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Structural racism is at the core of Chicago life expectancy gap: Community Power is crucial to making structural change, beating white supremacy, and advancing health equity

Jim Bloyd, DrPH, MPH

Collaborative for Health Equity Cook County

Health & Power Organizing Project

jimbloyd@gmail.com

September 27, 2023 2:30-3:30 p.m.

“only collective organizing by individuals has ever had the strength to change societal structures.”

Nancy Krieger, Social Epidemiologist

Krieger, Nancy. (2021). Ecosocial Theory, Embodied Truths, and the People's Health (Small Books Big Ideas in Population Health) (p. 54). Oxford University Press. Kindle Edition

Community Command Center Meeting (Online)

Office of Community Health Equity and Engagement

Rush University Medical Center, Chicago

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My public health work…

Local public health departments Los Angeles (CA), Lake and Cook Counties, Illinois (1990-2020)
Tobacco prevention; sex education; STI contact tracing; School-based health center (Cicero); National Collaborative for Health Equity (CHECookCounty.org) Strategic planning (IPLAN: CHA CHIP); CCDPH staff development “Roots of Health Inequity Dialogues;” Covid Hotline Coordinator; Staffed CCDPH Director’s Weekly Covid Update
Collaborative for Health Equity Cook County 2006-present
Retired CCDPH October, 2020
#StopGeneralIron solidarity leader Feb 2021--
Adjunct faculty UIC School of Public Health 2021
MPH (1990) UCLA; DrPH (2021) UIC School of Public Health
Dissertation: Public health leadership to achieve health equity: A case study of a national community of practice. Available at Linktr.ee/jbloyd

Jim Bloyd September 27 2023 Rush U Med Ctr

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Important note: Structural racism is the problem; the cause, not race.

Any significance between race and health is due largely to societal differences.
Race does not represent biological or cultural differences between groups.
Distinctions between races and the importance we place on physical appearance (like skin color) or genetic characteristics are driven by cultural, historical, ideological, geographical, and legal influences rooted in structural racism and white supremacy. Source: Adkins-Jackson, P. B., Chantarat, T., Bailey, Z. D., & Ponce, N. A. (2022). Measuring Structural Racism: A Guide for Epidemiologists and Other Health Researchers. American Journal of Epidemiology, 191(4), 539–547. https://doi.org/10.1093/aje/kwab239

Jim Bloyd September 27 2023 Rush U Med Ctr

10.1093/acprof:oso/9780192630971.001.0001

“Often propped up by scientific racism, the social processes of racialization produce racial categories that derive meaning through the differentiation of groups, not from characteristics associated with the groups (54, 55). Racism is the father of race and becomes salient because of society-specific and time-specific racialization (56). Epidemiologists must explain why 2 racialized groups, groups that do not have between-group differences in genetic structure and that have meaningful within-group variation in cultural practices, would have significant differences in health experiences and outcomes. Such an explanation is likely rooted in structural racism. “P541 Adkins-Jackson etal 2022

This is important because in using the word and concept “Race” to explain health inequities we do not want to perpetuate the mistaken idea, the myth that the root cause of health inequities between racialized groups are anything other than structural.

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CHECookCounty.org @CHECookCounty

Jim Bloyd September 27 2023 Rush U Med Ctr

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Source: Krieger, N. (2022, October 26). From embodying gendered injustice to advancing gender transformative intersectional science: An ecosocial proposal [Screenshots of online presentation of powerpoint slides]. Gender and Health: Impacts of Structural Sexism, Gender Norms, Relational Power Dynamics, and Gender Inequities. National Institutes of Health, Office of Women’s Health, Virtual,. https://orwh.od.nih.gov/about/newsroom/events/gender-and-health-impacts-of-structural-sexism-gender-norms-relational-power-dynamics-and-gender

Jim Bloyd September 27 2023 Rush U Med Ctr

This is the theory that guides my work and thinking about health equity: Nancy Krieger’s Ecosocial Theory of Disease Distribution.

Focus today:

Power; agency (Community Power)
Population distribution of health (Life exp)
Structured chance (structural racism)

Krieger, N. (2022, October 26). From embodying gendered injustice to advancing gender transformative intersectional science: An ecosocial proposal [Screenshots of online presentation of powerpoint slides]. Gender and Health: Impacts of Structural Sexism, Gender Norms, Relational Power Dynamics, and Gender Inequities. National Institutes of Health, Office of Women’s Health, Virtual,. https://orwh.od.nih.gov/about/newsroom/events/gender-and-health-impacts-of-structural-sexism-gender-norms-relational-power-dynamics-and-gender

is not simply a “framework”—because its purpose is not just to “frame” ideas but to generate testable hypotheses, explanations, and predictions about who and what drives population patterns of health and health inequities;

Krieger, Nancy. Ecosocial Theory, Embodied Truths, and the People's Health (Small Books Big Ideas in Population Health) (p. 23). Oxford University Press. Kindle Edition.

