Community health workers, health departments and the public attended an in-depth virtual presentation Monday night hosted by statewide advocacy nonprofit Health Equity Solutions that identified and defined the complex aspects of health equity, its relationship with racism and how it manifests.

The presentation opened Connecticut’s third annual Health Equity Week, offering an opportunity to learn and reflect on the systemic structures contributing to inequity, said Kevin Collins, director of training and outreach with Health Equity Solutions. Collins explained that opening the week with the terminology and concept allows participants to understand and fully engage in the conversation.

“[The presentation] is really a starting point. It’s the start of the conversation as it relates to health equity,” he said. “We don’t expect folks to leave here [as] experts in health equity. This is the first part of meaningful conversation.”

Program manager of training and outreach Namandje Wali began the presentation by defining keywords and concepts regarding health, race and inequity.

The World Health Organization defines health as a state of complete physical, mental and social well-being – not merely the absence of disease. Wali said they use the WHO definition because it shows that health is related to more than just a person’s physical well-being and sickness.

“We assume that health is only one of those things or maybe two of those things, but definitely not inclusive of all of those things,” Wali said. “It’s easy to see health and solely healthy behaviors and healthy actions, when realistically there are many factors that impact the state of a healthy being.”

Inequities come into play when differences in health status can be attributed to external conditions outside the control of an individual, Wali said. It manifests through social determinants impacting health outcomes, such as housing, socioeconomic status and access to affordable medical care.

For example, Wali said many individuals who don’t have health insurance don’t seek preventative care due to the cost and, as a result, have worse health conditions than individuals with insurance.

Social determinants are more than a person’s socioeconomic and educational background, though. For example, Black women with a college degree or higher are still nearly twice more likely to die of pregnancy-related causes than white women without a high school diploma, Wali said.

Although Connecticut has improved in terms of resources and health outcomes over the years, Wali pushed the audience to question who benefits from those resources.

“Who do these statistics highlight? Who can access these resources?” she concluded. “With the allocation of resources is someone able to live to their optimal health, then what factors play into these different outcomes?”

Collins noted the importance of discussing the impact of racism while working towards the ultimate goal of equity. In an interview with Record-Journal, Collins defined “race” as a social construct that classifies people into distinct groups based on specified criteria such as skin color, hair type and language spoken. He explained that race was created and is primarily used to justify the institutional oppression of those communities.

“Racism is a complex and multi-layered social system that creates and deems access to power, privilege, resources and information based on racial categories,” he said. “It’s an ideology, a belief system that has constructed a hierarchy based on race, which then lends itself to rendering groups as superior, dominant, and others as inferior or outside of the norm, which produces those inequities that we see.”

Collins compared the four forms of racism to the roots, branches and leaves of a large tree.

Structural racism lives within the root of the tree, Collins said. The foundational systems of power affect a person’s opportunities in all aspects of life.

“It occurs underneath, throughout and across all facets of society. It is cumulative and compounding in nature,” Collins said. “It lies on top of one another.”

The branches of the societal tree represent institutional racism, Collins continued. He explained that this form of racism comes from discriminatory treatment and unfair policies and practices, often leading to racially inequitable opportunities or outcomes.

Since we interact with these institutions, Collins added that the tree leaves bear fruits based on those actions and their connection to structural racism. For example, Collins said healthcare coverage is “exclusionary,” since it’s heavily tied to finances and many people of color aren’t able to afford it.

Interpersonal racism refers to racism between individuals such as bigotry, harassment or visible bias. One of the most recognizable forms of interpersonal racism is micro-aggressions.

“Microaggressions are aggressions and have a huge impact on us. But when we say micro, that refers to the span of time it takes for it to happen,” Collins said. “These, again, cause harm but are often deemed micro because of the time.”

Similar to interpersonal racism, Collins said internalized racism comes from people’s personal beliefs about their own identities and their relationship with them. In the tree analogy, interpersonal and internalized racism are represented by the people breathing the oxygen the tree creates and are influenced by the ideology.

“Systems are made up of institutions and institutions are made up of people,” Collins said. “So, if we are dealing with race and the ways it has impacted us, we’ve all had experience with race and racism and we need to talk about it in order to begin to move institutions toward equity.”

Program manager of training and outreach Taylor Tucker explained the difference between equality versus equity in a health context. He presented a slide depicting three individuals with different abilities trying to climb up different hills.

He defined equity as “everyone [having] the opportunity to attain optimal health regardless of race, ethnicity, gender, income level or other social factors that create barriers to health.”

Tucker explained that equality means everyone receives the same resource or tool regardless of their conditions and circumstances. So, in the example, the participants are all given the exact same tall street bike to help them. However, only one participant can use the tool because one boy is too short to ride the bike, which isn’t equipped for his rocky hill, while the last participant uses a wheelchair.

Meanwhile, Tucker said that equity is when everyone receives specified support and resources based on the person’s circumstances, barriers and needs. Tucker went through each person’s situation and provided the necessary tools to achieve their goals. For example, the short young boy is given a small mountain bike, while the individual who uses a wheelchair receives a motorized chair to help her climb the hill.

Collins compared equality to everyone receiving the same blanket without consideration of a person’s surrounding climate and environment. Instead, providing tailored services can help people reach their health goals.

“In order for folks to reach their optimum level of health...they need resources dedicated to their personal needs, their circumstances, the systems, the areas that they inhabit,” he said.

Health Equity Solutions will be hosting other events in honor of health equity week. They are hosting a “Community Health Worker Lobby Day” at the Legislative Office Building in Hartford on Thursday in collaboration with the Community Health Workers Association of Connecticut.

cvillalonga@record-journal.com203-317-2448

Reporter Cris Villalonga-Vivoni is a corps member with Report for America, a national service program that places journalists in local newsrooms. Support RFA reporters at the Record-Journal through a donation at https://bit.ly/3Pdb0re. To learn more about RFA, visit www.reportforamerica.org.