failure to include black communities in health policy perpetuates health disparities

as it stands, a growing body of evidence suggests that while many decision-making bodies proclaim publicly that they  want input from racialized and other marginalized communities , many institutions are not willing to listen to, accept or integrate what those communities have to say.

broad systemic problems  caused by longstanding exclusion and privilege  are increasingly being acknowledged as overdue for correction. however, these complex issues are far too often  papered over with helpful-sounding but empty rhetoric and symbolic and performative gestures of inclusion .

health-care disparities

our research , as part of the  public engagement in health policy  team, examines two key things:

1. how, and to what extent, black communities have been traditionally engaged in health policymaking; and,
2. how, through creating their own health-focused solutions and interventions, black communities’ self-advocacy and mobilization can provide great insight into persistent health system and policy gaps, and what potential solutions can look like.

black communities in canada and the united states are at  higher risk for contracting covid-19 , have been dying at disproportionate and alarming rates, and suffer greater negative economic impacts.

we have known for some time that  social determinants such as race, social class, education and environment  influence health outcomes in both everyday and emergency situations.

a recent review of  government-initiated public and patient engagement activities in health policy from 2001-21  showed that only 14 per cent of 132 cases even mentioned prioritizing or engaging with marginalized populations.

in response to this question, some scholars have argued that activities engaging the public in creating health policy are often merely performative “ spectacles of public participation .”

they are prone to  political interference, are often inadequately resourced and can result in unfulfilled expectations . they can also be self-selecting and deliberately  designed to make inclusive engagement difficult .

critical scholars have also pointed to  processes that favour amenable, acquiescent perspectives that do not disrupt the status quo , while devaluing, co-opting and delegitimizing dissenting and critical voices.

critical questions

it is therefore  critical that we continue to advocate  for the  collection of race-based health data across canada  to strengthen  health-equity discussions and policy reform .

veneer of action

one of the profound impacts of the black lives matter movement, particularly following the murders of george floyd and breonna taylor, has been growing exasperation with the ways  politicians and institutions often feign ignorance  about the  systemic barriers and forms of violence  black communities have long faced in their daily lives.

symbolic acts of anti-racism that present a veneer of action rather than substantive structural change only add insult to injury. for example, when engaging marginalized communities,  recruiting methods often favoured privileged populations , and one-off methods such as surveys were common, rather than substantively engaging marginalized communities in problem-solving.

we also need to understand that black communities are not sitting by idly in a burning house waiting to be engaged. they are often out there,  self-mobilizing , developing  systems of mutual aid , building  sophisticated community infrastructure  and  making their voices and demands heard . this work should be visible, lauded and properly resourced — not sidelined.

to be truly transformative, public engagement in health policy  must reflect the agency, diversity, and interconnectivity of all communities .

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failure to include black communities in health policy perpetuates health disparities

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