Social Justice, Race and the Intersection of Prevention

Dr. Wanda Boone


 

“If you want to improve in major ways, change your frame of reference. Change how you see the world, how you think about people…Change your paradigm, your scheme for understanding and explaining certain aspects of reality.”
- Stephen Covey, Principle-Centered Leadership



The murder of Mr. George Floyd has opened the floodgates to reveal the deep pain and inexplicable impact of racism on African Americans. The tears and images will not subside from our memories for quite some time. As Prevention Champions of Change we will use all the tools available to us to create trauma informed and equitable polices within our own organizations and communities.
 

The Strategic Prevention Framework is used to create and monitor change. The framework includes assessment, capacity building, planning, implementation, evaluation, sustainability and cultural competence. Prevention Champions of Change that use the framework are uniquely positioned to respond to racism and social justice inequities. Cultural competence involves the ability of an individual or organization to understand and interact effectively with people who have different values, lifestyles, and traditions based on their distinctive heritage and social relationships.[1]  To elevate cultural competency within prevention plans 1. Become aware of personal implicit bias: judging people based on perceived ability, gender, sexuality, class, skin tone, race, ethnicity, religion and/or age. 2. Acknowledge challenges to health and well-being experienced by African Americans. 3. Include community members to develop action plans.
 

The American Association of Pediatrics calls racism a socially transmitted disease passed down through generations, leading to the inequities observed in our population today.[2] Racism is a social system that plays out in different ways such as individual/interpersonal and systemic/institutional. African Americans experience racism (discrimination) in everyday life personally and systematically. African Americans are 2-5 times more likely to have bad outcomes across systems in NC. These poor outcomes are observed throughout the US.

Cultural Competence Graph[3]

 

Institutional racism compounded by micro-aggressions such as daily verbal and behavioral slights (viewed as suspicious) causes traumatic stress which in turn is linked to poor health and chronic disease. Racism/Discrimination is a Social Determinant of Health in the Community and Social Context: Social Integration, Support Systems, Community Engagement, Discrimination, Stress. Social determinants of health and discrimination should be front and center in prevention plans.

 

Social Determinants of Health

[4]

 

Equality, demonstrated in the first image, refers to equal inputs, though the outcomes can still be unequal. Equity, demonstrated in the second image, refers to inputs that may need to be different to achieve equal outcomes. In the third image, no support or accommodations are needed because the cause of inequity has been addressed and the systematic barrier has been removed.[5] Social Determinants of Health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.[6]

 

Equality Equity Liberation Visual

 

Historically, white privilege refers to a system in which white people enjoy an institutional or policy structural privilege over others. The system needs to be equalized. It is the system that maintains the inequality not the people. Likewise, it is the system that maintains the inequality within the African American experience.
 

There are three types of trauma, two are experienced to a greater degree by African Americans. Individual trauma including 10 Adverse Childhood Experiences (ACES) are experienced by all races: An ACE score of 4 or more of the following: Abuse: physical, emotional, sexual; neglect: physical, emotional; household disfunction: mental illness, mother treated violently, divorce, incarcerated relative, substance use (add number 11, racism) have led to the explanation of poorer health outcomes over the lifespan. These outcomes could include: lack of physical activity, smoking, alcoholism, drug use, missed work, severe obesity, diabetes, depression, suicide attempts, sexually transmitted diseases (STDs), heart disease, cancer, stroke, Chronic obstructive pulmonary disease (COPD) and broken bones.[7] Community Trauma impacts more African Americans due to the built environment: lack of social capital and mobility, historical trauma, substandard schools, structural racism, poor water and air quality, violence, poverty, substandard wages, lack of jobs, poor housing quality and affordability. Environmental Trauma disproportionally impacts more African Americans due to land use: tornadoes, hurricanes, COVID19.
 

Remember: You are more than the worst thing that happened to you.
 

The influence of racism has lingered far too long without being addressed in the fields of medicine, public health and prevention. Prevention Champions of Change move forward bravely, speak authoritatively, advocate with compassion and act boldly.
 

  • Create a safe environment in behavior and speech.
  • Prevent interactions that re-traumatize people    
  • Help ensure that partners and volunteers conform to trauma-informed principles  
  • Recognize that trauma-related symptoms and behaviors originate from an attempt to adapt to traumatic experiences.
  • Promote resilience. Resilience involves behaviors, thoughts and actions including focusing inwardly to determine stress levels, seeking to find balance in life (work, personal and fun), connect with positive people.

