January 2020 Newsletter

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Health and Housing Equity Connection

Gilvar Consulting Services Newsletter

January 2020

This month’s topic:

Racial Equity Leadership Resources

This month’s GCS newsletter is dedicated to articles and other resources to help change agents move from acknowledging the impact of implicit bias and white supremist assumptions that operate under organizational and community radar to creating action plans with concrete steps that will actually move the needle and advance racial equity. 

GCS projects include training, facilitation, and other support to agencies in the government and non-profit sectors that serve communities of color and seek to better align their internal culture and policies/procedures with their racial equity goals.  I provide these services in collaboration with consulting groups led by People of Color.  For example, on March 18, 2020 I’ll co-lead with Bernardo Ruiz, Principal at Racing to Equity Consulting (https://racingtoequity.org/) a workshop on titled Leading for Equity at the Housing First Partners Conference in Seattle (https://www.hfpartnersconference.com/).  

Articles and Other Resources:

From Data to Action

Citing data unmistakably link race with poor health and housing outcomes, leaders within public health agencies, community health care providers, Continuum of Care entities, and many other organizations have attempted to develop new strategies to produce more equitable outcomes. In seeking deep and lasting impact, however, these leaders encounter barriers stemming from the persistent influence of unconscious bias and white supremacy that pervades our culture. An October 2019 report by C4 Innovations titled Coordinated Entry Systems Racial Equity Analysis of Assessment Data (https://c4innovates.com/wp-content/uploads/2019/10/CES_Racial_Equity-Analysis_Oct112019.pdf ) outlines researchers’ findings that the most commonly used assessment tool for prioritizing access to scarce housing units for people experiencing homelessness results in statistically significant discrepancies in scores that favor whites over people of color. This article demonstrates why genuine community and organizational dialogue around these issues is so sorely needed. 

It’s Time to Address the Role of Implicit Bias Within Health Care Delivery by Shantanu Agrawal and Adaeze Enekwechi (https://www.healthaffairs.org/do/10.1377/hblog20200108.34515/full/) makes a strong case for the improved use of data to develop and institute practices to identify and counteract bias in clinical settings. Agrawal and Enekwechi argue that progress in turning the attention of health care providers and policy makers to the social determinants of health (SDoH) has created a risk for a false sense that inequity comes from outside the healthcare system.  To counter this risk they offer a range of action steps that health care providers can take in response to extensive research findings indicating that racial and ethnic minorities and women are subject to less accurate diagnoses, curtailed treatment options, less pain management, and worse clinical outcomes. Their suggestions include using a racial equity lens to better understand health care utilization data and performance. Specifically, they argue that “delivery systems and payers should use all available data to conduct subgroup analyses to determine whether individuals across demographic characteristics are receiving adequate and equitable care.”

Essential Leadership Skills for Getting Real in Organizational Racial Equity Planning

In Lessons About Leading for Racial Equity from Seattle’s Health Care for the Homeless Network (https://www.healthaffairs.org/do/10.1377/hblog20191115.414323/full/ ), I share my reflections on normalizing genuine dialog about race, bias, and white supremacy throughout all levels of an organization.  After studying the stark overrepresentation of people of color within Seattle and King County’s homeless population, the leaders of the Health Care for the Homeless Network’s 10 provider agencies as well as our governing board committed to do more to reverse racial outcome disparities. We also committed to develop an action plan rooted in input from front-line service staff. We soon discovered, however, that engaging front-line teams about disparities data and options for producing more equitable outcomes elevated simmering frustrations and distrust among many staff of color.  My article explores the lessons learned from openly acknowledging this response and collectively diving into exploring its roots.

Moving Beyond Implicit Bias Training

In their article Beyond Bias (https://gilvarconsulting.com/wp-content/uploads/2020/01/Beyond-Bias.pdf) Heidi Grant Halvorson and David Rock share findings that training in how implicit bias works does not per se reduce its influence on individuals’ decision making and make a compelling case that “organizations and teams can become aware of bias in ways that individuals cannot.” They then describe numerous strategies that organizations and teams can utilize to “collectively identify biases as they emerge and counteract them on the fly.” 

Harvard Implicit Association Test

One common method for developing a better sense of the subtly of implicit bias and the challenge of checking it at an individual level is taking the Harvard Implicit Association Test.  The test is free and easy to take at  https://implicit.harvard.edu/implicit/takeatest.html.

Recommended Books for People Seeking to be More Effective Anti-racist White Allies

  • Between the World and Meby Ta-Nehisi Coates
  • So You Want to Talk About Race by Ijeoma Oluo

Other Articles

City of Dallas Equity Assessment of Affordable Housing Policies

Along with colleagues Christine Campbell and Michele Williams, John conducted a racial equity assessment of the City of Dallas’s affordable housing policies.  The assessment relied on extensive community input and culminated in a presentation of 11 recommendations for change to the Dallas City Council.  The findings and recommendations are summarized in this final report.  Recommendations start on page 8, following the executive summary.

Accelerating Organizational Anti-Racism Work with Adaptive Leadership and Mindful Communication Practices

Transformational change at an organizational or systems level requires both deep listening and the willingness of leaders possessing decision-making authority to collaborate with those most directly impacted by the problems necessitating change. Few leaders I know would dispute this premise in the abstract, but many might struggle to explain in concrete terms how they walk the walk as well as they talk the talk. Moving organizations and communities from words to action around redressing institutionalized racism requires leaders not only to put listening and collaboration skills to the test, but to leap beyond the comfort zone of routine approaches to problem solving. Adaptive leadership and mindful communication practices can provide an excellent platform from which to dive into the deep water of acknowledging racism and other structural forms of oppression as powerful drivers of inequities in the areas of health, housing, and economic advancement.

Cross-silo Partnerships Boldly Tackling Inequities in the Midst of the Pandemic

New COVID-19 hospitalization data shine a stark light on the connection between homelessness and poor health.  The Minnesota Department of Health found that people residing in homeless shelters who were diagnosed with COVID-19 were 4 times more likely to be hospitalized and 3 times more likely to be admitted to an intensive care unit (ICU) than the overall population of Minnesota residents with a COVID+ diagnosis.  The hospitalization and ICU rates for people living unsheltered were even worse:  almost 10 times more likely to be hospitalized and 7 times more likely to receive treatment in an ICU.