South Carolina’s Department of Public Health (SC DPH) may be placing racial justice squarely in the middle of the state’s plan to bring “health equity” into health care. This is based on conclusions drawn from publicly available documents of SC DPH’s partner involved in creating our state’s health equity roadmap.
This research report introduces readers to the Alliance for a Healthier South Carolina (AHSC), one of the co-authors behind South Carolina’s health equity plan. Our focus will be on a specific AHSC document that outlines the basis for making racial equity and racial justice core to the South Carolina’s health care system. But other AHSC-authored items will be consulted to help explain and define AHSC’s guiding positions.
A Statement on Racial Justice
In 2020, a time of Black Lives Matter protests and riots and the advent of COVID-19, AHSC leadership released a Statement on Racial Justice on behalf of the group’s stakeholders. The statement claimed that, from AHSC’s inception, its commitment “to improve the health and wellbeing” of all state residents had been “built on the foundation of pursuing health and racial equity together.” Alluding to racial disparities in health outcomes, AHSC declared that “we have to acknowledge that the health inequities and social injustices due to systemic and institutional racism can no longer be accepted or tolerated.” The website post included a declaration in the name of AHSC’s member groups expressing solidarity with those “most impacted” in the state and calling for collective action:
As key public and private sector leaders in the state, it is time for us to stand up together with the people and communities in SC most impacted by these injustices and say, NO MORE.
• NO MORE to not openly acknowledging structural and institutional racism and associated racial biases as the root causes of major health, education and economic disparities for communities of color across SC;
• NO MORE just talking solely about pursuing health equity, but also take and encourage meaningful action at the policy, program and practice levels to achieve racial equity and justice;
• NO MORE taking actions to and for communities of color but rather work with those communities as equal partners in identifying and implementing solutions;
• NO MORE accepting racial disparities in health and wellbeing as inevitable, but rather embrace that these disparities are preventable by speaking with one voice and taking action with one purpose- a healthier SC for all.
This day, we renew our common commitment to achieving health equity, racial equity and social justice across our state. We will not rest until every person and family in SC, regardless of the color of their skin or where they live, learn, work or worship, have the opportunity to achieve their optimal level of health and wellbeing.
Juana Slade, Chair, Alliance for a Healthier SC
Monty Robertson, Director, Alliance for a Healthier SC
It is significant to note that AHSC views the “root causes” of South Carolina’s health disparities across the health care sector, education, and the economy, as resulting from “structural and institutional racism and associated racial biases.” This would suggest that, to AHSC, the key to eliminating disparities in health outcomes – a major focus of SC DPH’s health equity plan — is to focus efforts on addressing “systemic and institutional racism.” As a side note, this would put AHSC in complete agreement with the nation’s premiere health care agencies and medical systems which have been radicalized by Marxist-based ideology.
A different 2020 web post revealed that AHSC, “a coalition of more than 50 executive leaders from diverse organizations … recently released South Carolina’s first state health equity action plan.” It’s important to read their full statement at the provided link, since it carries enormous implications for the direction of South Carolina’s health equity strategy. Here is a snippet from the AHSC’s remarks:
The plan, titled “Collaborative Strategies for Advancing Health & Racial Equity in South Carolina,” was created by the Alliance’s Health Equity Action Team to support the framework of the state health improvement plan Live Healthy South Carolina by encouraging racial equity strategies in promoting health. It looks specifically at creating leadership capacity that promotes health and racial equity as core systemic values and how to take collective action at the policy and programmatic levels to eliminate equity-based gaps in health outcomes. (emphasis added)
From the post we may understand that the state’s “first state health equity action plan” is also about advancing racial equity and that it will “support” the state’s health equity framework Live Healthy South Carolina (LHSC). Advancing racial equity will, according to the text, involve developing a leadership cadre that will “encourage racial equity strategies in promoting health.” AHSC described a type of leadership that makes racial equity a key institutional element through “core systemic values” within health equity and presumably the state’s health equity approach. This generation of leaders engage collectively to target existing institutional policies and programs. And it appears from the following statement that, through the coordinated efforts of AHSC’s members, racial equity health strategies will be embedded across major categories of South Carolina’s health care, beginning with these:
Over the next five years, the Alliance will join with state, community and corporate partners to implement these strategies to eliminate health inequities and ensure fair and just health outcomes in South Carolina. This will include focusing on some of the biggest gaps in health outcomes in the areas of maternal and child health, behavioral health and chronic health conditions. (emphasis added)
The post links to “Action Plan 2019-2024: Collaborative Strategies for Advancing Health & Racial Equity in South Carolina.” (“Action Plan”) (Archived here)
The document showed the logos of AHSC and of LHSC, which is the SC DPH partner entity, and confirms that the “health and racial equity strategies” will serve as “a supporting framework for Live Healthy South Carolina.”