 

Use the Seven Strategies for Community Change and the Framework to Reduce Disparities:[8]
 

  1. Provide Information on Racism, Social Justice and Health disparities.
  2. Build Skills: Hold Town Halls and workshops designed to increase the skills of participants such as training on the judicial systems and school policies.
  3. Provide Support: Increase social capital by linking residents with formal and informal leaders in a community fair atmosphere.
  4. Enhance Access/Reduce Barriers - Increase the ease, ability and opportunity to utilize systems and services (transportation, bus passes, advocates)
  5. Changing Consequences – Engage the community in recognizing community members, leaders and business owners that institute innovative practices to impact the social determinants of health.
  6. Physical Design – Ensure that all parks and recreational facilities are in good condition regardless of zip code.  
  7. Modifying/Changing Policy – Formally change in written procedures through a City, County School Board Resolution that document: Racism is a Public Health Crisis.[9]  

 


 

“Returning hate for hate multiplies hate, adding deeper darkness to a night already devoid of stars. Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate, only love can do that.”
- Martin Luther King Jr.

 

 


References:

  1. https://www.samhsa.gov/sites/default/files/20190620-samhsa-strategic-prevention-framework-guide.pdf
  2. The Impact of Racism on Child and Adolescent Health. Maria Trent, Danielle G. Dooley, Jacqueline Dougé, SECTION ON ADOLESCENT HEALTH, COUNCIL ON COMMUNITY PEDIATRICS, COMMITTEE ON ADOLESCENCE. Pediatrics Aug 2019, 144 (2) e20191765; DOI: 10.1542/peds.2019-1765. https://pediatrics.aappublications.org/content/144/2/e20191765
  3. https://schs.dph.ncdhhs.gov/schs/pdf/NCPopHealthDatabyRaceEthOct2014.pdf
  4. https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/
  5. https://nam.edu/the-case-for-health-literacy-moving-from-equality-to-liberation/
  6. https://schs.dph.ncdhhs.gov/SCHS/pdf/MinorityHealthReport_Web_2018.pdf
  7. Hughes et al., 2017; SAMHSA, 2017, Cronholm et al. 2015; Slack, Font, and Jones 2017, Center on the Developing Child, 2019.
  8. http://www.durhamtry.org/AAHIP
  9. https://files.stablerack.com/WebFiles/67135/Resolution-RacismAPublicHealthCrisis.pdf

 


Dr. Wanda BooneDr. Wanda Boone’s career in prevention spans over 30 years. She founded Together for Resilient Youth (TRY) in 2003 after a corporate career in Research and Sr. National and International Executive Director, Quality Assurance and Regulatory Affairs. She Co-Chairs the Durham County Substance Use Task Force, Chairs the Durham Committee on the Affairs of Black People Health and Safety Committee, serves as a member of the Collaborative for the Effective Prescription Overdose Policies, facilitates TRY Resilient Together, a social group for parents that have lost children due to overdose, created Forward Together a Whole Health Approach to Addiction, served as a Healthy NC 2030 Resilience Social and Economic Factors work group Co-Chair, among many other affiliations. Dr. Boone is a guest speaker and technical advisor on the Strategic Prevention Framework, Trauma, Resilience, Implicit Biases, Racial Inequities, Social Determinants of Health, the Three Domains of Aces, Behavioral Health Disparities and more. TRY connects the dots using the public health model, uses environmental strategies and relies on data to guide prevention strategies. She has earned the title Social Justice Warrior.
 
Dr. Boone sees her work in Durham, the State of NC and indeed around the country as an effort to combat theseries of cultural shifts that have made substance use and risky behaviors so appealing to youth. TRY’s Mission is to prevent substance use among youth by addressing trauma and risky behaviors that can result in addiction and lost productivity in adulthood. TRY’s youth coalition Living in Future Tense (LIFT) and young adult coalition, College TRY are grounded in and guided by resilience building. The packaging and availability of tobacco and alcohol in more kid-friendly forms, the glamorization of drug use by media, the belief that marijuana is green and therefore good along with opioid misuse has led to the continuum and advancement of addiction, increased suicide, depression and risky behaviors among our youth and young adults. “Holding young people solely responsible for underage drinking (example) is like holding fish responsible for dying in a polluted stream.” –The Face Project
 
Dr. Boone has been a forerunner in the field Resilience/ACEs. She believes that children thrive when the adults that surround them are well and do well. She has been passionate and determined about exposing Adverse Childhood Experiences (ACEs) as key for many adults that struggle with behavioral, physical and emotional challenges. “Why am I like that?” Her project, Achieving Health Hand in Hand! (AHHH!) aims to engage adults in a Resilient Community safety net that benefits everyone.
 
Dr. Wanda Boone says, “My lifelong dream is to make a difference in people’s lives, to help them see the power within themselves to live their best lives and to create a more resilient community for all -together." -Ubuntu