PR R A C Poverty & Race

POVERTY & RACE RESEARCH ACTION COUNCIL

July/August 2011 Volume 20: Number 4

Why Racial Integration Remains an Imperative

In 1988, I needed to move from Ann Arbor to the Detroit area to spare my partner, a sleep-deprived resident at Henry Ford Hospital, a significant commute to work. As I searched for housing, I observed stark patterns of racial segregation, openly enforced by landlords who assured me, a white woman then in her late twenties, that I had no reason to worry about rent- ing there since “we’re holding the line against blacks at 10 Mile Road.” One of them showed me a home with a pile of cockroaches in the kitchen. Landlords in the metro area were con- fident that whites would rather live with cockroaches as housemates than with blacks as neighbors.

We decided to rent a house in South Rosedale Park, a stable working-class Detroit neighborhood that was about 80% black. It was a model of cordial race relations. Matters were different in my place of employment, the Uni- versity of Michigan in Ann Arbor. At the time, a rash of racially hostile in- cidents targeting black, Latino, Na- tive American and Asian students was raising alarms. Although overtly rac- ist incidents got the most publicity,

Elizabeth Anderson ([email protected] umich.edu) is John Rawls Collegiate Professor of Philosophy and Women’s Studies at the Univ. of Michigan, Ann Arbor. She prepared this précis from her 2010 book, The Imperative of In- tegration (Princeton Univ. Press).

by Elizabeth Anderson

they did not constitute either the domi- nant or, in aggregate effect, the most damaging mode of undesirable racial interactions on campus. More perva- sive, insidious and cumulatively dam- aging were subtler patterns of racial discomfort, alienation, and ignorant and cloddish interaction, such as class- room dynamics in which white stu- dents focused on problems and griev- ances peculiar to them, ignored what black students were saying, or ex- pressed insulting assumptions about them. I wondered whether there was a connection between the extreme resi- dential racial segregation in Michigan and the toxic patterns of interracial interaction I observed at the univer- sity, where many students were func- tioning in a multiracial setting for the first time.

My investigations led me to write my book, The Imperative of Integra- tion, which focuses primarily (but not exclusively) on black-white segrega- tion. Since the end of concerted ef- forts to enforce Brown v. Board of Education in the 1980s, activists, poli- ticians, pundits, scholars and the American public have advocated non- integrative paths to racial justice. Racial justice, we are told, can be achieved through multiculturalist cel- ebrations of racial diversity; or equal economic investments in de facto seg- regated schools and neighborhoods; or a focus on poverty rather than race; or more rigorous enforcement of anti- discrimination law; or color-blind-

ness; or welfare reform; or a deter- mined effort within minority commu- nities to change dysfunctional social norms associated with the “culture of poverty.” As this list demonstrates, avoidance of integration is found across the whole American political spectrum. The Imperative of Integra- tion argues that all of these purported remedies for racial injustice rest on the illusion that racial justice can be achieved without racial integration.

Readers of Poverty & Race are fa- miliar with the deep and pervasive racial segregation in the U.S., espe- cially of blacks from whites, which was caused and is currently main- tained by public policies such as zon- ing, massive housing discrimination and white flight, and which generates profound economic inequalities. Seg- regation isolates blacks from access to job opportunities, retail outlets, and commercial and professional services.

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CONTENTS:

Integration ……………. 1 Health Impact Assessment …………. 3

Asian American et al. Health Equity ……….. 7

Model Neighborhood Health Center ……… 13

Resources ……………. 19

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(INTEGRATION: Continued from page 1)

It deprives them of access to public goods, including decent public schools and adequate law enforcement, while subjecting them to higher tax burdens, concentrated poverty, urban blight, pollution and crime. This depresses housing values and impedes blacks’ ability to accumulate financial and human capital. If the effects of segre- gation were confined to such material outcomes, we could imagine that some combination of non-integrative left- liberal remedies—color-blind anti- poverty programs, economic invest- ment in disadvantaged neighborhoods, vigorous enforcement of anti-discrimi- nation law, and multiculturalist rem- edies to remaining discrimination— could overcome racial inequality.

