I often hear colleagues lament the indifference, resistance—or outright opposition—among gatekeepers to directly take on social, health, and racial inequity in communities. These gatekeepers include legislators, mayors, school board members, agency heads, executives, and others who wield positional power over policies and resources. Their influence looms large, but so does ours. A gatekeeper has been described as “anyone who works in an institution and has the power to give or deny access to their resources or equity—ranging from information and services to use of the bathroom key.” Gatekeepers can inadvertently keep social and institutional racism intact, even within respected organizations charged with protecting the public’s health;  or they can potentially transform institutions for the better.
Leading equity trainers, including The Racial Equity Institute (REI) and the People’s Institute for Survival and Beyond, emphasize the potential role for gatekeepers at all levels and in all places. REI encourages us to “lean in to our growing edge” to create equitable communities, even when it’s uncomfortable.
Rocio Munoz, Equity and Inclusion Policy Specialist at the Benton County, OR Health Department and previous guest on our blog, expressed this idea so well after the 2016 election: “I ask myself, ‘What can I do where I live, where I’m already affiliated?’ Our white allies need to speak up, but many feel that they lack the tools. As a practitioner, I tell allies to use their privilege. With the direction we’re going, we’re going to need you. Next time something’s not okay, you need to speak up. It can be anywhere: during meetings, even in emails. Everybody is doing their best but they have to take action.”
In a study conducted within Cone Health, a North Carolina-based integrated health network, researchers and clinicians found that African-American women would often stop or delay treatment for breast and lung cancers. Many hesitated to speak up about their needs or concerns if they had negative encounters with authority figures at critical points during their course of care. The hospital’s Accountability for Cancer Care Through Undoing Racism and Equity (ACCURE) project trained senior staff and other critical employees (i.e., gatekeepers) on unconscious bias and institutional racism. The hospital hired a “navigator” who was specially trained in particular barriers and beliefs that limit care for African Americans. Cone Health also instituted systems changes related to medical records and clinical care teams. Research on these efforts found that working with clinical gatekeepers reduced the disparity in treatment completion between whites and women of color.
And America Walks, a mission partner and ally of Active Living By Design, has infused racial equity into a seemingly straightforward charge: to make America a great place to walk by promoting safe, convenient, and accessible walking conditions for all. Recently, the organization has leaned in to better understand the difficult, underlying health barriers that people of color face. Check out America Walks’ webinar series “Walking Towards Justice,” which is skillfully hosted by Charles Brown. By featuring important books like “The Color of Law” and “The New Jim Crow,” the series has shed light on the relationship between intentional geographic segregation, the criminal justice system, and the impact of those systems on Americans’ ability to walk safely.
Outside of an institutional study, systems change, or webinar series, the most immediate place to accelerate equity is wherever you live and work. Act locally to better understand racial inequity in your community or organization, and look for others who are addressing the structures that perpetuate racism. Many communities have organized coalitions to raise awareness of longstanding inequality and systemic racism, create new relationships among people with very different life experiences, and collectively organize for equity. Explore how you can contribute to similar efforts in your community.
While we still need to work with high-level officials and hold them accountable for racially-equitable policies, we shouldn’t underestimate the impact we can make by transforming ourselves, our organizations, and our communities.
2. See this enlightening article: “Racism in Organizations: The Case of a County Public Health Department,” from the Journal of Community Psychology, 2007. It discusses how racism in our society causes discrimination and inequity to be rooted within public institutions responsible for assuring the health of their most vulnerable residents, in spite of professional standards and ethics.