Let's use health notes to roll back structural racism
COVID-19 exposed existing flaws in our economic and health care systems by taking a disproportionate toll on Black and low-income Ohioans. This is due to the increased prevalence of chronic health conditions in these communities that make them more susceptible to severe impacts from the virus.
Poverty is bad for one’s health. And so is racism. Unequal access to our health care system, and racism in the delivery of care, adds fuel to the “social determinants of health” fire.
In general, white and wealthy Ohioans tend to live longer, healthier lives than their Black counterparts and people with low incomes. Bad policy decisions, legal precedent and daily practice contribute significantly to this situation.
The good news is that most people agree Ohio’s policymakers and health care system must do better. There’s a growing movement among health experts, racial justice leaders and anti-poverty advocates to ensure lawmakers understand the health implications of the decisions they are making BEFORE passing laws.
Historic redlining, perpetuated by our federal government, along with the banking and finance industries, left many Black families in segregated areas where poverty is now concentrated. Many of Ohio’s Black communities are “areas of concentrated poverty” where 40% or more of the residents subsist on income below the poverty line. As a result, the communities themselves lack resources and have been long under-resourced by the state and federal government. Residents in these neighborhoods are more likely to live in substandard housing with pest problems, mold and lead paint. Kids are deprived of greenspace and parks to play in and safe, walkable, bikeable streets. Public policies steered polluting factories and highways next to or through Black neighborhoods, harming health with higher levels of noise and air pollution.
The results: higher rates of asthma and lead poisoning in Black children; more toxic stress that leads to hypertension, heart disease, and compromised immune systems; and fewer places to play, exercise and recreate, resulting in higher rates of obesity and diabetes.
The emotional trauma of forced enslavement and all that came after it, the wrongs of which have never been addressed, validated or atoned for, has been handed down from generation to generation contributing to a cycle of generational poverty and stress-induced health conditions.
The national so-called “war on drugs” resulted in the mass incarceration of non-violent Black men and then left them with permanent criminal records and enormous barriers to employment for their entire lifetimes. These “collateral sanctions” contribute to high unemployment rates, low incomes, and permanent, toxic financial stress in Black communities. And none of this helps reduce drug use — quite the contrary.
The point is that better-informed public decisions going forward can help get us out of this situation. The work starts by undertaking health and equity assessments of proposed legislation or rules, PRIOR to their adoption.
Policymakers must better understand the implications of public policies—even those that are well intentioned—BEFORE they pass them into law. In particular, our elected representatives must better understand the implications of proposed laws on those who are underrepresented in public decision-making bodies, those who are not in the majority, who are poor or vulnerable.
Fortunately, there is a tool to do this work. After a law is proposed but before it passes, the Ohio Legislative Service Commission can use the “health note” tool to write short briefs describing the health implications of proposed legislation across varying populations — similar to the fiscal notes or business impact analysis of proposed legislation they undertake now.
In August of last year, Governor DeWine’s Minority Health Strike Force recommended the use of health impact assessments in the policymaking process. Ohio House Representative Erica Crawley (D-Columbus) introduced House Bill 620, which, if adopted, would require the Legislative Service Commission to draft health impact assessments for all introduced bills.
Given heightened awareness of Ohio’s health divide, laid bare by COVID-19 over the past year, 2021 is a good year for policymakers to adopt processes of legislative review and analysis that will better ensure we all have equal opportunity to live happy, healthy lives, no matter our race or how much money we have. As the Ohio legislature debates the state’s budget for the next two years, HB 620 should be resurrected and incorporated into the provisions of the state budget, along with the proper resources for the Legislative Service Commission to do this important, foundational work.