By Olivia Borland and Edith Gaines
Many issues come to mind when asking Edith Gaines, Shawnee County Health Department Finance Officer and PHAB Accreditation Coordinator, why her health department decided to do a Racial Equity Impact Analysis. When conversations began, individuals took a step back and decided it was time to move from diagnosis to action on the following issues:
- Racial disparities that affect Shawnee’s County Health Ranking
- Premature birth and infant deaths among African Americans noted by the Fetal Infant Mortality Reduction (FIMR) Program
- Self-reflection and assessment that came with preparing to apply for PHAB accreditation
Daily racism leads to chronic stress. Chronic stress leads to increased and prolonged levels of stress hormones. Prolonged exposure to stress hormones, such as cortisol, leads to inflammatory reactions that cause chronic diseases. Therefore, African Americans have a lower life expectancy at birth and higher health disparities than any other race.
After attending the JustPartners Race Matters Institute trainings and engaging in community discussions on infant mortality sponsored by Kansas Action for Children, Gaines was excited about a clear, insightful tool she could use at the health department to address these challenges. JustPartners’ Racial Equity Impact Analysis is an assessment tool that works to address policy and procedure gaps in achieving racial equity. The tool considers who is making decisions around a policy, practice, or decision and asks how racial and ethnic groups will be affected, what their perception will be, and if there will be unintended consequences or disparities for certain ethnic and racial groups as a result. Based on these responses, the tool asks users to make revisions to a policy or practice that would contribute to more equitable conditions for all racial groups.
With the support of the Health Department Director, Edith recruited employees and community partners to get involved in the Racial Equity Impact Analysis. There were many established relationships recruited, but also a number of new connections made through networking at county-wide groups and coalitions. In the end, Shawnee County was able to expand partnerships with the Kansas Department of Health and Environment (KDHE), the Kansas Department of Children and Families (DCF), Valeo Behavioral Health (Community Mental Health Center), Go Topeka (Chamber of Commerce), the Topeka Public Schools-USD 501, Grace Med (FQHC), Topeka Center for Peace and Justice, and the Hospitality Incubator Program (HIP), which is a non-profit culinary arts institute.
Together, this group developed a mission of addressing the County Health Rankings through analyzing internal policies, plans, and procedures to ensure the Health Department supports the ability of all community members to achieve optimal health. Along with creating a charter and shared vision, the group agreed on an operational definition of structural racism. In order to address racial equity, a shared language is necessary. Their definition acknowledges that structural racism is a fundamental cause of health inequity and normalizes cultural, institutional, and personal hierarchies that disadvantage people of color, thus leading to adverse health and economic conditions.
The group is now in the process of analyzing 38 internal policies at the Shawnee County Health Department. These policies were identified through program staff speaking with the group to learn about the health department operations. At their monthly meetings, the group reviews policies related to dress code, employment termination, hiring procedures, breastfeeding during work hours, social media, and more. Using the racial equity tool, the group holds discussions about these policies and proposes changes. For others interested in doing this type of work, Gaines recommends lots of preparation. Each meeting needs a well planned, intentional agenda and for the prep work to be done and sent out to the group before they meet. Finding a system for document sharing is also an important hiccup due to HIPAA security that the group is still working on finding ways to overcome.
Recently, the group was awarded a Partners in Community mini-grant from Aetna Better Health of Kansas that they used to continue their work. The group provided personal protective equipment (PPE) kits to 100 disadvantaged families within Shawnee County’s highest COVID-19 per capita case zip codes. The PPE kits were comprised of a reusable cloth mask, a thermometer, a bottle of hand sanitizer, and the group’s brochures in English and Spanish. The group partnered with the Salvation Army’s Food Pantry to get the PPE kits distributed in the community.
The group wanted to address chronic and toxic stress in the workplace. Through the Health Department, the group was able to host two exciting trainings via Zoom. The first one is Organizational Trauma and COVID-19 that was tailored as professional development training for supervisors and managers. The second training, Cultural Humility and Trauma Informed Leadership, was extended to community partners. These trainings are founded on principles from evidence based Adverse Childhood Experience Study (ACES) – Trauma Informed Care. Both trainings were presented by Wichita State University through a technical assistance grant from KDHE.
After this phase is complete, the group will evolve into an internal Health Department Health Equity Group that will focus on cultural awareness trainings for staff and community partners and work to bridge gaps in access to care. They hope to maintain an inclusive environment and healthy organizational culture using the group’s progress and momentum. Externally, the Health Department wants to provide culturally competent services to clients and engage in work that addresses the social determinants of health.
Further Readings on Racism, Chronic/Toxic Stress, and Health:
- Structural Racism and Health Inequities
- Health Disparities and Stress
- The Three Realms of Adverse Childhood Experiences (ACES)
- Understanding ACES and Toxic Stress
Data Sources with Indicators Related to Racial Disparities: