How does liberation psychotherapy help us create a more just and equitable world?

Liberation psychotherapy aims to address the needs of those who suffer historical, cultural, systemic, and sociopolitical oppression.

Dr. Thema Bryant

This treatment approach has Latin American origins and was developed by Ignacio Martin-Baro, a Jesuit priest and community psychologist.

The goal is not just to help trauma survivors cope with the realities of oppression but also to help those facing oppression to think strategically (within themselves and their communities) about ways they can confront and uproot the ways oppression shows up in our day-to-day practices, our teachings, our research, and in our lives. This means addressing not only the ways we have been targeted but also in the ways we go about duplicating and replicating the oppressive systems we have learned.

Liberatory psychotherapy operates under the assumption that not only does trauma change the brain, but that healing can change the brain as well, particularly when the approaches to healing incorporate:

  • creativity
  • holistic approaches that integrate the mind, body, and spirit
  • mobilization to action
  • self care and community care
  • ancestral wisdom and indigeneity
  • a lineage of resistance that challenges colonial mindsets or the notion of inferiority
  • anger and suffering into transformation
  • testimonios

In short, liberation psychology enables individuals and communities to leverage their cultural resources and use them as medicine under the premise that we do not only inherit wounds, but also wisdom as well.

Learn more about the practice of Liberation psychotherapy from Dr. Thema

Reflection

How does this liberatory approach help us create a more just and equitable world?

Why do we use the Healing Justice framework?

According to Cara Page, Healing Justice is a framework that identifies how we can holistically respond to and intervene to address generational trauma and violence through collective practices that impact and transform the consequences of oppression on our bodies, hearts and minds. This framework is often used inside of liberation movements and organizations to bring a healing focus to the political and philosophical analysis of those spaces.

Healing Justice (HJ) is a framework rooted in racial justice, disability justice, and economic justice.

The principles of Healing Justice include:

We believe that in relationships we are hurt and in relationships we heal. While we don’t all need to become practitioners to heal, we must all do the internal and external work required to be in just relationship with ourselves, each other, in community, and with the land. This means confronting the dominant culture in the U.S. that enshrines individualism, ableism, patriarchy, capitalism, white supremacy, and settler colonialism. In this way, healing justice is cultural organizing, inside and outside of our movements. As Cara Page says, “Our movements themselves need to be healing or there is no point to them.”

Excerpt taken from the Fireweed Collective

Reflection

How can the Healing Justice framework be used to improve the health and relationships of those with whom you are in community?

Featured

Why is it important to approach our work in a way that is trauma-informed?

This resource can be useful for understanding how to address individual trauma

(particularly racial trauma and the individual impact of other forms of oppression)

According to Stephen Porges, PhD, not only does the body remember a traumatic experience, but it can actually get stuck in the trauma response mode.

So even when the threat is gone, the body still perceives danger and its defenses stay engaged.

Why does this happen and what can we do to repair this rupture when it occurs?

Excerpt taken from NICABM

So what does it mean to be trauma-informed?

The term trauma-informed services was originally coined by Maxine Harris and Roger Fallot in their edited book, Using Trauma Theory to Design Service Systems (2001).

By “informed about trauma” we mean two very specific yet different things.

First, to be trauma informed means to know the history of past and current abuse in the life of the person with whom one is working. Such information allows for more holistic and integrated treatment planning.

Second, to be trauma informed means to understand the role that violence and victimization play in the lives of most consumers of mental health and substance use services and to use that understanding to design service systems that accommodate the vulnerabilities of trauma survivors and allow services to be delivered in a way that will facilitate participation for that person in treatment.

Excerpt taken from a publication written by Harris and Fallot

In short,

  • Each person has a part of their nervous system that allows them to perceive whether they are in a safe environment or whether they may need to respond to an injury or threat
  • When we encounter a person or event that makes us feel unsafe, if we don’t have someone to come to our aid and help us feel safe again our bodies trigger a stress response in our autonomic nervous system.
  • This stress either pushes us toward mobilization e.g. flight or fight mode, or if we find that we are unable to fight or flee, we enter into either a state of terror know as freeze mode, or we collapse into flop mode where our bodies shut down to numb us to the impact of the impending threat.

