Addressing structurally racist policies is key to promoting health equity in Michigan, experts say

Addressing the social determinants of health (SDOH) is an important step in addressing racism as a public health challenge, according to health equity experts in Michigan. But, it is also about the dismantling of unwritten social structures affecting health. 

At our 2022 Michigan State of Reform Health Policy Conference, three experts discussed the challenge racism poses, how racism continues to affect the health of underserved communities, and how addressing SDOH and social structures can assist these communities. 

 

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Speaking on the panel were Debbie Edokpolo, Director of Health Equity and Social Justice at the Michigan Primary Care Association, Eric Doeh, President and CEO of Detroit Wayne Integrated Health Network (DWIHN), and Jan Delatorre, Program Officer of Nutrition and Healthy Lifestyles at the Michigan Health Endowment Fund. 

Edokpolo and Doeh said people often think of overt racism when describing the effects of racism on health, but people don’t often understand the structural impacts of racist policies. 

“Systemic and structural racism can be more destructive,” Edokpolo said. “Oftentimes, it has longer consequences on one’s health.”

These structurally racist policies and practices—relating to housing lines, food deserts, and access to local health care—contribute directly to the health and wellbeing of underserved Michiganders and Americans, the panelists said. 

“Racism endangers the health and wellbeing of people of color and other marginalized groups and communities,” Edokpolo said. “Racism takes a direct toll on people of color, causing unhealthy stress levels, feelings of powerlessness, and countless other negative impacts. A system that assigns values to individuals based on their race puts marginalized groups at a disadvantage for the structural opportunities that support health.”

For example, Edokpolo said there are more liquor stores in African American communities and less banks and investment firms. Delatorre said agricultural subsidies and lobbying cause unhealthy food to be sold at cheaper prices than healthier, locally grown foods. These unhealthy foods are in turn sold at local grocery stores in Michigan that are frequented by underserved communities. 

Doeh described the importance of recognizing access to health care as a major racial disparity affecting health outcomes. He highlighted the lack of access to transportation as an example.

“When transportation is a barrier for folks, you may have this huge building that has all of the state of the art [equipment and models], but people can’t get to it,” Doeh said. “When people don’t have access to those services, you start to see which communities [this is mainly affecting], and oftentimes, it is in impoverished communities.”

For example, COVID-19 hit Wayne County especially hard compared to the rest of Michigan. Doeh recalled people asking why that was, but he said this wasn’t new. He pointed to impoverished communities in Wayne County who don’t have reliable access to health care, time off of work to recover from infection, and the means to afford treatment.  

The panelists also described the importance of implementing SDOH and health equity-focused positions at health organizations. Delatorre said organizations around Michigan are starting to incorporate this lens internally, which is affecting the work they do externally. 

Doeh said DEI positions are important because they bring everyone to the table to have conversations on these issues and how they affect underprivileged communities. 

The panelists then discussed the project and programs to advance health equity and address SDOH. Doeh said DWIHN is partnering with community health centers and leaders to meet people where they are and promote outreach to get people to the services they need. 

Delatorre said the health fund allocates money to projects from health organizations around the state to address SDOH concerns. Delatorre specifically funds efforts to create a more “health-focused food system” in underserved areas. 

“It’s about funding strategies that make sure that neighborhoods are safe, organizing people to have effective transportation plans, and ensuring that local public health is part of that conversation in creating coalitions with people,” Delatorre said.