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Structural Racism: Multiple definitions

All definitions make clear that racism is not simply the result of private prejudices held by individuals, but is also produced and reproduced by laws, rules, and practices, sanctioned and even implemented by various levels of government, and embedded in the economic system as well as in cultural and societal norms. Confronting racism, therefore, requires not only changing individual attitudes, but also transforming and dismantling the policies and institutions that undergird the U.S. racial hierarchy. (Bailey etal. 2021 p768)

Source: Bailey, Z. D., Feldman, J. M., & Bassett, M. T. (2021). How structural racism works—Racist policies as a root cause of US racial health inequities. In New England Journal of Medicine (Vol. 384, Issue 8, pp. 768–773). Mass Medical Soc.

Jim Bloyd September 27 2023 Rush U Med Ctr

There is no “official” definition of structural racism — or of the closely related concepts of systemic and institutional racism — although multiple definitions have been offered.3-7 All definitions make clear that racism is not simply the result of private prejudices held by individuals,8 but is also produced and reproduced by laws, rules, and practices, sanctioned and even implemented by various levels of government, and embedded in the economic system as well as in cultural and societal norms.3,8 Confronting racism, therefore, requires not only changing individual attitudes, but also transforming and dismantling the policies and institutions that undergird the U.S. racial hierarchy.

it encompasses racist practices and systems that are embedded into institutions in the United States (1, 2). This form of racism is best described by the term structural racism. According to Bailey et al. (3), structural racism is the “totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice” (3, p. 1).” (Adkins-Jackson et al., 2022, p. 539)

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Why power?

When a people are mired in oppression, they realize deliverance only when they have accumulated the power to enforce change.

Rev. Dr. Martin Luther King, Jr. 1967

…power and health go together…

Jason Beckfield, Political sociologist, 2023

Jim Bloyd September 27 2023 Rush U Med Ctr

King, M. L. (1967, June 11). Martin Luther King Defines “Black Power.” The New York Times Magazine. https://timesmachine.nytimes.com/timesmachine/1967/06/11/83607552.pdf?pdf_redirect=true&ip=0;

Beckfield, J. (2018). Chapter 1 Key Concepts, Measures, and Data. In Political sociology and the people’s health. Oxford University Press.

Hazel Johnson (1935-2011) ‘Mother of environmental justice’

Chicago #StopGeneralIron high school students protested environmental racism

December 10, 2021

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Community Power Defined

Jim Bloyd September 27 2023 Rush U Med Ctr

Source: Pastor, M., Speer, P., Gupta, J., Han, H., & Ito, J. (2022). Community Power and Health Equity: Closing the Gap between Scholarship and Practice. NAM Perspectives, 6. https://doi.org/10.31478/202206c

“…the ability of communities most impacted by structural inequities to develop, sustain, and grow an organized base of people who act together through democratic structures to shift public discourse, set proactive agendas, influence who makes decisions, and cultivate ongoing relationships of mutual accountability with decision makers that change systems and advance health equity.”

“the authors have developed a working definition of community power as the ability of communities most impacted by structural inequities to develop, sustain, and grow an organized base of people who act together through democratic structures to shift public discourse, set proactive agendas, influence who makes decisions, and cultivate ongoing relationships of mutual accountability with decision makers that change systems and advance health equity (Pastor et al., 2020c).”

“Community power is about fundamentally making possible what might not seem possible at the start because of structural inequity”

”Individuals with positional power have the responsibility to listen and to work in authentic partnership toward structural or procedural changes”

Quotes source: Pastor, M., Speer, P., Gupta, J., Han, H., & Ito, J. (2022). Community Power and Health Equity: Closing the Gap between Scholarship and Practice. NAM Perspectives, 6. https://doi.org/10.31478/202206c

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Health justice through the lens of power (Michener 2022)

Jim Bloyd September 27 2023 Rush U Med Ctr

Michener, J. (2022). Health Justice Through the Lens of Power. Journal of Law, Medicine & Ethics, 50(4), 656–662. https://doi.org/10.1017/jme.2023.5

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#StopGeneralIron: Anti-racist hunger strike (Feb 2021) to #DenyThePermit

We had already done petitions, we had already done peaceful marches, we had already done marches at Lori Lightfoot’s house, we had already done all these things. We needed something. And that something was the hunger strike.”

Jim Bloyd September 27 2023 Rush U Med Ctr

From Top-right clockwise: Jade Mazon, Chuck Stark, Chris King, Donald Davis, Óscar Sanchez, Lauren Bianchi, Yesenia Chavez, Carlos Enriquez, Crystal Vance-Guerra, William ‘Kid’ Guerrero

“How do you organize in a pandemic, during the winter, against such a City-led project? Because ultimately, General Iron had been approved and was given all the green lights by the City despite my community, our neighborhoods saying no.

Source & Credit: Jay, C., Sayles, A., Stovicek, O., Vaughn, B., & City Bureau. (2021, November 11). Stories and Lessons from Inside the Stop General Iron Hunger Strike – South Side Weekly. Southside Weekly. https://southsideweekly.com/stories-and-lessons-from-inside-the-general-iron-hunger-strike/

Stories and lessons from inside the Stop General Iron hunger strike (South Side Weekly, November 11, 2021, by Corli Jay, Ahmad Sayles, Olivia Stovicek, Bridget Vaughn)

Hunger Strike in February 2021

How do you organize in a pandemic, during the winter, against such a City-led project? Because ultimately, General Iron had been approved and was given all the green lights by the City despite my community, our neighborhoods saying no.

We had already done petitions, we had already done peaceful marches, we had already done marches at Lori Lightfoot’s house, we had already done all these things. We needed something. And that something was the hunger strike.

“Leadership is the practice of mobilizing people, organizations, and communities to effectively tackle tough public health challenges.” (Begun & Malcolm 2014 p18)

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“We demand that CDPH follow its own community health improvement plan 'Healthy Chicago 2025’ and prioritize environmental justice, racial equity, and health equity in its actions.”

Jim Bloyd September 27 2023 Rush U Med Ctr

Open letter to Mayor Lightfoot & Commissioner Arwady, March 8, 2021

Signed by over 70 organizations & over 500 individuals

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Jim Bloyd September 27 2023 Rush U Med Ctr

“This brief outlines how the Chicago Department of Public Health (CDPH) analyzed community-level data on air quality, health, and social factors to identify, for the first time, which neighborhoods must be prioritized for efforts to mitigate and reduce air pollution.” p3

Available at: https://www.chicago.gov/content/dam/city/depts/cdph/statistics_and_reports/Air_Quality_Health_doc_FINALv4.pdf

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A hallmark of privilege…

data…are always produced by people, out of what they observe, fail to see, or suppress in the world in which they live. A corollary, in the case of people, is that a hallmark of privilege is who and what one can afford to ignore . Translated to the realm of science, this means it is imperative to ask: who produces and controls the data? To what end? And engaging with what history?

Krieger, N. (2021). Structural Racism, Health Inequities, and the Two-Edged Sword of Data: Structural Problems Require Structural Solutions. Frontiers in Public Health, 9, 655447. https://doi.org/10.3389/fpubh.2021.655447

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Collective action ideas

Press conference; release
Public letter
Testimony from an organization
Protest; street march
strategy meetings
Coalition member; support
Solidarity; technical support
Coordinated Social media
Public speaking; ‘outreach’
Following leadership of people most affected by structures of oppression
Group discussions for increased knowledge & community building
Support fund raisers

Jim Bloyd September 27 2023 Rush U Med Ctr

Video/ youtube
Op-eds
Emails/ phone/ door knocking/ other communication
Citizen science
Meet with officials
Organize tours
Read key documents and share findings with group

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Attacking life expectancy gaps requires structural change at levels higher than Rush service region (City; State; national) & solidarity with Community Power

Jim Bloyd September 27 2023 Rush U Med Ctr

Mode of Structural Racism	Opportunity to change law, ordinance , process, norms, ‘Rules of the Game’	Organization to explore & support (incomplete)
Unsafe, unaffordable housing;	Chicago Healthy Housing Ordinance	Metro Tenants Assn; CAFHA; CHE Cook County
Low pay/ safety	Eliminate tipped wages	ROC Chicago; Labor unions
Air pollution; toxic environment; Environmental justice	Chicago Cumulative Impact Assessment follow up	SETF; Blacks In Green; NRDC, LVEJO
Education inequities (PreK-12+)	vouchers undermining public schools	?
Taxation-Cook County	Ongoing reform of commercial & pvt property assessment	?
Climate crisis	Chicago affordable decarbonize housing proposal	Neighbors 4 EJ
Immigration-NO TENTS (Housing is a right for all Chicagoans!)	Co-Sign public testimony statement Bit.ly/tentsno by 8pm tonight Sept 27. Email info@CHECookCounty.org	Collaborative for Health Equity Cook County

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Questions for breakout groups

What work that you do takes aim at changing structural racism? (laws, rules, policies, practices, norms that support and recreate a racial hierarchy).

What examples of organizations building Community Power for health justice do you know of? How do they do their work?

What kinds of laws rules, policies, practices or norms contribute to creating the life expectancy gap in Chicago?

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Following slides are optional…

Thank you!

Jim Bloyd, DrPH MPH

jimbloyd@gmail.com

Collaborative for Health Equity Cook County

CHECookCounty.org @CHECookCounty (Twitter, X)

Participant: Health & Power Organizing Project

Jim Bloyd September 27 2023 Rush U Med Ctr

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“Whites’ normative participation…”

My main argument is that we all participate in SR [Structural Racism] (no one can be outside SR much like no one can be outside capitalism or patriarchy) and that most Whites’ racial behavior is seemingly non-racial, habituated, and even apparently race-neutral. Whites’ normative participation in the racial structures of everyday life, I argue, is more significant for the reproduction of racial order than the actions and behavior of “racist” actors. (Bonilla-Silva 2021 p514)

Source: Bonilla‐Silva, E. (2021). What Makes Systemic Racism Systemic ? Sociological Inquiry, 91(3), 513–533. https://doi.org/10.1111/soin.12420

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“Social structure and human agency are co-constitutive” Beckfield

Jim Bloyd September 27 2023 Rush U Med Ctr

Social Structure

Human Agency

“only collective organizing by individuals has ever had the strength to change societal structures.”

Although it is certainly true that randomness and simple luck play roles in the distribution of life chances (Jencks, 1972), people are not objects dropped through a quincunx. Indeed, one of the fundamental complexities of social science is that social structure and human agency are co-constitutive. But the quincunx does help in the visualization of how politics and policies structure life chances in spatially and historically varying ways, and we can even elaborate on the classical quincunx by allowing the elements to take on time-varying attributes that a ect path probabilities in systematic ways. Take race, for instance. Race is a system of categorization that creates differential relations between people and their institutional contexts, so it could be incorporated into the quincunx as a variable magnetic eld that would raise or lower the odds of different turning points for different elements of the population, depending upon physical properties of the elements themselves.

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Orgs: Frontline community people power, solidarity, federal government

Jim Bloyd September 27 2023 Rush U Med Ctr

Southeast Side Educators for Environmental Justice

Partial list

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Jim Bloyd September 27 2023 Rush U Med Ctr

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“This is what environmental justice looks like.”

Michael Regan, Administrator EPA, February 18, 2022

US EPA, O. (2022, February 18). Statement from Administrator Regan on RMG Permit Denial by the City of Chicago [News Release]. https://www.epa.gov/newsreleases/statement-administrator-regan-rmg-permit-denial-city-chicago

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HUD found Chicago to be in violation of the US Civil Rights Act of 1964 (US HUD 2022)

“In 2016, as the City began engaging with General Iron, the City launched its Industrial Corridor Modernization Initiative to “guide future public and private investments.”...the City designated all but three of the Industrial Corridors as “Receiving Corridors,” meaning that in those areas the City would “reinforc[e] traditional industrial activities.”...The Industrial Corridors not designated as Receiving Corridors are disproportionately White...the twenty-three designated as Receiving Corridors are collectively 20% White. By contrast, the three Industrial Corridors not designated as Receiving Corridor are collectively 68% White.”

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Source: Gaige, J., & US Department of Housing and Urban Development. (2022, July 19). Letter of Findings of Noncompliance with Title VI and Section 109 Southeast Environmental Task Force, et al. V. City of Chicago Case No. 05-20-0419-6/8/9. https://www.hud.gov/sites/dfiles/Main/documents/Letter_of_Finding_05-20-0419_City_of_Chicago.pdf p14

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“For the first time in decades, life expectancy for Black residents of Chicago fell below 70 years. Latinx residents saw 3-yr drop between 2019 & 2020.” ��Source: Mayor’s Press Office April 25, 2022 https://www.chicago.gov/content/city/en/depts/cdph/provdrs/health_data_and_reports/news/2022/april/life-expectancy-in-chicago-declined-during-the-pandemic-s-first-.html Graphic: Chicago Health Atlas

Jim Bloyd September 27 2023 Rush U Med Ctr