This article is written by Laya Lakkaraju, health program administrator,and Rubab Zahra-Hassan, program co-ordinator, New York State department of health/health research, Inc. This article is one of the entrants in Apolitical's 2020 American public servant writing competition.

New York State (NYS) is the fourth most populous state in the United States, with a population more than 19 million. It is also the fifth most diverse state.

Despite the opportunities, NYS provides to its residents from different backgrounds, classes, races and ethnicities, there continue to be vast inequities in access to housing, income equality and many other basic needs.

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In NYS, these inequities persist and impact health and health outcomes.

The rates of premature deaths (before age 75) are more than 1.3 times higher for black non-Hispanic in comparison to white non-Hispanic populations. The Hispanic population has similar premature death rates in comparison to white non-Hispanic people.

And if you’re black, you’re much more likely to suffer from heart disease, one of the leading causes of death in the United States. You’re also more likely to die from it. Black non-Hispanics experienced the highest heart disease mortality rates, which are almost four times the rate for Asian/Pacific Islander non-Hispanics and 1.5 times higher than white non-Hispanics.

Even when we control for other factors, we know race and ethnicity play a critical role in determining health outcomes.

As of 2016, asthma hospitalisations among black non-Hispanics were approximately five times greater than white non-Hispanic New Yorkers. What this means is, even when we control for other factors, we know race and ethnicity play a critical role in determining health outcomes.

Race plays a critical role in determining health outcomes not only in New York, but all across the US, according to [this](https://books.google.com/books?hl=en&lr=&id=luNal8EZdZoC&oi=fnd&pg=PP11&dq=+++++++++++National+Center+for+Health+Statistics,+++++++++++Health,+United+States,+1998,+with+Socioeconomic+Status+and+Health+Chartbook,+++++++++++Pub.+no.+(PHS%2998-1232+(Hyattsville,+Md.:+NCHS,+++++++++++1998+++++++++++). National Centre for Health Statistics report, the prevalence of hypertension and diabetes is two to three times as high among African Americans as among whites.

Towards racial justice

This shows the critical role race and ethnicity plays in determining health outcomes.

In the Race Reporting Guide, published by research and advocacy institute Race Forward, racial justice is defined as ‘the proactive reinforcement of policies, practices, attitudes and actions that produces equitable power, access, opportunities, treatment, impacts and outcomes for all’.

This requires governments, civil society and individuals to not only ensure they engage in anti-racist behaviours, but to also deliberately create systems and supports that achieve and sustain racial equity.

The New York State Department of Health (NYSDOH) Centre for Community Health (CCH), is a government agency that staffs doctors, nurses, administrative and policy professionals who aspire to improve the health and wellbeing of all New Yorkers by engaging people in building healthier communities. CCH programs support chronic disease prevention, improvements in nutrition and physical activity choices, and maternal and child health through implementation of a policy, systems and environmental change framework in NYS communities.

It is critical to dismantle the systems that do not work for everyone and create innovative and disruptive systems that better the health of all New Yorkers.

CCH works in other areas of prevention, including programs to combat communicable diseases. CCH is prioritising racial justice when working with internal and external partners to create policies and implement programs. Across all of its programs, CCH is taking carefully measured and planned strategic steps to actively create equitable power, access and opportunities and to sustain change that will bridge health equity gaps in the long-term. CCH is striving to be proactive and using an anti-racist approach to improve health outcomes.

In 2017, CCH leadership recognised that to solve a systemic issue like racial inequity, there was a need for leaders, thinkers and contributors who have lived realities related to race and who belong to minority groups. CCH’s first step was to create a CCH-wide racial justice workgroup with participants of colour at the forefront. Participation was voluntary, and all CCH staff interested were welcomed. This call for diverse members also allowed people of colour who were not currently in leadership positions to take a step forward and take up leadership roles to operationalise racial justice work. We had more than twenty staff from different program areas join this initiative.

Actions to create change

After forming, the workgroup’s first charge was to define racial justice and develop a plan to direct and communicate CCH’s vision.

The workgroup undertook several tasks in its first year, including developing a common definition of racial justice and creating a framework that included the vision and commitment to racial justice across CCH, to be used by CCH leadership staff to communicate initiative goals and activities.

In year two, CCH launched a three-phase training plan to begin to inform staff across CCH about the topic. Phase one included online training on racial justice and racial health inequities, intended to set the stage and define key terms. Phase two consisted of in-person facilitated trainings, led by an expert in the field, to bring greater perspective of this work for staff. The final phase is continued in-person trainings in various formats that include book clubs, lunch and learn sessions, film screenings and discussions.

It is important to note that this work is challenging. It is often met with resistance to change at many levels, lack of financial support, and longstanding and rigid organisational processes.

Such staggered efforts towards capacity building allow staff to have a steady transition into enhancing their understanding of racial health inequities and how to apply the racial justice lens to projects and programs. These are important efforts to educate and embolden staff to be change-makers in their own capacity.

The different components of the initiative all seek to go beyond simply quantifying disparities in health to preparing public health staff and developing programs that systematically eliminate inequities. This allows for the reduction and potential elimination of systemic inequities.

It’s very important that government agencies systematically undo and change ways they work, educate, provide public health services and conduct research. It is critical to dismantle the systems that do not work for everyone and create innovative and disruptive systems that better the health of all New Yorkers.

Ensuring a full life for all

It is important to note that this work is challenging. It is often met with resistance to change at many levels, lack of financial support, and longstanding and rigid organisational processes. Even though such challenges exist, they are small in comparison to the racial health inequities that continue to keep our communities unhealthy.

These challenges should not deter efforts in implementing and promoting this work to create a healthier New York, nor should they keep you from promoting racial justice in your local context. Despite these challenges, CCH’s vision for racial justice, in addition to thoughtfully created staff capacity and planned strategic initiatives, helps in overcoming barriers toward equity. All New Yorkers, independent of race and ethnicity, deserve to live a full life with the most favourable health outcomes, and CCH is committed to accomplishing this goal. — Laya Lakkaraju and Rubab Zahra-Hassan

CCH received technical assistance from the Government Alliance on Race and Equity (GARE) to guide implementation. GARE supports government entities in developing goals and implementing strategies in alignment with racial justice. GARE assisted in the pilot initiatives and will continue to assist in the development and implementation of an action plan. The Racial Equity Action Plan will be created to integrate racial justice principles into each program across CCH. CCH staff will utilise the action plan to prioritise community and stakeholder impact and support and sustenance of this work.

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