The Action Plan begins by attributing the basis for a health equity approach to “growing recognition among health experts” that “health and well-being” is determined by “social and environmental factors.” The result is “major equity-based gap in health access and health outcomes.” According to AHSC, “[t]hese equity gaps are driven by disadvantages and discriminations.” Among the several influencing factors cited in the Action Plan was “the impact of systemic barrier [sic] to health rooted in history.” (emphasis added) Later, the document makes explicit reference to “systemic and institutional racism.” The stated purpose of the action plan was “to understand and address the root causes of health inequities by increasing capacity and building infrastructure to collectively respond to current and emerging equity-based issues.” In social justice literature, the term “root causes” is another term for both systemic racism and white supremacy.
The Action Plan’s guiding principles
The guiding principles behind the Action Plan’s “health and racial equity strategies” were the following, quoted verbatim:
Guiding Principles
These health and racial equity strategies are built on the following set of guiding principles:
• We recognize and acknowledge that racism, unconscious and implicit biases, and the discriminatory effects of structures and policies created by historical injustices have an independent influence on all social determinants of health and have a harmful impact on health. (emphasis added)
• We understand that every individual and organization in South Carolina is adversely impacted from a social and economic standpoint by the major existing health and racial equity gaps.
• We commit to facilitating equity-stratification of all relevant health and healthcare data/metrics. (emphasis added)
• We believe that meaningful engagement of marginalized communities and those most impacted by health inequities as an equal voice in the health improvement decision-making process is vital.
• We actively support diversity and inclusion in the workforce development pipeline. (emphasis added)
• We promote using a “health in all policies” approach to promote health and social equity at the community and state levels. (emphasis added)
In the Action Plan’s guiding principles, we see that AHSC chose from among all potential social determinants of health (SDoH) and opted to begin its discussion by making an “acknowledgment” linking health impacts to “historical racism,” unconscious biases, and discriminatory institutions and their policies. The Plan calls for community engagement among “marginalized communities” and populations, giving them a decision-making role in crafting health and racial equity policies. AHSC expressed its support for a “workforce development pipeline” involving “diversity and inclusion.”
“Equity-stratification” of data
The guiding principles commit to advancing “equity-stratification” in healthcare data and metrics. Though not mentioned in this document, this would necessarily entail the re-configuring of medical data systems to focus on collecting and evaluating racial and socio-economic factors as key to gauging progress in the equity agenda. The entire medical care system would, consequently, become fixated on race and income data as a measure of the “quality” of the services it provides. Equity-based data collection and analyses could result in future health policies and decisions about allocation of health resources being made on the basis of race and socio-economic status among population groups. The goal would no longer be top-notch health care. The holy grail would be to eliminate health disparities between black and white populations. Those health disparities would be pursued across every economic and social sector identified as producing SDoH. See Part 1 of this article series for some of the categories of SDoH named on the SC DPH web page for health equity with regard to eliminating health disparities. (Archived here.)
In South Carolina, one of the more shocking examples of how equity-stratified data are used is found in a report by the South Carolina Institute of Medicine & Public Health (IMPH). The document may have been relocated at the time of this publication, but is archived here. The acknowledgments include the AHSC Health Equity Action Team and, individually, Monty Robertson, now Executive Director for AHSC. Also named is someone from SC DPH (then DHEC) and individuals from among South Carolina’s key health and education institutions.
The IMPH report uses data to explain health disparities by race due to systemic racism as “revealed” during the COVID-19 era. It opened with a “statement about racism as a public health crisis” and included a “brief history of racism and health care.” This was followed by data and graphs relating to SDoH and racial disparities. The section on SDoH closed with “expert-derived recommendations for reversing course and creating a stronger safety net for South Carolinians.” Following these recommendations would ensure that South Carolina is transformed into a nanny state.