Non-Integrationist Remedies Are Insufficient

Such non-integrationist remedies are insufficient because they fail to address the full range of effects of segregation on group inequality. The Imperative of Integration documents three additional effects that can only be undone through integration: social/ cultural capital inequality, racial stig- matization, and anti-democratic ef- fects. These effects recognize that seg- regation isn’t only geographic, and so can’t be undone simply by redistrib-

Poverty and Race (ISSN 1075- 3591) is published six times a year by the Poverty & Race Research Action Council, 1200 18th Street NW, Suite 200, Washington, DC 20036, 202/906- 8023, fax: 202/842-2885, E-mail: [email protected] Chester Hartman, Editor. Subscriptions are $25/year, $45/two years. Foreign postage extra. Articles, article suggestions, letters and general comments are welcome, as are notices of publications, conferences, job openings, etc. for our Resources Section. Articles generally may be re- printed, providing PRRAC gives ad- vance permission.

© Copyright 2011 by the Poverty & Race Research Action Council. All rights reserved.

uting material goods across space. More fundamentally, segregation con- sists of the whole range of social prac- tices that groups with privileged ac- cess to important goods use to close ranks to maintain their privileges. This includes role segregation, where dif- ferent groups interact, but on terms of domination and subordination.

Everyone knows that who you know is as important as what you know in getting access to opportuni- ties. This idea captures the social capi- tal effects of racial segregation. In seg-

Avoidance of integra- tion is found across the whole American politi- cal spectrum.

regated societies, news about and re- ferrals to educational and job oppor- tunities preferentially circulate within the groups that already predominate in a given institution, keeping disad- vantaged groups off or at the back of the queue. Cultural capital also mat- ters: Even when the gatekeepers to important opportunities do not inten- tionally practice racial discrimination, they often select applicants by their “fit” with the informal, unspoken and untaught norms of speech, bodily comportment, dress, personal style and cultural interests that already pre- vail in an institution. Mutually isolated communities tend to drift apart cul- turally, and thereby undermine dis- advantaged groups’ accumulation of the cultural capital needed for ad- vancement. Integration is needed to remedy these inequalities.

Segregation also stigmatizes the disadvantaged. When social groups diverge in material and social advan- tages, people form corresponding group stereotypes and tell stories to explain these differences. These sto- ries add insult to injury, because people tend to attribute a group’s dis- advantages to supposedly intrinsic deficits in its abilities, character or culture rather than to its external cir- cumstances. Spatial segregation rein- forces these demeaning stories. Eth- nocentrism, or favoritism towards

those with whom one associates, in- duces self-segregated groups to draw invidious comparisons between them- selves and the groups from which they are isolated. They create worldviews that are impervious to counterevidence held by members of out-groups with whom they have little contact. They tend to view extreme and deviant be- haviors of out-group members, such as violent crimes, as representative of the out-group. Role segregation also creates stereotypes that reinforce out- group disadvantage. People’s stereo- types of who is suited to privileged positions incorporate the social iden- tities of those who already occupy them. Occupation of dominant posi- tions also tends to make people prone to stereotype their subordinates, be- cause dominant players can afford to be ignorant of the ways their subordi- nates deviate from stereotype.

Popular understandings of racial stigma and how it works lead people to drastically underestimate its extent and harmful effects. We imagine ra- cially stigmatizing ideas as con- sciously located in the minds of ex- treme racists. Think of the KKK mem- ber who claims that blacks are bio- logically inferior and threatening to whites, proclaims his hatred of them, and discriminates against them out of sheer prejudice. Most Ameri- cans despise such extremists, disavow explicitly racist ideas, and sincerely think of themselves as not racist. Most say that racial discrimination is wrong. It is tempting to conclude that nega- tive images of blacks are no longer a potent force in American life.

Tempting, but wrong. While the old racist images of black biological inferiority may have faded, they have been replaced by new ones. Now many whites tend to see blacks as choosing badly, as undermining them- selves with culturally dysfunctional norms of single parenthood, welfare dependency, criminality, and poor attachment to school and work. Since, on this view, blacks are perfectly ca- pable of solving their own problems if they would only try, neither whites nor the government owe them any-

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2 • Poverty & Race • Vol. 20, No. 4 • July/August 2011

Understanding Health Impact Assessment: A Tool for Addressing Health Disparities

by Saneta DeVuono-powell & Jonathan Heller

Health is a big topic of concern these days. Despite outspending all other developed nations on health care, our nation ranks 26th in life ex- pectancy. In recent years, we have witnessed growing obesity, diabetes and asthma rates, in addition to nu- merous other health problems. Not surprisingly, these health problems have a disparate impact on vulnerable communities, with people of color and those in poverty bearing a dispropor- tionate health burden. For example, infant mortality rates for African Americans are more than twice the national average, and the life expect- ancy gap between poor African- American men and affluent white women is more than 14 years. For advocates who work with these com- munities, health disparities are not new. What is new is the emerging consensus that health outcomes will not improve unless we address social and environmental factors tradition- ally understood as unrelated to health. Improving access to health care and trying to change behaviors are not enough; we must address the decisions and policies that are not traditionally thought of as associated with health.