There are three main types of trauma that people may experience:

  • Acute Trauma typically a single traumatic experience, such as an accident, natural disaster or sexual assault.
  • Chronic Trauma occurs when a person experiences multiple, long-term and/or prolonged traumatic events (e.g. domestic violence, bullying, addiction, sexual abuse and long-term illness).
  • Complex Trauma is the result of multiple different traumatic experiences. Potential causes can include childhood abuse, domestic violence, oppression, or civil unrest.

Trauma therapy is a specific approach used to build an understanding of how traumatic experiences affect an individual’s mental, emotional and physical well-being. This type of therapy aims to help children, adolescents and adult survivors heal from the effects of trauma.

*Excerpt taken from Routledge.com

 

The explainer video below provides a succinct way to understand how trauma affects people and how we can work together to overcome it.

Reflection

  1. Why is it important to approach individual healing in a way that is trauma-informed?
  2. How does inequity impact the way marginalized groups experience trauma and resilience?
  3. Why is it important to work to repair inequitable or oppressive systems in a way that is trauma-informed?

Goal Setting

illustration of person searching along a path for a destination represented by a map pin

What is goal setting?

Goal setting theory was established in the 1960s by a couple of researchers named Edwin Locke and Gary Latham.

Goal setting can be useful part of a healing practice because often:

  • we are more likely to take ownership of goals when they are self-directed 
  • we are more likely to self-regulate our behavior successfully if we create goals that hold significance or intrinsic value, particularly if they are necessary for our own survival
  • it will be easier to feel a sense of self discipline when we can witness and measure our own progress toward goals that improve our quality of life and sense of self direction.

How is Goal Setting related to your healing practice?

illustration of 3 spoons representing energy and capacity to complete functional daily activities

In your Self-Care practice:

Goal setting can help you:

  • brainstorm and identify a vision for what you’d like to work toward
  • help you assess the feasibility of what you MUST have versus what you’d LIKE TO have
  • help you establish attainable priorities
  • develop a strategy for how to achieve that vision
  • measure and incentivize any progress you make toward the goals that you establish

From a project or organizational perspective:

In addition to the benefits we’ve identified when setting goals in your self-care practice, goal setting can help you:

  • define the strategic values and broader context your goals must align with
  • establish assessment criteria and performance metrics to help you refine your goals, your methodology, and the resources you allocate toward toward attaining those goals
  • continually improve your progress in ways that are transparent and accountable toward those who contribute their time, energy, and efforts toward your vision

When establishing a Collective Care practice:

illustration of two people climbing a mountain and the person who has made the most progress is reaching out to assist the person below

Within a collective-care practice, goal setting can help you:

  • identify any areas where you may need additional resources or support in order to pursue/ attain a goal (e.g. education, training, funding, staffing, etc)
  • identify any areas you may need to ask for or coordinate assistance
  • create shared vision or strategic alignment within your support network

How does Goal Setting Work?

[Project Opportunity] What would an effective goal setting tool look like?

Locke and Latham recommend developing goals that are:

  • SPECIFIC: clearly defined so that you know what you’re working toward
  • MEASURABLE: set up in a way that you can track and monitor your progress
  • ACHIEVABLE: actually feasible and that you have the resources to do
  • RELEVANT: important enough for you to follow through with in your pursuits
  • TIMELY: within a period of time that makes your efforts actionable so that you get started and make progress the way you intend

If you’re just starting out in the pursuit of a unfamiliar or challenging goal, it can be challenging to identify or plan how you will succeed in the goals that you’ve set.

Examples

In your Self-Care practice:

Many people wrestle with large abstract goals when making New Year’s Resolutions. They may set a vague goal like, “become a healthier person” or a specific goal like “go to the gym 5 times a week” but be completely unaware of how to establish an exercise regimen that will help them consistently achieve their goals without injury.

From a project or organizational perspective:

Often with large projects, organizations may similarly struggle with a lack of clarity as to how a goal accomplishes a larger strategic objective, or how to plan and implement a large project that has many moving tasks, stakeholders, and/or competing interests.

When establishing a Collective Care Practice:

Similarly, limited time, resources, and levels of investment can make it difficult to mobilize a community unless there is a shared vision and conveners to facilitate the coordination of shared governance and responsibilities.

Goal Setting Strategies

Guided Questions:

To demonstrate, we'll use the self-care example:

What would a healthy version of yourself look like?

In order to define the answer to this question you can use a variety of strategies to brainstorm potential goals to work toward, including:

  • Make a list of habits you’d like to pursue or you think might provide benefits to your current quality of life
  • Discuss your answer with another person or group (which can sometimes help generate ideas you may not have considered)
  • Create a vision/mood/pin board of images that represent your idea of the habits and practices you believe would improve your health and quality of life
  • Review old photos, apps, goals that remind you of the times in your life when you’ve felt healthiest and happiest

Can you think of other ways to answer this question?

Develop assessment criteria

We’ll continue to use the question from the previous example to consider how these might be developed:

In order to develop assessment criteria, it may be beneficial to apply any of the following methods to begin to narrow down or identify goals that may be more in alignment with the version of yourself you believe reflects the health goals you’d like to set:

  • Develop a clear mental map of what you’re working toward by looking up how those with previous experience exploring your goal have defined and/or approached their pursuit of it. (Sometimes it can be helpful to identify a person or framework (school of thought) used to inform your goal so that you don’t have to reinvent the wheel).
  • Identify how those with previous experience exploring your goal have measured their progress or implementation of the goal you’d like to pursue (for example, if your goal is to develop a yoga practice, how did others get started or build up enough strength and stability to implement their yoga practice? what did success look like for them? will you attempt a similar goal or modify it for your own vision?)
  • Identify which steps will make your goal feasible (and a reasonable timeline for implementation)
  • Sort and categorize your ideas into a list of “MUST have” versus “WOULD LIKE to have” to help you establish priorities
  • Which ideas would be easy and simple to implement?
  • Which ideas might require more planning or resources?

For example, the Centers for Disease Control use assessment criteria called the “Social Determinants for Health” that are used to describe the environmental factors that shape human health.

Image Source: Click to View

Using the CDC model, goals for “being a healthier person” could range from diet and exercise to:

  • changing air filters in your home to reduce the risk of respiratory illnesses
  • going back to school to earn an advanced degree so that you can earn a higher income and improve your living conditions
  • moving to a neighborhood closer to a park or commuting via public transit to increase the amount of steps you get daily

Image source: click to view
The "Dimensions of Wellness" model, the assessment criteria used to "become a healthier person" might include:
  • deepening your spiritual practice
  • going to therapy
  • setting more personal boundaries with professional colleagues
  • or attending more social functions in an effort to improve the health of your interpersonal relationships

By this point you should start to get a clearer picture of the types of goals you have the capacity to implement and which you’ll need to develop a strategy or get help to implement.

Ultimately, however you choose to set and implement your goals will be dependent upon whether you have the appropriate amount of time, energy, and resources to pursue the goals that you set.

Keep it simple.

Goals that are simple enough to implement when you are busy, have low energy, or can resume quickly if you have to navigate a crisis are going to be the goals you most likely to be successful at.

If your goal is too vague to explain to others or to ask for help, there’s less of a chance you’ll be able to hold yourself accountable or be able to ask for help when you need it.

That being said:

What kinds of Goals would YOU like to accomplish?

Mental Healthcare Reform

What is a legislative agenda?

According the Centers for Disease Control, a legislative agenda is a policy development strategy designed to prevent injury and the spread of illness/ disease by conducting health and economic analysis of the burden by injuries and their consequences that should be voted upon by state, local, and federal legislators (1). The legislative agenda is used to estimate how much evidence-based prevention will be needed to avert healthcare costs from an organizational, public health, or societal perspective.

Why would you need a legislative agenda?

The following public health policy priorities listed below are provided to demonstrate how you can advocate for an issue that you care about [in collaboration with social justice advocates, health providers, and philanthropic organizations].

Action Plan Template [part 1]

This Legislative Agenda [template] lists objectives for legislative action at the national level on Mental Health Reform issues that affect the quality of care patients receive when seeking mental health services, including instances in which the patient has been ordered to receive involuntary care.

The agenda was created to demonstrate the process of identifying high-priority issues for legislative action and to create a business case for better coordination of care when regulatory action is needed.

In addition to the legislative priorities for advocacy, the issues identified in the template also create a business case for the creation of an augmented reality app which helps patients provide informed consent/ monitor whether they are receiving humane care and assists patients with tracking medical information including:

  • review & update critical documentation (e.g. HIPAA forms, treatment plans)
  • assistive tech for patients with low vision, hearing impairments, limited English proficiency (LEP)
  • view visual examples of prescriptions to mitigate risk of retaliation/ prescription errors
  • track and monitor prescription side effects
  • clarify key terms and concepts they may encounter during treatment (e.g. 72 hour holds, mental inquest warrants) and
  • designate a patient advocate

This legislative agenda template is based upon the work of the National Coalition for History & the Center for Lobbying in the Public Interest but you can google the term and find easier examples.

How does this template work?

In this action plan template, we will first list national level policies that should be followed and monitored by mental health providers that should be reported to the following agencies when they are not adhered to. We will also list the following forms of documentation you should/ and can request to receive when seeking mental health care.

Second, we will identify key issues that may emerge while seeking mental health care at the state, regional, or local level and for which effective patient advocacy may be compromised due to lack of coordination and a lack of regulation regarding informed consent, and recommendations for how to address these challenges.

Note: don’t hesitate to use you resources including your local health department, primary care provider, legal aid, or philanthropic institutions.

This post is under construction.

Key Terms and Concepts:

Although health practitioners often refer to the following health care terms as if they are interchangeable, it’s important for those seeking medical care and patient advocates to understand the differences between the following concepts in order to receive the appropriate care:

Mental Health: According to the Centers for Disease Control [CDC],

Mental health is an important part of overall health and well-being (2). Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices. 

Behavioral Health: According to the Substance Abuse and Mental Health Services Administration [SAHMSA],

Behavioral health refers to the evidence-based interventions for disruptive behavior disorders and diagnostic categories or behaviors that cause trouble at home, school/work, or in the community at-large (3).

Behavioral disorders may involve (4):

  • Inattention
  • Hyperactivity
  • Impulsivity
  • Defiant behavior
  • drug use
  • criminal activity

Such behavior may first appear in any developmental stages: early childhood, school age, or adulthood (3).

Disability: The World Health Organization defines the term ‘Disability’ as:

an umbrella term for impairments, activity limitations and participation restrictions, referring to the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors)(5)

which require specific health, educational, rehabilitation, social, and support needs (6).

Disability is measured and assessed by the individual’s ability to capacity to navigate their own health conditions, environmental factors, and functional daily activities with little or no impediments (7).

Mental Illness: The Substance Abuse and Mental Health Services Administration defines mental illness as:

Mental disorders that involve changes in thinking, mood, and/or behavior (8). These disorders can affect how we relate to others and make choices. These illnesses are common, recurrent, and often serious, but they are treatable and many people do recover. 

  • Serious mental illness is defined by someone over 18 having (within the past year) a diagnosable mental, behavior, or emotional disorder that causes serious functional impairment that substantially interferes with or limits one or more major life activities.
  • For people under the age of 18, the term “Serious Emotional Disturbance” refers to a diagnosable mental, behavioral, or emotional disorder in the past year, which resulted in functional impairment that substantially interferes with or limits the child’s role or functioning in family, school, or community activities.

Trauma: According to The Substance Abuse and Mental Health Services Administration,

Individual trauma results from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being (9). 

Substance Use Disorder: According to The Substance Abuse and Mental Health Services Administration,

Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home (8).

