In the wake of the murders of Ahmaud Arbery, George Floyd, Breonna Taylor, Nina Pop, Tony McDade and so many others, philanthropy, public and private health organizations and agencies have released statements denouncing racism and affirming that “Black Lives Matter.”
Interestingly enough, many of these organizations made similar declarations in the past around “equality,” “equity,” “diversity” and “inclusion.”
Much of this resulted in little action to actually address the culture, policies and practices of these organizations as well as make positive differences in the lives, safety and well-being of the Black people they serve and/or the Black people that work in their organizations.
This moment calls for a radical commitment toward action that addresses structural changes in health organizations and agencies. Action that challenges and shifts power. The information below provides examples of how health organizations and agencies can implement structural solutions to address the structural racism that exists (yes, it does exist!) within their organizations.
Here is how you start. (This is not an “I solved racism” checklist.)
1. Acknowledge how racism (specifically anti-Black racism and white supremacy culture) operates within your organization. (No one is exempt.)
Racism and white supremacy culture are embedded in all organizations. This includes yours, and it permeates throughout your structure, policies and practices. No one is exempt despite how progressive or liberal you’ve claimed to be, despite past declarations of equality, equity and social justice, or the placement of Black people, Indigenous people or other people of color (BIPOC) in “token” leadership positions.
It is important that you accept this fact and acknowledge it publicly (the same way you publicly declared “Black Lives Matter” publicly) and use this information as the foundation to establish a concrete plan to begin combating racism and white supremacy in your organization.
Note: Recognize and value the expertise of BIPOC in your organization. Do not add trauma to the BIPOC in your organization. Do not burden BIPOC with “white tears” or mandate additional emotional, intellectual, mental, spiritual or physical labor. Ask. Be ready for that “no.” The BIPOC in your organization should not bear the brunt of these efforts. Nine times out of 10, they are already overworked and have carried the emotional, mental, physical and financial burden of your racist and white supremacist policies and practices.
2. Establish accountability mechanisms.
Any change in policy and/or the creation of a new initiative must be accompanied with multiple mechanisms of accountability. Every organization measures what matters.
If Black lives and dismantling systemic racism matters to you beyond your public statement, you must have metrics to track and measure your internal and external initiatives. These metrics must be measured at every level—including the C-suite and individual employee levels in every section of your organization. You must have consequences if those metrics are not met. Without consequences, there is no incentive for an organization, its board, leadership and/or employees to transform.
There is large evidence that tying all metrics to performance pay, bonuses, tenure and promotion is the most effective way to ensure organizations are making progress on racial justice. Secondarily, if you have leaders and employees who do not support an anti-racism agenda within your organization, you must also have policies that reinforce accountability for those leaders and employees. Whether it’s reprimands, low employee rating or pay and position reductions, we must see your commitment operationalized. Every part of the organization should develop metrics and accountability to include but not limited to board governance, executive leadership and strategy, programs operations, sales, marketing, supply chain and human capital.
Being reprimanded, a reduction in pay and/or termination will suffice.
3.“Show me the money!" Invest in anti-racism and divest from racist and white supremacy culture practices.
Everyone in and around your organization knows how you spend internally and externally when you are real about something. Adjust your budget by investing internally in the time and effort needed to implement your radical change.
Make an effort to fund and contract with Black institutions and organizations, especially if your health organization or agency has made a commitment to address the health inequities that exist within those communities. You must do business with Black organizations and businesses if you want to be an anti-racism organization.
Your whole supply chain operation must reflect your commitment to address these inequities and injustices. Whether you are buying pens, pencils and paper or using a search firm to replace senior executives, you must contract with Black-owned businesses.
4. Transform the composition of your board of directors and senior staff.
Let’s face it, if you knew how to dismantle racism and build an organization that operationalizes a commitment to structural change, you would have already done it. We know that structural problems require structural solutions. In order to be different, you must look different as a leadership team. There is a high correlation between successful outcomes for racial justice and when you have racial diversity at the decision-making table. An organization’s board of directors and senior staff hold an insurmountable amount of power.
That power can reinforce a paternalistic and white supremacy construct if the board and senior leadership team is not sufficiently filled with Black leaders. You must appoint, hire and recruit differently.
Health organizations should review the racial and ethnic compositions of their board of directors and senior staff and challenge themselves to fill these positions with BIPOC (at least 51% of the positions). Among this group, more than half of the people of color should be Black.
5. Do your homework. Then do some more.
Review the following the anti-racist resources.
- Anti-racism resources for white people
- The Center for the Study of Racism, Social Justice, and Health
- Racism: Science & Tools for the Public Health Professional
- North American Society for Pediatric and Adolescent Gynecology (NASPAG) Anti-racism and Ally Resource list
- Association of American Medical Colleges Anti-racism in Medicine Collection
- Research in Policing, Civil Rights, and Racial Justice
- National Association of County and City Health Officials (NACCOS) Roots of Health Inequity
Joia Crear-Perry, M.D., Luella Toni Lewis, M.D., and Anton J. Gunn are principals at The Health Equity Cypher.