Conservatives and liberals should rally around equity
Of the many executive orders issued on Day One of the Biden administration, those directed at equity have caused perhaps the greatest consternation among the president’s critics.
The decrees — four of them — lay the groundwork for policies that aim to address and eventually undo “systemic racism and discrimination in our economy, laws and institutions.” America’s promise, the White House says, is “out of reach for too many families of color.”
Even though the use of the word “equity” has a long pedigree in American politics, today its use and elevation in public policy discussions has set off hand-wringing in some circles that this is the beginning of the end — the application of a term with “no meaning” that is really just a clever shortcut in our nation’s inevitable march toward socialism.
In practice, achieving equity in America would mean that every person — irrespective of zip code, income, race, ethnicity, or occupation — has a fair and just opportunity to not just survive, but thrive. In reality, we’re not even at the end of the beginning of our nation’s path toward an equitable future.
During my tenure as commissioner of Chicago’s Department of Public Health, efforts to achieve equity were not political maneuvers meant to give to one or take from another. My colleagues and I saw our work as integral to the long-term goal of ensuring that every person in Chicago had a fair and just opportunity to not just survive, but thrive. Health is about so much more than health care. A healthy neighborhood is one that is a genuine community, safe and walkable. It’s a place with stable housing, access to fresh foods and public transportation. It’s a place where a child can get a quality education, play in parks and read in libraries. We aspired to bring this form of equity to every child in Chicago and we should work together to achieve equity for every child in America.
Simply defined, equity is about fairness, which is among the most subjective words in the English language. However, we can objectively examine other measures — the unemployment rate, household wealth, life expectancy, educational attainment — that reflect the barriers centuries in the making that have harmed communities of color, in particular. Even so, equity is not a liberal or conservative concept that needs to be tethered to one party. Issues of inequity can plague people in rural America and urban dwellers alike — a lack of broadband access, hospital deserts, a dearth of public transportation, food insecurity and underfunded schools are plagues unrestrained by politics or party. Individuals can suffer the effects of inequity because of economics, education, long-festering discrimination, or some other barrier like geography. In rural counties in the center of the country, for instance, a shortage of pharmacies is hampering the distribution of COVID-19 vaccine, potentially extending the pandemic in these communities. In addition, decisions not to expand access to Medicaid under the Affordable Care Act stand to exacerbate health care inequities in the dozen holdout states. In Georgia, Wisconsin and many states in between, people’s access to health care is limited simply because of where they live.
The reason we need policies at all levels that consider equity across sectors — from education to health care to transportation to law and justice — is because issues of equity can be like dominoes in a person’s life. I’m a pediatrician. I know that if a mother does not have access to prenatal care, her child stands to have a worse outcome at birth. And if that same child is born into a neighborhood with high crime rates and old homes slathered in lead paint, that child’s chances are diminished further. And if that child’s school doesn’t have the resources to provide a good education — and during this pandemic, online learning — that child will be unlikely to grow up to find a stable job with good benefits. This all ultimately will impact how long that child will live and the dominoes of that life and other children with similar challenges and barriers in that neighborhood will continue to fall in familiar and predictable patterns.
The connections are clear to see, but only if we’re willing to look. Take the issue of safe streets and housing. The city of Chicago has been a convenient foil for gun rights groups who battle regulation by citing the carnage in my home city. These arguments tend to focus narrowly on gun violence while conveniently ignoring the many root causes. But that gun violence is the toppling of one more domino, often the end piece in a chain of inequities that began with redlining, forced segregation and other forms of embedded discrimination in housing that have long-term impacts on health and well being. Chicago’s South and West Sides are disproportionately affected by gun violence and these neighborhoods also have not seen the investments in resources common in other parts of the city. These inequities show up in gun violence statistics, housing instability and in the disproportionate impact of COVID on people of color we’ve seen in Chicago and across the U.S. throughout the pandemic.
Public health outcomes are not just about the choices an individual makes, but the choices available to people in any community. Importantly, equitable policies serve all people, including those who have benefited from our current system. As we have found during the pandemic, we are interconnected, and a community’s health and well being cannot and should not be sequestered by neighborhoods.
In our politics today, language is often weaponized in an attempt to end the discussion, blunt any policy changes and too often to maintain the status quo. This is done to inflame rather than illuminate the issues. We cannot let this happen with the word equity or the concept of a more equitable nation. We need health equity in America in the same way that we need clean water, nutritious foods, safe streets and good schools. We need these basic necessities in the reddest counties in Utah and in the bluest neighborhoods of Chicago.
Equity, properly understood, is a bridge to a better future for all Americans.
Julie Morita is executive vice president of the Robert Wood Johnson Foundation and served on President Biden’s COVID-19 Advisory Board during the transition. She was formerly a medical director, the chief medical officer and then commissioner for the Chicago Department of Public Health. Follow her on Twitter: @DrJulieMorita.