  1. CDC – https://www.cdc.gov/injury/pdfs/shd_policy_tool-a.pdf
  2. CDC – https://www.cdc.gov/mentalhealth/index.htm
  3. SAMHSA – https://store.samhsa.gov/system/files/characteristicsandneeds-idbd.pdf
  4. SAMHSA Assessment Criteria for Behavioral Disorders- https://www.mentalhealth.gov/what-to-look-for/behavioral-disorders
  5. WHO Definition of Disability- https://www.who.int/disabilities/world_report/2011/chapter1.pdf
  6. WHO Contextualization of Disability- https://www.who.int/disabilities/world_report/2011/chapter2.pdf
  7. WHO Disability Survey- https://www.who.int/disabilities/data/brief-model-disability-survey5.pdf?ua=1
  8. SAMHSA Definition of Mental Health Disorders – https://www.samhsa.gov/find-help/disorders
  9. SAMHSA Definition of Trauma – https://www.integration.samhsa.gov/clinical-practice/trauma

Prevalence (U.S.)

Evidence Based Practice: How do we know this is even a problem?

Mental Health

Stay tuned for more info:

Behavioral Health

Stay tuned for more info:

Disability

Stay tuned for more info:

Mental Illness

Stay tuned for more info:

Trauma

Stay tuned for more info:

What would Mental Health Equity look like?

Mental Health Equity: Stay tuned for more info

Behavioral Health Equity: Stay tuned for more info

Disability Equity: Stay tuned for more info

Trauma Equity: Stay tuned for more info

Mental Health Parity & Addiction Equity: Stay tuned for more info

  1. CDC –
  2. SAHMSA – https://www.samhsa.gov/behavioral-health-equity
  3. SAHMSA – https://www.samhsa.gov/find-help/treatment

How were health disparities created?

This is the first installment of a five-part series on the origins of health disparities.

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This stark image of disparity depicting a segregated bread line ‘At the Time of the Louisville Flood’ was taken in 1937 Photo credit:Margaret Bourke-White

Objectives

Upon completion of this post, participants will be able to:

  • Have a shared understanding to describe health and economic disparities
  • Understand how community resilience is different from property based systems of wealth
  • Have a shared language & mental map to measure whether their understanding of the role of public health and philanthropy  is community-centered or based upon models that create/ replicate disparities in health

 

What are health disparities? | Defined

The term “health disparities” is often defined as “a difference in which disadvantaged social groups such as the poor, racial/ethnic minorities, women, disabled, and other communities that have persistently experienced social disadvantage or systemic discrimination to the point that they experience worse health or greater health risks than better resourced/more economically advantaged social groups.”[2]

 

Trigger warning:

This post includes an image of people who were enslaved to describe how disparities and extractive capital were used to create disparities in resources, dismantle democratic governance within communities, and shape the way we frame who is worthy of investment (and how that shapes community health )

 

How was health measured BEFORE colonialism?

Prior to the establishment of agrarian farming practices, Indigenous Hunter/Gatherers experienced shorter lifespans because their lifestyle was organized around preventing food scarcity. While injury and illness occurred often during these daily activities, epidemics were scarce because the earliest indigenous peoples did not have to grapple with epidemics caused by the accumulation of waste or contaminated food and water.

image of Bhimbetka Petroglyphs, the earliest known cave paintings in human civilization found in India
Bhimbetka Petroglyphs, the earliest known cave paintings in human civilization (discovered in India during the 1990s)

The accumulation of tools, food, and the resources needed to sustain health were used to increase community resilience in the face of threats to their survival. Injuries, disabilities, and chronic illnesses were attributed to ancestral deities and spirits that could either be treated through rituals and the fate of those afflicted was considered beyond the control of the individual and their fate was surrendered in the hands of the spirits which governed the fate of the the those facing afflictions.

One way this practice evolved to fundamentally shift the way community health was measured in communities was in the storage and accumulation of the assets needed to build bargaining power and hierarchal status within early agrarian communities.

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The “Great Bath” of Mohenjo-Daro is the earliest known public water tank of the ancient world. Most scholars believe that this tank would have been used in conjunction with religious ceremonies. Copyright: Copyright J.M. Kenoyer/www.harappa.co

Early agrarian societies formed as a way to better regulate the supply of surplus food storage to serve as a buffer against:

  • seasonal food scarcity and changing climates,
  • contaminated food supply, and
  • natural phenomena like plant disease and drought.