For the past few decades, public health agencies focused on trying to improve health by addressing indi- vidual behavior related to poor health outcomes. At the same time, social and economic inequalities continued to increase and we witnessed grow- ing and persistent health disparities. Today, the life expectancy gap be- tween the most and least affluent is increasing, and the areas with the greatest social and economic inequali-

Saneta DeVuono-powell ([email protected] humanimpact.org) is a Research As- sociate at Human Impact Partners.

Jonathan Heller ([email protected] impact.org) co-founded Human Im- pact Partners in 2006.

ties have the worst life expectancy and mortality rates. Studies repeatedly show that even when you control for individual variables, external factors like where people live, the quality of their housing and education, income attainment and stress levels correlate with depression, chronic disease, mortality and health risk behaviors. Given this knowledge, health advo- cates have begun to realize that they cannot improve health conditions

HIA addresses the determinants of health.

without addressing these factors, which are known in public health circles as the social determinants of health. Health Impact Assessment (HIA) is a tool that can help highlight these links and mitigate health dispari- ties because HIA addresses these de- terminants of health. Although HIA has been practiced outside of the United States for many years, its use here is just beginning to gain traction. In 2007, a study found just 27 HIAs had been conducted in the U.S. In the subsequent four years, an additional 92 HIAs have begun or been com- pleted.

A Health Impact Assessment is de- fined as “a combination of procedures, methods and tools that systematically judges the potential, and sometimes unintended, effects of a proposed project, plan or policy on the health of a population and the distribution of those effects within the population.” HIA aims to increase the consideration of health in decision-making arenas that typically do not consider health. HIA also identifies appropriate actions to manage those effects. There are two desired outcomes of an HIA. One is to influence plans policies and projects in a way that improves health and di- minishes health disparities. The other is to engage community members and other stakeholders so they understand what is impacting community health and how to advocate for improving health using a transparent and evi- dence-based process.

A typical HIA includes six steps: 1. Screening—Determines the need,

value and feasibility of an HIA; 2. Scoping—Determines which health

impacts to evaluate, the methods for analysis, and the workplan for completing the assessment;

3. Assessment—Provides: a) a profile of existing health conditions; b)

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The Relationship between HIA and Environmental Impact Assessment (EIA)

The National Environmental Policy Act (NEPA) of 1969 (42 U.S.C.§4321 et seq.) requires that proposed federal activities consider the environment and establishes Environmental Impact Assessment as the mechanism for doing so. Although NEPA requires health to be consid- ered in EIA, too often health is not evaluated meaningfully as part of the process. HIA can complement EIA either by integrating HIA into EIA, as has been done, for example, in Alaska, or as a stand-alone process and report that is submitted as commentary on the EIA. Unlike EIA, barring a few limited State examples, no legislative requirements trigger HIA, so the EIA process is a good entry point, enabling HIA to elevate health concerns.

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evaluation of potential health im- pacts;

4. Recommendations—Provides strat- egies to manage identified adverse health impacts or enhance positive health impacts;

5. Reporting—Includes development of the HIA report and communica- tion of findings and recommenda- tions; and

6. Monitoring—Tracks impacts on decision-making processes and the decision, as well as impacts of the decision on health determinants.

Within this general framework, ap- proaches to HIA vary as HIAs are tai- lored to work with the specific needs, timeline and resources of each par- ticular project. This article briefly describes two HIAs as examples of how and when an HIA can be con- ducted and then discusses strategies for using HIA to address health dis- parities.

Case 1: Long Beach Downtown Develop- ment Plan

In 2010, the City of Long Beach in Southern California proposed plans for extensive new development in their downtown area. The Long Beach Downtown Plan proposed including 5,000 new residential units, 1.5 mil- lion square feet of office, civic and cultural spaces, 384,000 square feet of new retail space, and 5,200 new jobs. The plan, however, did not men- tion affordable housing or job creation for the current residents of the area. This oversight was particularly troublesome given the demographics of Downtown Long Beach, an area that is currently populated by an eth- nically diverse and predominantly low-income population whose current employment and housing needs are not being met (the list for Section 8 hous- ing is currently closed and has a ten- year wait).

