Get all our letters by signing up here

Need equity?

“And I was already on my way to being a true freak, because I knew I would always choose to go where my blood beats, in any and all directions.”

bell hooks

“We’ve done our work for 15 years without a focus on racial equity and had success. So why should we make this core to our work now?” This was the primary question put to me at a recent meeting with a group of healthcare policy advocates in the Northwest. The room was largely folks who saw “equity” as the latest progressive fad. They didn’t want to go chasing buzzwords and yet they couldn’t see why racial equity might be a core part of the daily work they did in predominantly white, rural communities.

You know, I couldn’t blame them for not wanting to slap some new approach on their work – racial equity or otherwise – to please an audience or a funder. I thought that was wise. And yet, there was this mountain to move, something I had to help them see that had been in front of their eyes the whole time, but invisible to them. This group of healthcare advocates had learned and believed that racial equity was an “urban” issue that one only works on when there is a visibly large number of people of color in one’s community. In that case, advocates hold some trainings and workshops to confront personal biases and prejudices. Then everyone goes back to their primary work at hand, feeling wiser and woke without major changes to the core of their work.

Had this been five years ago I would have started sweating, feeling the room darken and a large spotlight shine on me. I’d have grabbed my top hat and cane and tried to convince them it was worth their time, that it was both morally important and would help their organization. I’d acknowledge their position of not seeing and not knowing as acceptable and then feel like it was my responsibility to persuade and enlighten them.

Yet, today, while I can understand their position, I can no longer accept it. While I had compassion for why they asked the question — it is one I get about once or twice a week — I no longer accept the role of persuader or convincer. Instead, I took a deep breath, and I said something like this, with love and care:

Imagine you are having heart problems and go to a heart surgeon. They are quite good with a scalpel. They can talk to you all day long about what’s wrong with your heart muscle, what it needs and how it will benefit from an operation. They sound smart, and you’re feeling pretty good about the surgery. But then you realize they haven’t said anything about blood, or hemoglobin, or veins and arteries. They really understand how heart muscles work, but they don’t understand the underlying system. Sure they acknowledge there is a thing called blood, but it’s not part of the muscle tissue they focus on when doing surgery. So, would you let them cut you open?

I wouldn’t. I’d want that nice, well-meaning surgeon to go learn a bit about the circulatory system and how it works before they raised their scalpel again. For me, the same dynamic exists for non-profit professionals. Just as it would be misguided to do heart surgery without understanding the circulatory system, it is equally misguided to attempt systemic governmental or societal changes in the US without understanding racial inequity/justice and accounting for them and addressing them in your strategies to achieve your mission.

Questions of race are embedded in healthcare. The US healthcare system was designed to provide for the health of some at the expense of others. This logic is born out of the history of slavery as made clear in the 1619 project.  And we need look no further than the recent decline of the life expectancy of white people in states that have refused Medicaid expansion and expanded/loosened gun laws to see the connection between health in rural white communities and race. The racist policies, and the racist electoral rhetoric of politicians committed to centering and maintaining white power are killing people. Fighting racial injustice must be a part of any strategy to improve healthcare in the US.

I tend to stop somewhere around there and we all take a deep breath in the room.

I would have done these advocates no favors by denying them the truth. Organizational leaders who do not understand the racial dynamics at the core of how our government, society, and economy function are never going to achieve their mission in the long run. They’ll have limited successes, and then keep wondering why the system never seems to change.

Inevitably, after I share this analogy with a group, they look at me and say: OK, Nico – we get it. We need to understand that racial injustice is a core part of pretty much every system in the US we want to change and we need to make racial justice a part of our work. But what do we do with the folks above our pay grade (in senior staff or on the board) who don’t yet get it?

My answer is simple: Stop giving them the knife.

We must create the conditions to call senior leaders into a period of meaningful analysis and reflection. I will often need to design dialogue or interventions that call in and make bare tough, uncomfortable questions for senior leaders: tough enough to compel them to stop and compassionate enough to provide them the energy to dig deeper. This isn’t often something staff are able to do themselves given the power dynamics of a workplace. So, we must create the conditions for others to help. [a recent screening of Late Night brought this point home]Before moving to action with a team, I often invite senior leaders to see themselves for who they are and fully understand the systems they operate in, in order to find a new, more effective path forward. I seek to create a space where they can courageously acknowledge without shame: They’ve had important successes, and they’ve been making mistakes. They have missed opportunities, they have done a disservice, and at times they have done harm.

I certainly didn’t come to these realizations on my own. It’s taken years of trial and error to live into my understanding of systems and racial equity; years of ruminating on the invaluable work of others, including:

• Ian Haney Lopez’s work: Here’s a great video with Heather McGhee from Demos, and Ben’s Beacon Podcast interview with him on his new book Merge Left
• Vu Le’s simple and direct post
• The Government Alliance on Race and Equity’s assessment tool
• Colorlines and Race Forward
• REI’s Ground Water Approach
• The groundbreaking research from Race to Lead
• The Awake to Woke to Work report from Equity in the Center

Along the way I’ve had the honor to learn with path breaking thinkers like Kerrien Suarez, executive director of Equity in the Center. Check out our chat and Kerrien’s approach to why racial equity is at the core of our work.