Advancing the Social Determinants of Health as the Pathway to Recovery for Black People
The COVID-19 pandemic has exacerbated the historic and systemic issues that have long beset Black communities. Black people experienced more hospitalizations and deaths, lost more jobs and businesses, and are now predicted to have a lower life expectancy as a direct result of COVID-19 than any other racial or ethnic group. Where some may chalk up what is happening in the Black community to genetic codes or general pandemic fallout, that is not the case. The impact of COVID-19 on the Black community is a direct consequence of the social determinants of health (SDOH)—factors that can impact health such as where we live, how much money we make, and whether we have access to food, healthcare, and housing. If we want Black people in America to live healthy lives, thrive financially, and bolster our economy, we need more than vaccines and treatments; we need to make sure we invest in the social determinants of health in ways that meet the needs of Black communities.
We often describe the SDOH as the conditions in which people live, learn, work, play, and pray. While this definition is a great way to quickly communicate the importance of the SDOH, it just gives us a sense of what they are, not why they matter or how to truly move a successful SDOH agenda.
We do often talk about the SDOH as a set of actions—bringing affordable housing, grocery stores, transportation, good paying jobs, clean air and water, quality childcare and schools, parks and recreation, small businesses, and other amenities to communities. And moving an SDOH agenda is about all of this. But if these actions aren’t centered or rooted in Black people’s experiences, then our SDOH agendas will fall short. It might not matter how many SDOH advances we bring to a Black community if we don’t provide what Black people specifically and structurally need. If we only provide the what of SDOH, without an understanding of the why and how, a just recovery will remain beyond our reach.
Last year, Citigroup estimated that the cost of racism to our economy was $16 trillion. This loss of income results from discriminatory lending to African American entrepreneurs, wage disparities, housing credit discrimination, discrimination in accessing higher education, and more. If housing and community development practitioners move forward in our action-based work without considering the larger systemic forces at play, we are unlikely to achieve the results we seek. We will be focusing on what’s easiest rather than what is best for the Black community. As a result, we will continue to increase the amount of money lost rather than shifting the balance sheet to gains.
How do we move the why and how of SDOH? The first step of the why is to learn, listen, and converse with the Black community, which seems obvious, but in practice doesn’t always happen. In Thoughts on Centering Blackness and Employment Equity in Detroit, Sarida Scott alludes to the power and importance of understanding and incorporating Black history and the Black experience into our community development and housing work. Our field has become so professionalized, with our degrees and complicated spreadsheets, that we can forget we actually might not know everything. So often we see Black communities for their thorns rather than the beautiful roses of our people, culture, art, history, and triumphs. To ground our work in the why, we need to review data, read history, study past and current community plans, piece together the stories that explain what led to today’s conditions, participate in anti-racist training, and develop earnest questions that draw out answers from the community itself. This is not the time to hypothesize; this is the time to listen for the solutions that come forward from the community. To do this, we need to go where Black people want to be heard and figure out how to build trust in order to move their priorities and interests.
In one initiative I worked on, the partners—including the county public health department, social service and housing advocacy agencies, community developers, and residents—sought to address health disparities in a Black community. Initially, we were focused on programmatic intervention to address high hypertension rates. But as we engaged more with the community, onboarded residents into the initiative planning table, and studied the neighborhood history as part of our planning process, we changed our focus to making structural changes in the living conditions of the Black people in the community. We discovered that at one point there had been nearly 100 food outlets in the neighborhood along with three grocery stores. With the construction of freeways and the global outsourcing of local jobs, their thriving food and small business infrastructure shuttered. We also learned that rising rents were increasing stress levels and forcing people to make choices between eating healthy food and taking medication. We realized that our programmatic strategies needed to fit into a larger context of aligned actions. The work of the partnership became tackling the affordable housing crisis amongst Black residents, addressing the small number of Black-owned businesses, attracting a grocery store to erase the decades the community had been without one, and driving change by implementing programming that focused on celebrating community assets, culture, and leadership.
Once we are clear on the what and why of SDOH, we need to focus on how to move our SDOH agenda, which usually depends on investment and capital. In 2021: Changing the Perspective from Need to Opportunity, Ja’Net Defell provides guidance on the kinds of capital, creativity, and capacity support that Black communities need. She argues that we should look at investment through an opportunity lens rather than focusing on deficits and risks. Moving an SDOH agenda requires significant capital. We need to think beyond grants and below-market-rate loans, which are important but not always sufficient or available. Creative strategies that can contribute to securing the capital and investment needed to move SDOH agendas include leveraging balance sheets to secure assets, allocating staffing for place-based initiatives, partnering with developers, providing real estate and financial consulting, providing capacity supports to new developers, and finding ways to prioritize Black neighborhoods in city and county plans.
Another critical element of the how is strong partnerships across sectors, including community residents. The complexity of moving an SDOH agenda for achieving health opportunity and equity by nature requires diverse and aligned partners. No one organization, resident, or institutional partner can accomplish this work on their own. In Recovery Together: Developing a Collective and Equitable Approach to Economic Recovery, Joanna Trotter writes about the importance of cross-sector collaborations. She discusses her work at the Chicago Community Trust and the importance of partners in advancing their bold “Together We Rise” initiative. The Trust recognized the need not only to implement a multi-faceted, community-led-and-informed initiative, but to bring together a diverse set of partners to move the initiative in the ways the community identified that they wanted to rise. Similarly, all the partners involved were essential to the evolution of the initiative I described above.
Moving an SDOH agenda isn’t easy, but it is possible. We are living in unprecedented times that give us a real opportunity to make change now. As we move toward recovery, it’s time to figure out how we, as practitioners, move beyond our sector boxes and really listen and partner to build sustainable spaces where Black people can live, learn, work, play, pray, and thrive in all dimensions, not just now but forever. If we center the Black experience to guide and move our SDOH work, we can achieve a deeper and collective health and economic recovery. The COVID-19 vaccine will not be a silver bullet for the Black community unless we pair our vaccination campaigns with committed action that focuses on the what, why¸ and how of the social determinants of health.
Romi Hall has years of experience managing place-based initiatives at the intersection of community development and health. Currently, Romi is the Director of Healthy Homes and Communities at NeighborWorks America. Prior to joining NeighborWorks America, Romi was the Director of Neighborhood Collaborations at the East Bay Asian Local Development Corporation in Oakland, CA. In that role, she established and oversaw the organization’s neighborhood-based collective impact work. She also previously worked as a project manager in St. Louis, MO, at Beyond Housing on their 24:1 initiative and provided guidance to 24:1’s strong communities and health strategies. She also has prior experience in early childhood development and faith-based organizing. Romi has a Master’s in Public Health from Drexel University and a Bachelors of Art in Journalism from the University of Nevada, Reno.