Racism impacts our health and well-being. This is something we don’t say often enough, despite the fact that people of color still have higher rates of morbidity and mortality than white people.

The stresses of racism start in the womb through stressors on mothers. Continuing in childhood and throughout life, discrimination and oppression are embedded in social institutions, policies, cultural practices, and interactions in everyday life. Research has shown that discrimination raises the risk of emotional and physical problems, including depression, hypertension, cardiovascular disease, and mortality, which largely impact people of color.¹ A study by Kathryn Freeman Anderson found that 18.2 percent of black participants experienced emotional stress and nearly 10 percent experienced physical stress—compared to 3.5 percent and 1.6 percent for white people. Even when controlling for socioeconomic status, racial disparities in health still exist due to forms of racism like segregation and discrimination.² Racism is a powerful force that leads to persistent disadvantages.

I recently attended a Racial Equity Workshop, where we practiced reframing problems and determining solutions using a racial equity lens. We discussed how, in order to create sustainable change, solutions must address all three manifestations of racism[3] simultaneously or consecutively:

• Institutional/structural: how our systems, policies, and procedures have been structured to support beliefs, standards, norms, and practices of white people and oppress people of color
• Cultural: norms, beliefs, and standards that advantage white people and disadvantage people of color
• Individual: internalized beliefs, attitudes, or bias that support white superiority

Many times, social justice efforts focus solely on one area, like policies and environmental changes, but overlook the importance of transforming culture and individual ideologies.

Culture gives us the resilience to ride out structural policies and go back to the norm. While resilience is usually a positive thing, in this case it means that biases are harder to change. Therefore, it is key to create a multi-level strategy that addresses all three manifestations of racism to improve health.

Various organizations are working to create multi-level approaches to improve racial equity, and thereby improve health:

• Minneapolis Parks & Recreation Board (MPRB) joined 13 local and regional agencies as a part of a learning cohort for the yearlong Government Alliance on Race and Equity Advancing Racial Equity. The board also began conducting implicit bias training for interview panels and hiring managers, instituted a new ordinance to address racial and economic equity in new neighborhood park projects, and developed a 2017-2018 Racial Equity Plan.
• King County had hundreds of employees attend the Equity & Social Justice Forum on implicit bias and structural racism and subsequently created an anti-bias facilitation guide. In 2015, the county created the Office of Equity and Social Justice to support and coordinate internal and regional equity activities. These included making bus services more affordable for riders who qualify for reduced fares⁴ and launching two Equity Social Justice trainings based on the PBS documentary RACE – The Power of an Illusion.
• Living Cities developed a racial equity and inclusion strategy with an institutional planning process for integrating race, equity, and inclusion outcomes and indicators throughout programming and operations. Staff are also proactively learning as an organization about racial equity and inclusion strategies, models, and outcomes.⁵ In the last year, Living Cities joined forces with the Government Alliance on Race and Equity, a project of the Center for Social Inclusion, to start Racial Equity Here. The initiative provides technical support.