Concern about the potentially ad- verse impacts this plan would have for

local residents led local organizations to decide to conduct a rapid Health Impact Assessment. The HIA, con- ducted by East Yard Communities for Environmental Justice, Californians for Justice and Human Impact Part- ners (HIP—an Oakland-based non- profit) in early 2011, focused on mea- suring what impacts the proposed plan would have on housing and employ- ment and how these changes would affect the health of residents. Because the advocates wanted to be able to use the HIA to respond the Draft Envi- ronmental Impact Report (EIR), there

A typical HIA includes six steps.

was a short timeline. This necessarily limited the scope of the HIA, but it was still a useful tool for concerned community advocates and local orga- nizations. Fortunately, there was a proposed Community Benefits Agree- ment, which allowed the HIA to fo- cus its recommendations as well as point to a specific and feasible alter- native course of action. Over a three- month period, staff worked together to gather data on: (1) existing health, housing and employment conditions in Downtown Long Beach; (2) the potential impacts of the proposed plan; and (3) the potential impacts of pro- posed community benefits.

The availability of affordable, qual- ity housing and adequate employment opportunities have direct health im- pacts. The Long Beach HIA cited studies showing that the nature and stability of housing and employment impact a variety of health indicators, including mortality rates, infectious disease, depression and substance abuse. Based on the analysis of the existing demographics and conditions in Downtown Long Beach, the HIA found that the diverse residents (Long Beach is the most ethnically diverse city in California) were already fac- ing a shortage of quality affordable housing and adequate employment op- portunities and suffering from asso- ciated health problems. For example, the HIA found that 46% of renters

were spending more than the recom- mended 30% of their income on rent and 25% were spending more than 50% of their incomes on rent, and that overcrowding was already a problem in Long Beach. Not surprisingly, the rates of asthma, heart disease and other health issues (which can be re- lated back to housing cost and quality and to jobs) in Long Beach are sig- nificantly higher than the county av- erage.

The HIA findings indicated that, as proposed, the Downtown Plan was likely to have negative impacts on a variety of health-related indicators, including: overcrowding, population displacement and unemployment. The HIA also found that the adoption of the proposed Community Benefits Agreement would mitigate some of the negative impacts resulting from the proposed Downtown Plan by provid- ing additional very-low-income and moderate-income housing units and increasing employment opportunities. The HIA recommended that the plan adopt these benefits. The HIA in Long Beach was in response to a city de- velopment plan, was submitted as a comment on a Draft Environmental Impact Report, and was limited in scope to impacts on housing and jobs. Findings from the rapid HIA were highlighted in local media campaigns focused on the proposed Downtown Plan. The City of Long Beach is ex- pected to respond to comments on the EIR in the coming months.

Case 2: Paid Sick Days Policies

In most developed countries, paid sick days are a given. In the U.S., however, there is no federal law man- dating paid sick days and about 4 out of every 10 workers do not have paid sick days. Not surprisingly, low-wage workers, mothers and those who work in the food service industry are much less likely to have paid sick days than most white-collar workers. In 2007, San Francisco became the first juris- diction in the U.S. to mandate paid sick days for employees. Subse-

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quently, various jurisdictions have in- troduced legislation that would do the same, including California in 2008 and Congress in 2009—neither of which passed. Surprisingly, although access to paid sick days has clear health implications, initially health was not part of the discussion sur- rounding efforts to mandate paid sick days. The main frame through which decision-makers viewed this legisla- tion was that of economic impact of requiring employers to provide paid sick days.

From 2008-2010, a series of Health Impact Assessments that looked at paid sick day requirements were con- ducted. In 2008, an HIA of the Cali- fornia Healthy Families, Healthy Workplaces Act (AB 2716, entitling employees to accrue one hour of paid sick time for every 30 hours worked) was completed by Human Impact Part- ners and the San Francisco Depart- ment of Public Health (SFDPH) at the request of the Labor Project for Work- ing Families. The following year, HIP and SFDPH conducted an HIA of the federal Healthy Families Act of 2009. The California and Federal Paid Sick Days HIAs looked at the potential health outcomes for workers, families and communities, including impacts on recovery from illness, use of pre- ventative health care services versus emergency rooms, as well the trans- mission of infectious disease in res- taurants, schools and workplaces. The HIAs found that paid sick days has many positive health outcomes, in- cluding: improved food safety in res- taurants; reduced transmission of the flu in childcare settings and nursing homes; and reduced emergency room usage. The HIAs showed that legisla- tion that would entitle more workers to paid sick days would be good for everyone’s health—workers them- selves, as well as people whose lives are touched by the same workers.

