Prevent Racism and Promote Health Equity:

 More than a Midsummer Dream
 

Author: Cele Fichter-DeSando, MPM
 

The world that Shakespeare created in the comedic play Midsummer Night’s Dream is filled with enchantment, joy, love, transformation, magic, and a belief that anything can happen. The midsummer world that we live in is filled with pain, trauma, and inequities and it is tempting to lose hope with the belief that nothing can change. 

“If you lose hope, somehow you lose the vitality that keeps moving, you lose that courage to be, that quality that helps you go on in spite of it all. And so today, I still have a dream.” Martin Luther King Jr.

In the January issue of the PTTC Post, we celebrated the legacy of Martin Luther King with the 2023 theme set by the King Center of  “It Starts with Me: Cultivating a Beloved Community Mindset to Transform Unjust Systems.” We have reached the mid-point of the year and it is time- not for despair- but for revitalizing and re-establishing our goal of transforming unjust systems.

Racism and Public Health

The Centers for Disease Control and Prevention (CDC) defines racism as “a system—consisting of structures, policies, practices, and norms—that assigns value and determines opportunity based on the way people look or the color of their skin resulting in an unfair advantage for some and disadvantage for others” (CDC, 2021). According to the CDC, racism is a serious threat to the public’s health as racism in all its forms negatively affects the mental and physical health of millions of people. Racism creates health inequities and prevents those affected from attaining their highest level of health, affecting the health of the entire country (CDC, 2021).

Recognizing that racism negatively impacts mental health and contributes to unequal access to resources and services, the CDC has developed actions and resources to  prioritize minority mental health, combat racism, and promote health equity (CDC, 2022).

Steps to Mental Health Equity

• Ensure mental health programming incorporates perspectives, ideas, and decision-making from appropriately representative people of racial and ethnic minority groups at all stages of programming – from planning to implementation to evaluation.
• Consider the data on mental health when developing organizational priorities and programs.
• Prioritize action on and/or meaningfully account for the potential influence of social determinants of health when designing mental health programs.
• Measure the impact of racism on mental health and develop best practices for reducing racism and its consequences.
• Ensure mental health educational materials are culturally and linguistically appropriate
•  and follow health equity principles for communication such as using plain language.
• Take intentional steps to increase the reach of mental health information to racial and ethnic minority groups through culturally responsive communication outlets.
• Establish and foster partnerships with other organizations to fill gaps in reach and/or expertise.
• Verify and promote available free and low-cost mental health resources.
• Explore referrals to mental health services to ensure those served can be efficiently connected with needed resources.

Barriers to Health Equity

To further promote equity and prevent racism it is important to address factors that may be barriers to care. Identifying the barriers and establishing mechanisms for addressing and eliminating barriers is an important step in promoting health equity. The American Psychiatric Association (APA) identifies multiple factors that contribute to mental disparities for racial/ethnic, gender, and sexual minorities (APA, 2023) including

• Lack of insurance/underinsurance;
• Mental illness stigma;
• Lack of diversity among mental health providers;
• Lack of culturally competent providers;
• Language barriers;
• Distrust in the healthcare system; and
• Inadequate support and funding for mental health service in safety net settings. 

Racism, Trauma, and Mental Health

In addition to the barriers to care, Mental Health America (MHA) describes the impact that racism has on mental health due to trauma. Trauma places an undue burden on the mental health of people of color and other marginalized groups. According to MHA, racism is a mental health issue because racism causes trauma, and trauma directly affects mental health and mental well-being (MHA, 2023). Past trauma is prominently mentioned as the reason that people experience serious mental health conditions today. First-hand experiences of racial discrimination, as well as witnessing or hearing about discrimination from others or in the media, can cause or intensify stress and racial trauma (CDC, 2023). MHA identifies several factors in addition to the trauma caused by institutional racism and bigotry that inflict trauma including

• People avoid them and their neighborhoods out of ignorance and fear;
• Banks and credit companies won’t lend them money or do so only at higher interest rates;
• Mass numbers of their peers are incarcerated;
• School curricula ignore or minimize their contributions to our shared history; and
• Racial profiling.

Promoting Health Equity

To conduct a midsummer check-in on your program goals there are several resources available  to assist with preventing racism, reducing trauma, promoting health equity, and transforming unjust systems.

Office of Behavioral Health Equity Resources - The Substance Abuse and Mental Health Services Administration (SAMHSA) Office of Behavioral Health Equity (OBHE) coordinates SAMHSA’s efforts to reduce disparities in mental and/or substance use disorders across populations. OBHE defines behavioral health equity as “ the right to access high-quality and affordable health care services and supports for all populations, including Black, Latino, and Indigenous, and Native American persons, Asian Americans and Pacific Islanders, and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality” (SAMHSA, 2023). 