Because communities could shelter in place and store resources (e.g. food and tools) much longer, the prevalence of illness that originated from poor hygienic conditions and poor sanitation created the first public challenges among regional populations.

 

Emergence of disparities in access to capital

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Seals such as these were used by merchants in the Harappan civilization. Photo courtesy of Carolyn Brown Heinz

As early humans expanded their knowledge of tools, land use, and animal domestication, those with the most favorable conditions or who controlled the most effective tools and knowledge for production found themselves with increased bargaining power in decision-making.  

This created disparities in tools and knowledge.

This shift in accumulation of surplus value created an incentive for those who controlled capital to accumulate personal wealth.

Systems of commerce and land distribution also emerged to increase the productive capacity of property and expand wealth creation.

 

Emergence of hierarchal social structures & Disparate access to resources

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(Sumerian Artifact from one of the world’s earliest Mesopotamian civilizations kept at The British Museum, London). The upper register shows a naked priest followed by three worshippers. The priest pours an unknown liquid offering from a spouted vessel into a stemmed dish or stand, in front of a horned god figure. In the lower register, there are three worshippers; one of them carries an animal offering and one of them is a woman who is shown “full-faced.” She may be a priestess or she may represent the donor of the plaque. The priest’s libation is being poured in front of an unknown temple. The plaque was excavated at Ur, in the ruins of one of the residences of the high priestess of the moon god Nanna. Early dynastic period, circa 2500 BCE, from Ur, Mesopotamia, Iraq.

Those who, either experienced unfavorable growing conditions or encountered barriers to production, became much more reliant upon the benefactors who controlled resources like food, tools, and labor distribution for their survival and subsistence.

The labor force became another source of wealth for property owners. This fiscal value of human capital became measured by the costs used to maintain the force versus the revenues produced by their labor production.

This reduced the incentive of those who benefitted from these disparities to redistribute their resources and decision-making power in a way that was democratic or that prioritized the collective resilience and wellbeing of the community.

Those who controlled resources and capital were able to barter and negotiate for additional wealth, loyalty (and in many cases would steal under threat of coercion or violence) and the tools or expertise to make themselves more competitive than other members of their community through this concentration of wealth. 

These shifts in incentive and power dynamics resulted not only in creating

  • systemic power imbalances,
  • the increase of infectious disease, and
  • fundamental shifts in the way we understand the role of bodily autonomy and consent in the labor force.

fundamentally shifted these communities relationship to one another, property ownership, and investment.

Property-Centered versus People-Centered communities

6702The ownership and concentration of wealth, knowledge, and bargaining power shifted the way societies were structured that transformed  communities from being resilience centered toward redirecting labor activities toward concentrating the wealth and influence of despots

Society’s collective understanding of how power should be distributed became defined by those who held the most bargaining power, many of whom willfully asserted their claims to supremacy.

Knowledge, tools, and the extraction of human labor became much more commonplace.

This proprietary approach to capital created an incentive for property owners to develop strategies to control the supply of capital and create barriers to social mobility. Many of these efforts to suppress competition exposed those with less bargaining power to much higher risks of exposure to unsafe, unsanitary conditions.

These emerging hierarchal structures also shifted how narratives were framed regarding how merit is regarded and even went so far as to dictate whom would be considered worthy of dignity within the power structure.

Consequently, Accumulated and inherited wealth, or the ability to contribute toward property owners’ accumulation of wealth became the key metric for merit.

Many of these strategies even went so far as to create systems of wealth and property ownership using mechanisms like systems of forced labor, taxation, and debt.

Those who sought to keep and expand their status created narratives that attributed their fiscal advantages to royal supremacy and divine right, to dissuade subordinates from rebellion.

Often these messages were accompanied by violent and forceful indoctrination or state sanctioned practices of exclusion.

Property owners were granted authority over decision-making, and often chose to prioritize their commercial interests over the needs of the community.

