Assessing Internal Perspectives Is the Absolute First Step for Healthcare Systems, Organizations, And Government Entities Seeking To Advance Health Equity
Written by Stacy Scott, Ph.D., MPA.
I am a Black woman who has spent my career in public health. Every project I have led, every advisory board I’ve sat on, every change I have driven, each step forward has come at a great personal cost rarely discussed in equity-focused improvement initiatives: the burden placed on the people of color who work on them.
In recent years, there’s been an influx of organizations speaking up against racism and bias and their impact on health outcomes. These welcome declarations have been followed by improvement projects paired with new public health measures focused specifically on eliminating health disparities.
While laudable, these projects and those who spearhead them, have often focused on external outcomes, unintentionally overlooking a pressing first step: assessing how internal structures, policies, and practices impact their own employees.
If you don’t treat the people within your organization with fairness, how do you expect those same people to promote fair and just methods in their projects? I ask. How can you expect me, as a Black woman, to address racism on behalf of an organization while dealing with organizational racism myself?
These two questions get to the heart of an all-too-common pair of problems:
- Does internal racism persist in organizations working to address racism externally?
- Does its persistence take a unique toll on people of color—the very people required to lead this work forward?
The toll internal racism and bias take when working in public health
A 2019 survey found that over 40 percent of U.S. employees have seen or experienced racism in the workplace. It would be exorbitant hubris to assume that statistic, or at least some version of it, doesn’t apply to health equity initiatives as well. Yet, the expertise of the staff (public health and healthcare professionals) combined with the urgency of the work—reducing Black maternal mortality rates, for example—can make it easy for organizational and project leadership to justify not first looking internally.
This is a grave misstep. Health equity improvement projects are emotionally exhausting for people of color in a way their white counterparts cannot understand, which makes internal structures that counter racism and bias all the more important.
To watch the results of these projects on people that look like you… it’s draining, especially because you cannot walk away. I always say I’m not speaking for all Black people, but when you’re the only person of color on a certain project, you don’t really have a choice. Knowing that I am championing the cause of so many others is this extra burden I have to carry, on top of my day-to-day experiences in this country as a Black woman.
This is not just a job: It is my personal; it’s my professional; it’s my state of being.
The unending weight is toxic. It starkly illustrates why health equity projects need formal mechanisms dedicated to supporting employees and partners of color—acknowledging and responding to the emotional toll these projects take. This work must go hand in hand with external health equity goals.
Without internal assessment and racial equity training, the weight continues to go unaided and is made worse by micro aggressions, bias, and internal racism.
When my expertise is ignored on a project, that’s me being marginalized. I know that. But I’m still filled with self-doubt. I worry that I’m being oversensitive. The mere fact that I have to ask myself, “am I being ignored because I am a Black woman or am I just imagining it?” That is a problem. It’s a terrible feeling to always have to second guess yourself. To constantly have to live under that, every day, all day.
What I describe is harmful, both to people and to the project’s aims. After all, harming the people most qualified to address racism prohibits improvement.
Ensuring a safe and productive place to pursue health equity initiatives is vital for their success and for the health of the people of color who work on them.
Change requires a rigorous internal assessment
Developing supportive structures starts with an internal assessment. Begin by asking employees questions about their perception of their organization’s commitment to diversity, anti-racism, equity and inclusion.
- Are there formal policies in place?
- Have you assessed those policies? If yes, who was involved in that assessment?
- Who benefits from these policies, both internally and externally?
- How are staff affected by stressors, internally and externally, related to their race and/or gender?
- How are project partners affected by stressors related to their race and/or gender?
The answers to these questions cannot wait. Without them, well-intentioned equity improvement projects will continue to reinforce the same oppressive structures they seek to undo.
For so long, I have been working to change the system, so those who follow me don’t have to experience what I experienced. It’s been a slow, yet constant evolution since enslavement. One generation after another generation trying to make it better for the next generation. But when does that struggle end and when is enough, enough?