With decades of experience working as a public health nurse, Dr. Pam Guthman knows racism impacts every aspect of society, from the economy to housing to education.
Given her nursing background, Guthman, now a clinical assistant professor of nursing at UW-Eau Claire, also knows how the lack of access to stable housing, good paying jobs and quality education — all social problems that are rooted in racism — negatively impacts people’s health.
“Racism is directly tied to health equity,” Guthman says. “You can’t address health equity without addressing racism.”
That, she says, is why she was eager to contribute to a statewide effort that resulted in the Wisconsin Public Health Association declaring that racism is a public health crisis in Wisconsin.
Already, nearly 40 organizations in Wisconsin, including cities, health care and insurance organizations, school districts and nonprofits, have signed the online Racism is a Public Health Crisis in Wisconsin declaration.
By signing the health crisis declaration, individuals, local governments and organizations are acknowledging the crisis and committing to taking actions to address it, Guthman says.
Research has long shown that some minority groups have an increased risk of health issues like heart attacks, high blood pressure, low-birth weights and other serious medical conditions.
However, the health impact of racism goes well beyond health care itself, a reality that nurses in population health try to expose, Guthman says.
"'Health care’ is really ‘sick care’ as we wait until the cumulative stressors of not investing in upstream factors such as social connectedness, housing equity, safe neighborhoods and transportation, take their toll from high levels of the stress hormone, cortisol, that accumulates and we see the illnesses we are seeing today,” Guthman says. “This is an issue when our society and our funding mechanisms do not embrace the importance of moving upstream to achieve population health.”
It’s critical that societies address factors such as the environment, housing, transportation and education as they have a significant impact on people’s overall health outcomes, she says.
“All those things require a significant understanding about racism, power and inequities,” Guthman says. “We see racism and health inequities through the school to prison pipeline or a criminal justice system with a disproportionate number of young black men imprisoned.”
Social issues need to be addressed to fully improve population health, Guthman says, noting that other countries already assure these factors are more equitably addressed in their society.
When there is more equity between the lowest and highest socioeconomic gradient, there is a more inclusive and healthier population, she says.
“Racism is a barrier,” Guthman says. “People don’t have the same opportunities to be healthy. For example, where you live affects every aspect of your life. It affects your employment options, education, access to health care and even what you eat. All things that affect your ability to be healthy.”
Issues around racism and health equity are so complex that it is challenging — but necessary — to have a shared narrative if people are going to come together to make meaningful change, she says.
The UW Population Health Institute’s Mobilizing Action Toward Community Health Group is leading that effort through its Wisconsin Healthiest State Initiative, a collective effort to advance health equity in Wisconsin.
One of the initiative’s areas of focus is creating a shared narrative that will help people and organizations talk about racism’s impact on health in ways that will lead to actions that support health equity.
“Our goal is to create a vision for health equity in Wisconsin that is based on shared language,” Guthman says. “That shared language can then lead to coordinated action across the state.”
Guthman was part of the work group tasked with developing the shared narrative.
“We had to have some very difficult and intense conversations,” Guthman says of the work group, which included people from throughout the state. “We are trying to create a just society, a society that is safe and has opportunities for all. To find common ground we have to have difficult conversations.”
With the narrative and the health crisis declaration now in place, her team has shifted its focus to ensuring that the shared narrative leads to action.
The Wisconsin Healthiest State Initiative includes convening statewide partners, setting shared priorities around health equity, leading work groups to make progress on shared priorities and hosting statewide summits.
During odd years, agenda-setting meetings are held to assess progress and to refine and identify shared priorities. In even years, a statewide summit is held to provide training and capacity building, as well as building support and alignment around priorities.
At the first Healthiest State Summit in 2017, the group identified six health equity priorities, including declaring racism a public health crisis.
Other priorities included centering leadership of those most impacted by inequity; building diverse alliances and partnerships; developing a health equity narrative with strong frames; creating a health equity legislative/policy agenda; and identifying and supporting public health champions.
This fall, leaders from across the state who are committed to advancing health equity gathered to develop the 2020 summit agenda, with the narrative and the declaration of racism as a public health crisis at the forefront.
Guthman says her work with the health crisis initiative aligns well with UW-Eau Claire’s goals around equity, diversity and inclusivity.
Her UW-Eau Claire “Building Health Equity Policy Agendas in Wisconsin” equity, diversity and inclusivity project includes her work with the statewide group that aims to move health equity forward in Wisconsin.
“Through our EDI work, our faculty and staff — including Dr. Guthman — are engaged in many impressive projects that are making positive change on and off campus,” says Jodi Thesing-Ritter, executive director of Equity, Diversity and Inclusion and Student Affairs. “Dr. Guthman’s hard work is making our campus and our state stronger.”
Guthman says that while her EDI project is complete, her commitment to health equity is ongoing.
“Health equity is nothing new to me,” Guthman says. “It’s always been at the forefront of my advocacy for populations who have various needs. I will continue to use my experience in population health to make a difference at the community and state levels.”
Photo caption: Dr. Pam Guthman is part of a statewide effort that resulted in the Wisconsin Public Health Association declaring that racism is a public health crisis in Wisconsin.