Laborers who were most impacted were not granted the opportunity to share in the decision-making, but rather experienced the impact of those decisions. In many cases they were even deprived of resources or publicly humiliated when they expressed dissent with those decisions

There were often many cases in which  dissenters perspectives were violently suppressed when they openly resisted despots and property owners.

Labor control systems, militaries, and were developed to coerce subordinates and the labor force into compliance.

These resulting trend of territorialism, socio-political suppression, and normalization of extractive, supremacist structures often resulted in the loss of communal knowledge, traditions, and inter-generational support.

We see patterns of this mindset replicated throughout colonial history as land acquisition and involuntary labor were used to establish criteria for who we believed was worthy of merit and who deserved to be subservient or poor.

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This disturbing photo was taken in Lubo, Belgian Congo – November 14, 1924 to illustrate the history of Belgian colonialism in the Congo. Photo credit: Dispatch Press Images

 

 

How do disparities in wealth creation shape the way we measure merit and health?

Property ownership fundamentally shifted the way early civilizations shaped our current understanding of community health. This production model, also known as the extractive capital framework shifted the prioritization of the well-being and resilience of communities toward a model in which those with less resources were forced to collaborate or scheme to convince those who control the most resources that their needs and interests were WORTHY of the investment.

 

Reflect:

How does your understanding of power, and the way it is distributed, impact the way you approach power distribution in your own community or organization?

How racial disparities shape health disparities

We often see disparities or statistical trends where people of different genders, ethnicities, and abilities don’t have the same access to financial stability, decision making or health outcomes.

But these disparities didn’t just happen in a vacuum.

They are often the result of specific policies or widespread institutional practices that create these inequalities.

What are racial disparities?

The term “health disparities” is often defined as “a difference in which disadvantaged social groups such as the poor, racial/ethnic minorities, women and other groups who have persistently experienced social disadvantage or discrimination systematically experience worse health or greater health risks than more advantaged social groups.”[2] When this term is applied to certain ethnic and racial social groups, it describes the increased presence and severity of certain diseases, poorer health outcomes, and greater difficulty in obtaining healthcare services for these races and ethnicities. When systemic barriers to good health are avoidable yet still remain, they are often referred to as “health inequities.”[3]

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Why Bring Up Racial disparities?

In the United States, like many industrialized nations shares a history in which European colonists immigrated and seized property from indigenous populations in order to generate wealth for European property owners but restricted wealth building opportunities for people of other ethnicities with policies and practices designed to limit competition from other populations.

More importantly, these policies and practices were structured in such a way that prohibited non-white Europeans from making decisions about their own health, civil liberties, or living conditions. The policies also provided white property owners and post war veterans a financial and educational wealth-building advantage during the same period these policies were enacted to create disparities. Any advances or successful efforts to shift policy to create a more equal society in which everyone has the opportunity to build free and healthy lives has been undermined by those who have benefitted from these disparities through policies like (redlining, urban renewal, Nixon’s deregulation and shift toward a debt based monetary system, mass incarceration, gentrification, etc).

The choices made by these policy makers throughout United States history have created stark differences in wealth and health outcomes.

In 2016, the Institute for Policy Studies (IPS) and the Corporation For Economic Development (CFED) released the findings of a study in which they investigated trends in household wealth over a 30-year period and found that without ‘significant policy interventions, or a seismic change in the American economy,’

If current economic trends continue, the average black household will need 228 years to accumulate as much wealth as their white counterparts hold today. For the average Latino family, it will take 84 years.

The research showed that the average wealth of white households increased by 84 percent between 1983 to 2013, which was three times the gains that African-American families saw and 1.2 times the rate of growth for Latino families.

Coincidently, significant disparities in health resulting from disparities in access to care resulted in a similar trend among census tracts that experienced these wealth disparities.

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While faulty cultural narratives that attempted to pathologize (or stereotype and stigmatize) communities of color for these outcomes, the realities these communities face was much more a byproduct of this long history of political and social apartheid than could be attributed to individual behaviors.

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While factors like poverty, unemployment, and unhealthy health behaviors were assumed to be the product of poor moral or cognitive capacity to make better decisions, public health researchers began to use epidemiological surveillance methods to investigate the root causes for these health disparities.