Health in all policies, an “integrated government” approach
The Action Plan promotes a “health in all policies” approach. The World Health Organization (WHO) likewise urges the use of Health in All Policies (HiAP) to enhance “intersectoral action to address the social determinants of health equity.” HiAP is described by WHO as “an approach that aims to address policies such as those influencing transport, housing and urban planning, the environment, education, agriculture, finance, taxation and economic development so that they promote overall health and health equity.” It’s literally about the process of writing policies that intentionally bind health outcomes to every economic and social sector. Naturally, it focuses on SDoH. The cited WHO page is rather emphatic about the educating the health worker to better understand SDoH. WHO also underscores the importance of advising policymakers toward HiAP-driven services and outcomes. Several U.S. organizations have translated the global HiAP model so it can be implemented at the national, state, and local levels. It’s not clear if AHSC and SC DPH follow a specific model of HiAP.
Educating about institutional racism
Four “strategic goals” are named in the second half of the Action Plan and readers should examine them. Some observations will be offered here. The first strategic goal involves education and training.
The Action Plan offers few clues about the content of the proposed training other than that it will “increase awareness” of the “root causes” behind health inequities, “including systemic and institutional racism.” Of the seven total strategies and key actions listed, four mention some aspect of educating parties about “institutional racism.” Therefore, if we were to imagine the content, we might expect it to involve a very intensive Diversity, Equity, and Inclusion (DEI) approach. Participation would extend beyond healthcare workers to include employees of businesses, students, community workers and volunteers, state workers, and others.
The Plan calls for “cultural competency training.” It’s more common in health care settings to see the term “cultural humility,” a closely related idea that developed from within the nursing and health care profession. Both cultural competency and cultural humility involve critical consciousness, a concept from Marxian ideology. It refers to a state of mind, internalizing the viewpoint of the poor and oppressed, leading to a profound shift in one’s worldview. This altered way of seeing the world instills a “compulsion” to elevate the status of the poor and oppressed in all decisions. The commitment to activism is a key component of the psychological transformation toward critical consciousness and this is drummed into students during training. The descriptive term “compulsion” was offered by a professional counselor seeking the most apt description of the effect of critical consciousness on the behavior of instructors and fellow students in her graduate-level mental health studies program.
The topic of DEI, cultural competency training, and cultural humility is deserving of a separate report, owing to the significant impact this type of education has on the attitudes and beliefs of participants who are then primed to enact social change through progressive and socialist policies.
Systems change
The Action Plan, in Goal 3, seeks to “[i]nstitute specific policy, practice, and system changes that remove barriers to health and racial equity within organizations and communities.” Equity is all about the complete transformation of American systems and policies away from our existing social values toward a progressive, antiracist belief system and from capitalism to socialism. It’s about centralizing government oversight and control over resources, including human capital, where people are increasingly viewed as a collective, divided into identity groups, rather than as individuals.
Community organizing for racial equity
Under Goal 4 strategies, the Action Plan described health systems developing collaborative partnerships with the business community and education institutions. These partnerships would “maximize diversity and inclusion at all levels of training and employment.” This would allow sharing, comparison, and perhaps streamlining of “best practices around hiring, training and policy changes that support an inclusive work environment.” Racial equity goals could be introduced to all South Carolina counties through “equity-focused collective improvement activities.” Examples provided included “Data Walks, Community Health Assessments, Community Health Improvement Plans, and Community Dialogues.” Among the bullet points for “key actions” was “[p]artner with organizations and groups to elevate efforts on social justice issues.”
One awkwardly worded bullet item was: “[d]evelop opportunities for capacity building with community leaders around health equity challenges and solutions. One interpretation supported by health and racial equity materials belonging to other organizations suggests this is community activism training and organizing, perhaps involving community based participatory research (CBPR) projects.
CBPR involves encouraging community residents to identify a health care social justice issue relevant to their lives. They are trained to canvas neighborhoods, collect and stratify data, and create reports and presentations that are used to influence policymakers. Their university partners are conditioned to approach them with a posture of “cultural humility” and to view these local researchers as possessing special knowledge and insight by virtue of their “marginalized” status and personal experience of oppression. For academics, it results in access to data that can’t be obtained through normal means, owing to language barriers and reluctance of residents to be honest with outsiders.
Part 4 of this series will look at the history and formation of AHSC, including the stakeholder organizations bringing a centralized power system to our state through health care.
Here are the links to Part 1 and Part 2 of this series.
The post SC Health Care in the Crosshairs of Racial Justice appeared first on Palmetto State Watch Foundation.