When “Upstream” Public Health Efforts Fall Short

When I came to public health almost two decades ago, I cut my teeth at a local health department working on what was then referred to as “health disparities.”

But, I fear we have gotten comfortable passing off slightly upstream work as equity work.

Across public health, we must build a deeper understanding of racism as a system of advantage* — otherwise our health equity efforts are bound to simply remain diversity and inclusion projects.

We must be able to identify when a call for change is about accommodating structurally oppressed people into the existing system.

  • Racial inequity looks the same across systems
  • Socio-economic difference does not explain the racial inequity
  • Inequities are caused by systems, regardless of people’s culture or behavior

If we truly believe that everyone has the fundamental right to the conditions for optimal health, we will face our nation’s history and acknowledge the intentionally designed racial hierarchies and their connection to power. We will begin to leverage our power. And we will commit to healing.

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