What they found was that many of the communities that faced these health disparities were concentrated in census tracts with low homeownership and limited access to resources due to how cities were zoned and disparities in hiring and lending practices.

Residents in these census tracts who experienced higher rates of obesity, hypertension, and diabetes were significantly less likely (statistically) to have access to safe affordable food, were more likely to live in contaminated housing or to experience violence in their neighborhoods (by both law enforcement and from vigilante groups who took retaliation into their own hands rather than risk being placed into a victim/offender relationship with law enforcement), and were also less likely to earn the revenue or secure loans to get their basic needs met, let alone for high ticket costs like healthy housing, transportation, or childcare.

Whereas previous generations of black and brown immigrant families were able to pool resources and use tools like public housing and food assistance programs that were initially designed to help white working class workers save up enough money to purchase homes with government subsidies, which was the origin of much post-war middle class wealth.

Deregulation policies which ended the savings and loan model and government subsidies initiated by Nixon changed the monetary system in which wealth was transferred and how that distribution was concentrated. Families who could access to loans were expected to borrow loans and pay installments over long periods of time in order to create wealth using interest payments and stock dividends for the property owners and regulators who already had access to homeowner equity and other forms of pre-existing wealth.

Nixon’s War on Drugs criminalized black and brown communities for narcotics consumption and distribution, even though the primary source of drugs entering the country came through the military and medical system. The mass incarceration of black and brown communities created additional barriers to social mobility resulting in hiring and voting restrictions.

But the historic disparities didn’t just harm the black and brown folks who consumed controlled substances. The effects of these regulations and practices also replicated disparities among members of these communities who did their best to assimilate into a monetary system that wasn’t designed to include them.

In 2018, the research team led by Dr. Willian Darrity and Darrick Hamilton that investigated whether African Americans who:

  • invested in higher educational attainment
  • invested in homeownership
  • purchased and banked from an investment pool concentrated predominantly within the black community
  • put more money into savings
  • increased their financial literacy
  • developed better entrepreneurship skills
  • emulated successful minorities (e.g. entertainers, athletes, investors)
  • improved soft skills or ‘personal responsibility’
  • created stable two parent families

would be able to close the wealth gap in their Racial Wealth Gap Study.

What their study did was debunk many myths and narratives that had been used to discredit the efforts of communities that had experienced racial and financial apartheid

So how do we repair it?

Click to learn more about the role of Equity in ending racial disparities.

What does a healthy relationship look like?

angry

Holding space for other people can be challenging at times.

One of the quickest ways to

hold space for others when you’re ill-equipped to respond the way the other person would like

minimize the risk of moral injury and/or

improve the quality of your relationships

is ask yourself this one question:

What does ‘healthy’ look like for THIS relationship?

How do our actions contribute or create barriers toward creating the relationship dynamic to which we aspire? And what is our motivation for these actions?

Investigating this answer led us to understand that the question we really needed to be asking was whether our expectations of the people who interacted with and/or the behaviors we contribute aligned with the outcomes to which we aspired.

Are we displaying the type of behaviors we need to bring out the best in our relationships?

What makes a great community?

community

What makes a great community?

What is our role in our toward shaping this community and why have we chosen to participate in THIS role versus others?

Exploring the answers to these questions led us to understand that the question we really needed to be asking was whether we had a healthy understanding of what makes up a community and how we understand our relationships within our communities.

Does our understanding of community reflect a healthy expectation and understanding of what community REALLY means?

Reflect

How do YOU define community?

What do you wish more people understood about what it means to be a part of a healthy community?

What makes up a community?

What kind of resources exists in our community (and to whom)?

Why are these resources distributed in this way?

What responsibility, if any, do we have to ensure that our contributions prevent barriers rather than create barriers for those who can’t afford access to an equitable distribution of resources?

I would encourage you to work through the following questions with the folks in your community that you engage with?

  • What do you enjoy about being apart of a community?
  • What have you found challenging?
  • What would you like to see?

How do your answers align with those of the folks in your community that you interact with?