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Moving beyond equity to become an anti-racist health department: lessons from Tacoma-Pierce County


Everyone should have the opportunity to achieve good health. However, a legacy of systemic racism has resulted in significant health disparities for Black, Indigenous and other people of color in cities all around the country. They experience poorer birth outcomes, have higher rates of chronic disease and die younger than their white counterparts. They are denied the chance to reach their full health potential.

By working together with government agencies, businesses and community organizations, public health departments play a crucial role in improving people’s lives by promoting policies that dismantle the institutions and systems that perpetuate racism, violence, poverty and injustice.

At a February webinar, Sebrena Chambers, director of the Strengthening Families Division at the Tacoma-Pierce County Health Department and Jahmad Canley, CEO and senior consultant at Potential Unleashed, discussed how the health department is working to dismantle racism and shared what other agencies can do to get started.

Racism is a Public Health Crisis

“Good health won’t be a reality for all residents unless we address racism as a root cause of poor physical and mental health for Black, Indigenous and people of color,” Chambers said.

Health equity is not new work for the Tacoma-Pierce County Health Department. In fact, they’ve been focused on it for more than 10 years.

Racism is interwoven with the social, economic and environmental factors that drive our health, including education, housing and economic opportunities, Chambers noted. Recognizing that, Tacoma-Pierce Health Department has long prioritized issues like healthy housing, for example, working with residents to develop an affordable housing action strategy for the county.

Following the murder of George Floyd in 2020, the health department renewed its commitment to protect and improve the health of all people in Pierce County, turning its anger into action. The department engaged the County Board of Health, and in a resolution passed unanimously, the board declared racism a public health crisis.

The resolution outlined the Board of Health’s support to:

  • Assess internal policies and procedures to address and reform structures and processes that contribute to race-based decisions and actions.
  • Reshape its discourse and agenda to actively engage in anti-racist work, particularly anti-Black racism.
  • Review its budget and make recommendations for funding changes.
  • Partner with community to co-create solutions.
  • Promote policy and system level changes within Pierce County to move beyond equity and undo racist structures.

“We can resolve disparities by changing the systems that cause them,” Chambers said.

Racism, Resilience and Action Response Team

As a next step, the health department created a Racism and Resilience Action Response Team.

Through its work, the team aims to address racism as a root cause of unequal health outcomes at all levels – individual, interpersonal, institutional, community and systemic, Chambers explained.

They’re focused on the following four strategies:

  1. Data—Elevate racism as a public health crisis through data.
  2. Training and education—Support staff and commit to department-wide anti-racism development.
  3. Policies—Develop and support racial equity policies. Commit to racial equity in communications strategies.
  4. Sustainability—Fund the work of transforming systemic racism. Engage and uplift communities affected by racism, particularly anti-Black racism.

“Action begins with a commitment to do the uncomfortable but necessary work to dismantle racism. We looked at our internal systems, who we serve, how we spend our money, how programs are operating, how we are working with our community,” Chambers said.

One of the tools the department is using to evaluate its own policies, practices, program structures and culture is a continuum on becoming an anti-racist multicultural institution, Chambers noted. To learn more about the continuum, click here.

“We must be accountable to the communities most affected by racism and systematically eliminate ideas and policies that cause harm to Black, Indigenous and other impacted ethnic and racial groups,” Chambers said. “We must commit to justice, healing and action.”

The department continues to work with communities and stakeholders most affected by potential policies and practices to identify priorities and ensure that any decisions incorporate their knowledge and perspectives, she said.

“When community members have input into decisions that affect their health where they live, learn, work, worship, and play, we are more likely to succeed,” Chambers said.

Progress and Potential

Since last year, the department has taken several steps to implement its strategies.

To gather better data on people’s attitudes and behaviors, the Tacoma- Pierce County Health department led the state effort to developed and submitted anti-racism questions to be added to the next state Behavioral Risk Factor Surveillance System survey.

“This is a unique opportunity for health departments and community partners to get more information on racial discrimination and identify cross-sector opportunities for moving forward,” Chambers noted.

The department immediately started an affinity group immediately after the death of George Floyd, starting with Black staff to give them a safe space to grieve and unpack their feelings and thoughts, Chambers said. There are now affinity groups for Latinx and other staff members of color, as well as white staff members.

The team also developed a training roadmap and is providing training to staff and executive leadership focused on shared language and definitions, understanding historical context, recognizing how racism shows up individually and in policies and systems and exploring different ways to interrupt racial oppression.

In addition, they completed a rapid assessment of their hiring and employment practices, including recruitment, demographics, performance evaluation and promotion policies, and added core competencies on racial equity.

The next step, Chambers said, is to look at the department’s procurement policy to ensure that it is intentionally fair and equitable.

To keep the work going, the department continues to build and nurture meaningful community partnerships to center the experiences of communities most harmed by racism and ensure their participation in policies, actions and decisions that may affect them.

The department is also identifying resources to fund a position to continue to move this work forward. Future activities include further staff training, modifications to the current Incident Command Structure to implement long term racial equity and justice objectives and continue to work on community-based policy and systems changes.

“We know we don’t have all the answers. The answers are already in the community. We need the community’s input, and we’re at the table and there is room for all. We all have the strength to dismantle institutional and systemic racism. We can only do this together,” Chambers said.

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