OBHE provides resources for gathering data, practice and workforce development, policy initiatives, population-specific information, cultural and linguistic competency, and other resources (SAMHSA, 2023). Improving access to behavioral health care, promoting quality behavioral health programs and practices, and addressing social determinants of health are essential for reducing persistent disparities in mental health and substance use services for underserved populations and communities. SAMHSA has several Email Updates for organizations and individuals to receive the latest updates to assist programs in promoting health equity. 

CDC's Health Equity Guiding Principles for Inclusive Communication are intended to help public health professionals ensure their communication work, including communication of public health science, meets the specific needs and priorities of the populations they serve and addresses all people inclusively, accurately, and respectfully. These principles are designed to adapt and change as both language and cultural norms change. Language in communication products should reflect and speak to the needs of people in the audience of focus, using non-stigmatizing language (CDC, 2022). 

Inclusive Communication Principles

• Use a health equity lens when framing information about health disparities; 
• Use person-first language and avoid unintentional blaming; 
• Use preferred terms for select population groups while recognizing that there isn’t always agreement on these terms;
• Consider how communications are developed and look for ways to develop more inclusive health communications products; and 
• Explore other resources and references related to health equity communications.

Responsible Communication Tips - The May 2023 issue of the International Society of Substance Use Professionals (ISSUP) Newsletter highlighted an article by Rachel Crowell at The Open Notebook on communicating responsibly about substance use and addiction (Crowell, 2023). Responsible communication can dispel myths, highlight inequities and combat stigma and racism. Using Crowell’s communication tips can help you to check and develop your materials and communications for health equity promotion.

Tips for Responsible Communication on Substance Use

• Use precise humanizing language
• Include subject matter experts, including those with lived experience, and provide anonymity when possible
• Use trauma-informed reporting/communication skills
• Select images carefully to avoid perpetuating stereotypes
• Check for biases, assumptions, and myths
• Do not overstate findings, include scientific limitations, and the need for further research
• Keep your communications in context to avoid further mischaracterization and racial profiling
• Provide a solution focus and resources for the reader to access

Health Equity and Inclusion Resources - The Prevention Technology Transfer Center (PTTC) Culturally & Linguistically Appropriate Practices Work Group, developed a compilation of Cultural Responsiveness Resources to help individuals understand the impact of culture and identity in prevention efforts.  The resources are free to access and are updated periodically to ensure the inclusion of the most relevant resources. 

Conclusion

Formally recognized in June 2008, July is Bebe Moore Campbell National Minority Mental Health Awareness Month. This awareness month was created to bring awareness to the unique struggles that underrepresented groups face in regard to mental illness in the United States. Bebe Moore Campbell was an American author, journalist, teacher, and mental health advocate who worked tirelessly to shed light on the mental health needs of the Black community and other underrepresented communities. To continue the visionary work of Bebe Moore Campbell, Mental Health America (MHA) develops a BIPOC Mental Health Month public education campaign each July dedicated to addressing the mental health needs of Black, Indigenous, and People of Color (BIPOC).

Together we can prevent racism, promote health equity, transform unjust systems, keep dreaming, and keep hope alive for more than a midsummer night.

"We choose hope over fear. We see the future not as something out of our control, but as something we can shape for the better through concerted and collective effort. We reject fatalism or cynicism when it comes to human affairs; we choose to work for the world as it should be, as our children deserve it to be." 
-- President Obama to the United Nations General Assembly, September 24, 2014

References

American Psychiatric Association, (APA), 2023. Mental Health Disparities: Diverse Populations. APA, 2023  https://www.psychiatry.org/psychiatrists/diversity/education/mental-health-facts

Center for Disease Control and Prevention (CDC) 2022. Health Equity Guiding Principles for Inclusive Communication. 2022. https://www.cdc.gov/healthcommunication/Health_Equity.html

Center for Disease Control and Prevention (CDC) 2022. Prioritizing Minority Mental Health. CDC, July 12, 2022.

https://www.cdc.gov/healthequity/features/minority-mental-health/index.html

Center for Disease Control and Prevention (CDC) 2021. Racism and Health. CDC, 2021. https://www.cdc.gov/minorityhealth/racism-disparities/index.html

Crowell, R, 2023. Covering Substance Use and Addiction Responsibly. The Open Notebook, May 16, 2023. https://www.theopennotebook.com/2023/05/16/covering-substance-use-and-addiction-responsibly/

International Society of Substance Use Professionals (ISSUP) 2023. Covering Substance Use and Addiction Responsibly. ISSUP newsletter - Issue 149: May 24, 2023.

Mental Health America (MHA), 2023. BIPOC Mental Health Month. 2023, Mental Health America, Inc.https://www.mhanational.org/bipoc/mental-health-month

Mental Health America (MHA), 2023.Racism and Mental Health, 2022 https://www.mhanational.org/racism-and-mental-health

Substance Abuse and Mental Health Services Administration (SAMHSA), 2023. About the Office of Behavioral Health Equity. SAMHSA, 2023. https://www.samhsa.gov/behavioral-health-equity/about