatives, we are approaching and addressing those frontline issues.
I think there are so many beautiful relationships. People get to take what they have learned, and how they want to implement it into the workforce, and then they get to be represented there as well. The biggest issue I have with that is all the burden on communities of color to still do this work, to champion and fight to say, I am a representative with this grassroots organization, or representative for my religious institution, or representative within the workspace, and back to the point of white supremacist structures, and historical disadvantages that have been placed in these communities. I still have to fight as a representative in this space.
The entire framework of restorative healing becomes often times, like we mentioned, this empty phrase to say, yeah, we did it, this is antiracist, we kind of have equity. We have a representative who leads the workshop once every three months, so it’s kind of done. I don’t know what it looks like to get larger communities on board to actually do the work. I think for a minute we were there, after the death of George Floyd followed with Breonna Taylor and Ahmaud Aubrey, because that was one of the first moments the country woke up to say, wow, this has been bad all along. Communities of color were saying, we have been living this all along, thank you for finally seeing it.
Now the responsibility isn’t on communities of color. We are still representatives to bring ourselves and our communities into these spaces, but the responsibility is on others to do the work they have the resources to do as well. So, I am agreeing with both sitting in the intersection.
>>JANICE D’SOUZA: We have about 10 minutes. Usually, at this part of the webinar, people start talking about next steps and how do we move on. Usually, I’m hesitant in these conversations because I’m like, we just started talking. We just started figuring out what is needed and how do we go to the next steps.
I would be interested to know your thoughts on next steps, what needs to happen, who the burden of restorative healing falls on, anything. Any thoughts that you have.
>>KAMILAH PICKETT: There is a question that I wanted to answer in the Q&A. Where does healthcare go to help people of color get beyond being seen as objectified recipients? I’d say everybody is objectified and recipients in the U.S. healthcare system. That is just how it’s set up. Some people clearly get the shorter end of the stick, but it was set up to objectify us all. We are all customers, payers, dollar signs. That’s how it works.
A better model, and one that would include all the things we talked about, and some semblance of restorative healing, would be one where folks could get the care that they need without regard or respect to insurance, or co-pays, where they would have access to healthcare in their neighborhoods that is culturally competent, and not by a definition of culturally competent that just says, Black people like these things. Asian people like these things. I have been on the end of Muslim women like this type of healthcare. And it has nothing to do with any experience I have had in my entire Muslim woman life.
So, we have to fundamentally change the way we think about healthcare in this country. It is not a product or commodity to be had, or negotiated with, but it is all right. We have the money to do that. We have the people to do that. It just has not been done because people who control it don’t think it makes fiscal sense. Somehow it makes more sense to have people sick than to have everybody well.
It is having conversations that change the way we talk about healthcare and what it is, and what it looks like, where it can be located, who can administer it, who can be involved.
I have done work with all ends of the age spectrum, from Medicare recipients to kids in public schools to parents trying to get their kids healthcare. In every situation, one of the biggest impediments outside of cost and access was people not knowing how to have conversations about their health. People who knew how to advocate for themselves in every other arena of life, they would get in front of a healthcare provider and just freeze up. Not know what to say. Just kind of take whatever that person gave them and either leave with something that didn’t fit, or something they couldn’t afford, or something that wasn’t practical for their life, or wasn’t what they went to the doctor for in the first place.
As public health practitioners, we know that. Study after study after study, it says Black women are not listened to when they go to the doctor. We are the last folks they want to give pain medication to. We have the highest amount of mortality across all social economic status, across education, across income. We have the lowest outcomes. It’s not because of anything intrinsically wrong with us. It’s because of the way the system operates, and the way that folks talk about healthcare, and who is a dependent, who is a drag on the system, and who deserves more.
We can even see that most pointedly in the vaccine distribution, right? Vaccines should be going to communities that are most densely packed, and that have less of an ability to socially distance or stay home from work, or to have their kids be home. Those are the people that should be getting it first. In every single major metropolitan area, those are not the people getting it first, right? It is not supposed to be dictated by income, but it very much is. It is supposed to be going to people who need it first, and that, according to the mortality rate, would be Black folks and brown folks. We are not the people getting it first.