Paid Sick Day HIAs were used by coalitions of proponents of the vari- ous paid sick days legislation. Al- though neither the California nor Fed- eral legislation passed, the HIA helped advocates articulate a public health rationale for the policy, thereby

By coupling the HIA with extensive legal comments on the environmental impact report and an economic analysis, we have proven that affordable housing and local hiring community benefits are legally appropriate, economically feasible and would improve the health of Long Beach residents. — Susanne Brown, Legal Aid Foundation of Los Angeles

changing the public discourse about the issue from a question of labor rights or employer costs to the issue of improving the health of all people. At the same time, the HIA offered a rationale for public health officials to

Two complementary strategies: focus on process, focus on out- comes.

support paid sick days, a policy they may not have previously engaged. This health framing was picked up in other jurisdictions, and Milwaukee advocates used the California HIA along with Milwaukee-specific data to inform public opinion on a local 2008 paid sick day ballot measure. Legis- lative advocates publicized health facts through the local media, and the ini- tiative passed with the support of two- thirds of the votes of Milwaukee resi- dents. More recently, Connecticut became the first state to pass paid sick days legislation. In making their ar- gument, advocates in Connecticut fo- cused on the health benefits the bill would provide.

Strategies for Using HIA to Address Health

There are a wide variety of projects, policies and plans where an HIA can be useful, and the first step of any HIA helps determine whether it is an appropriate tool. Conducting an HIA requires six steps (as outlined above). During the first two steps (screening and scoping), those in- volved assess the need for an HIA as well as which health measures to evaluate. HIAs start with hypotheses

that are informed by scientific review as well as by lived experience of com- munities and stakeholders, and then research informs whether the hypoth- eses are true. This process allows those involved to think about the health of a particular community and understand the variety of ways that social factors are implicated in heath.

The HIA on the Downtown Plan in Long Beach and the HIA on paid sick days highlight how advocates can use a health lens. Framing the issue of equity around health can be a very powerful tool. Because HIA addresses social determinants of health, advo- cates and communities may find that the use of an HIA can create head- way around a social issue. Often a health lens makes it more difficult for opponents to argue against address- ing the real needs of a community. Using an HIA as a strategy for devel- oping a health lens can be particularly effective because HIA is a research- based tool that provides scientific data in addition to assessing mitigation strategies.

The differences between the two above case studies highlights two complementary strategies for using HIA to address health disparities: fo- cus on process, and focus on out- comes. Ideally, an HIA utilizes a ro- bust process of multi-stakeholder par- ticipation, and also uses robust data analysis to influence the outcome of the project it is assessing in a manner that produces good health outcomes. However, HIA can have powerful impact even if it ends up being more outcome- than process-driven, or vice versa.

In Long Beach, advocates were concerned about a land use plan and wanted a tool they could use to weigh

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(HIA: Continued from page 5)

in on an existing, fast-moving process. Although the HIA process was impor- tant, given the short timelines, what mattered most was to have an impact on the proposed plan. HIA was ap- pealing because it could produce an evidence-based report, highlighting potential health consequences, to sub- mit as a comment on the Draft Envi- ronmental Impact Report that was being prepared. In this case, this cre- ated a time constraint, which limited and therefore deemphasized the HIA process. HIAs provide stakeholders with multiple ways to weigh in at vari- ous stages in a decision-making pro- cess, almost always with the goal of influencing the final decision. The HIA can be used to legitimize or as- suage concerns, and can offer a mechanism to introduce recommen- dations or alternatives.

Although HIAs are typically set up in a way that allows them to have some impact on outcomes, there are also reasons for conducting an HIA that focuses more on process. Through conducting an HIA, structured oppor- tunities for capacity-building, relation- ship-building, transparent and demo- cratic process (e.g., stakeholder par- ticipation), community organizing, and developing messages are avail- able. Regardless of outcome, an HIA can be useful and impactful because of these opportunities.

Often, the process of engaging multiple stakeholders in HIA actually brings about change in the decision.

In addition to quantitative data, HIAs often include community surveys or focus groups, which help lend a voice and credibility to concerns about the issue. In the Paid Sick Days HIAs, the material gathered from focus groups was useful for highlighting the health concerns of workers, giving a personal voice to the issue, and for engag

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