« June 2019 Issue
Pushing the Boundaries of Health Advocacy and Justice
By: Tori Bilcik, Development and Communications Associate, Community Catalyst
When you think of “health care,” you probably think of a doctor’s office, or a hospital, or maybe your insurance coverage. But what if you got sick and needed to get to a doctor and didn’t have adequate transportation to get there? Or if your doctor prescribed bed rest, but you’re experiencing homelessness and don’t have access to a safe bed? Transportation, housing, education and other social services certainly aren’t “health care,” but they do have an outsized impact on health outcomes.
Jessica Curtis, senior advisor for the Center for Consumer Engagement in Health Innovation, is coordinating Community Catalyst’s internal work to address social determinants. She shared how Community Catalyst is stepping up its support and technical assistance to help grassroots organizers, advocates and policymakers identify and navigate opportunities to address social determinants through health policy and advocacy.
“We talk a lot about how all of these issues – housing, community development, food, transportation – involve incredibly complex systems where we lack expertise,” Curtis shared. “We’re not setting out to become food or housing experts. We see opportunities to build a bigger tent and bring in other sectors to help us advance the health justice movement, and vice versa. We want to help facilitate that connection and sharing of knowledge and relationships.”
Curtis acknowledged that addressing social determinants of health requires navigating some bumpy terrain. The Trump administration has already co-opted social determinants language and rationales to support harmful Medicaid work requirements. State and local policymakers could also offer “social determinants” proposals that sound good on paper but curtail benefits or privatize services. For example, a 2017 fare hike from the Rhode Island Public Transit Authority ended fare exemptions for people with disabilities. This caused significant numbers of people with chronic health needs to miss medical appointments and skip visits to soup kitchens. In other words, the fare hike was pitched as a way to increase public funding for transportation – a social determinant of health – but actually curtailed the number of people who could access services like soup kitchens and limited access to health care for many people with disabilities. It should be noted that a determined campaign of grassroots advocacy and activism by those directly affected by the increase succeeded in getting RIPTA to rescind the fare hike.
Advocates outside of the health world have also raised concerns about the privatization of services like food and housing and how that work is being placed on the health care system instead of being viewed and funded as public goods.
“In many communities, equitable housing, food systems and transportation don’t exist because of decades of public disinvestment,” Curtis said. “Solutions that over-rely, or only rely, on health care interventions to address social drivers in these communities run the risk of sidestepping deeper questions about the need for public investment.”
In addition to developing policy resources for advocates and policymakers, Community Catalyst is expanding its investment in grassroots organizing and leadership development to build grassroots community power to address social determinants. For the Community Catalyst team, this work is a necessary part of deepening the organization’s commitment to and practice of racial justice.
“We view social determinants work as the practical intersection of racial and health justice,” Curtis said. “Why do health disparities persist? If we look at who's living in communities over-burdened by issues like pollution or housing shortages, we find that people of color, American Indians and Alaska Natives, Native Hawaiians and Pacific Islanders are often bearing that weight. Why are our neighborhoods racially segregated now at pre-Civil Rights Era levels? We have to recognize the over-400-year history of structural racism in this country that has laid the foundation for these disparities in social determinants of health to persist.”
According to Dara Taylor, director of diversity, equity and inclusion at Community Catalyst, addressing social determinants of health is a key aspect of the organization’s pursuit of health equity, of equal importance to the organization’s goal to advance policies that address coverage and affordability, quality and access, and cost containment. For Community Catalyst, that means recognizing the role that structural racism plays across all sectors that can, and do, adversely affect health outcomes and exacerbate health disparities.
“Our vision of health equity is one where everyone has the opportunity to achieve the best health outcomes possible,” Taylor said. “We must acknowledge that when all is accounted for, systemic injustices such as racism are persistent and deeply impact various populations’ ability to access and receive quality care. At Community Catalyst, we name and work to dismantle these injustices while elevating the voice and promoting the engagement of consumers in the process of creating a health care system that is just for all.”
With these priorities in mind, it is also critical to let consumers take the lead on setting the agenda for addressing social determinants of health in their communities.
“We're trying to ground the work in what communities want and need for themselves,” Curtis said. “Laws and systems have long been rigged against these communities. We’re working with them to change that, by making the health care system more responsive to the vision they have set for themselves and their communities.”