I think that we tend to separate out conversations. And when you do that, you lose sight of the bigger picture, and the bigger picture is the system doesn’t work. One of the attempts of equity may close a particular gap but not the whole thing. It may make a momentary increase, but there’re ways for you to close gaps, or close gaps for one population and increase them for another one. It shouldn’t be this seesaw thing. It’s not a zero-sum game where if one community gets access, that means that another community doesn’t. That’s how we have been socialized to think about it, but that’s not how it actually is.
I think if we broaden the way we think about health, broaden the way we think about equity and what that means, that it’s not something that white people are giving to Black and brown folks. It is something they need to do for their health as well. Your physical health might be all right, but we are talking about faith. Your soul can’t be right if you are doing that. I think if we broaden those conversations, we’d get closer to solutions that actually work.
>>SHAUNESSE’ JACOBS: I would love to hop in on that. Thank you, Kamilah, because I was going to address that question as well. It ties into Andrew’s question as well. Absolutely. Semantics are huge in determining who gets access to healthcare, what health actually is, and how health is deployed. We absolutely have to change conversations around what health means, and how it can be holistic. It is not diagnostic at a base level.
Also, we can’t just think about healthcare as its own system. Healthcare, like everything else, is influenced by all of the systems around us that exist socially. So, if you just think of addressing health on its own, without fixing the other parts of society, it gets us nowhere because we’re still in the same place.
There is a phenomenal scholar at Howard, Doctor Byron, who does a lot of work… Just because one community is decentered, doesn’t mean the spotlight just goes on one other community. It means everybody gets a seat at the proverbial table, and because everybody gets a seat at the proverbial table versus people having to stand in a line outside the door, means the conversation gets to be more robust to actually understand what all communities need, so their needs can be at the table, and so we can discuss how to fairly and justly allocate resources so all communities needs can be met.
Back to the idea of the least of these. If we are thinking about a single-payer system, there’s ton of research that talks about the benefits of a single-payer system, and how it can change U.S. healthcare wholeheartedly. That is not what our capitalist model likes to hear, so we don’t do it. Even with the single-payer system, if we don’t fix the systemic issues at the core of our society, if we don’t talk about how one group is privileged far above all other groups, that becomes problematic, because health, like Kimberly was saying, is not in a vacuum.
We can’t think of individual or communal health in a vacuum or the healthcare system in a vacuum. You definitely cannot think about fixing this in a vacuum for to go back out into problematic society to revert to functioning as it previously did.
>>KIMBERLY ARNOLD: I definitely agree with both of you. I think that’s been a recurring problem in this nation. Any time you talk about health, the immediate thought is healthcare, and it’s two different things. Even in the training that most medical students receive, they don’t even get training in social determinants of health, they don’t get training in health disparities. Most of the time the training is only focused on there is the patient presenting XYZ symptoms, and I’m going to treat it with this medication. Half the time they’re not even prescribing holistic approaches to addressing health problems. They’re not telling you to work out or eat healthy because they’re going to get a payment from the pharmaceutical companies for recommending certain prescriptions.
My very first job was working at an internal medicine clinic when I was 15 years old and I saw this firsthand, which is why I decided not to continue with the healthcare path I was on because I was like, nobody is focusing on prevention. No one is focusing on addressing these different inequalities and inequities within education, housing, income, employment, all of these other things that are going to be related to health and are going to either promote health or cause barriers to people living healthy lifestyles.
At the end of the day, unless we do take a wider view of health and really taking a more holistic approach to addressing health, we are going to still be in the same boat. We can’t just only focus on health insurance. That is only a small fraction of the problem. Even when you really look at health problems in and of themselves, only about 20 percent of the causes of health problems are linked to genetics or individual factors. A lot of it is policy, environmental concerns, housing. A whole host of things that are outside of just looking at genetics and someone having a predisposition to something.
Yes, you can have a predisposition to diabetes, but if you have money, if you have a stable place to live, if you have food, if you know how to cook that food in a way that is healthy, if you know how to work out, all these other things can change that narrative. So, we really have to take a more holistic approach to addressing health disparities, and not just continuing to focus on the healthcare system, the healthcare system, because the healthcare system does not have all the answers. It takes the multisectoral approach to addressing these problems.
>>JANICE D’SOUZA: Thank you, everyone. Thank you for letting me sit with you as you have this conversation. This was deeply enriching.
American Civic Life
American Civic Life