Black Resistance and Resilience: What About Health Civil Rights?
As societal and political forces escalate to limit access to and exercise of the ballot, eliminate the teaching of Black history, and work to push us back into the 1890s, we can only rely on our capacity to resist. The enactment of HR 40, the John Lewis Voting Rights Act, the Breathe Act, and the closure of the racial wealth gap is not the end. They too will require us to mobilize our resources, human and material, and fight for “freedom, justice, and equality”; “self-determination”, and/or “social transformation.” (ASALH, 2023)
This year’s theme for Black History Month—Black Resistance—recognizes the increasingly bold public efforts to minimize or reverse the hard-fought rights and assets of African Americans in a culture that continually upholds the tenets of white supremacy. Whether at the ballot box, in the classroom, at the bank, in the grocery store, or at a health clinic, Black and Brown people incessantly face the interconnected, intersecting inequalities intentionally baked into systems and structures for no other reason than to exploit, curtail, and devastate their families.
As evidenced in the extensive and disparate effect of the three-year pandemic on Black and other communities of color, health and well-being remain some of the starkest indicators of how society values BIPOC children, youth, and adults. But through resistance and resilience, many communities have effectively found incremental ways to improve the social determinants of health, such as embracing ancestral traditions and healing modalities through a decolonization of thought and practice. Another way to break down barriers to medical and mental health resources is through reinforcement of federal protections and guidance to service providers.
Health and Well-Being Civil Rights
Nearly 60 years ago, the U.S. Health and Human Services (HHS) Office for Civil Rights (OCR) was created to desegregate hospitals shortly after the passage of Title VI of the Civil Rights Act of 1964 and creation of the Medicare program. OCR has deep roots in enforcing federal civil rights laws that ensure nondiscrimination based on race, color, and national origin. Recent priorities of OCR in enforcing federal civil rights laws that ensure nondiscrimination include revised policy rules with the Affordable Care Act, newer service guidance with vaccine equity and access to telehealth, and promotion of reproductive health care.
Strengthening Nondiscrimination in Health Care
OCR issued a proposed rule revising Section 1557 of the Affordable Care Act, which is one of the federal government’s most powerful tools to ensure nondiscriminatory access to health care.
“Strengthening Section 1557 supports our ongoing efforts to provide high-quality, affordable health care and to drive health equity for all people served by our programs,” said Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure. “This work will help eliminate avoidable differences in health outcomes experienced by those who are underserved and provide the care and support that people need to thrive” (HHS, 2022).
Additional Resource: Civil Rights for Providers of Health Care and Human Services
Ensuring Vaccine Equity
Vaccine equity is when everyone has fair and just access to COVID-19 vaccination. But there are many social, geographic, political, economic, and environmental factors that create challenges to vaccination access and acceptance, and that often affect racial and ethnic minority groups. In light of this, OCR issued guidance to providers about their obligations under Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act to ensure non-discrimination in administering COVID-19 vaccination programs.
Additional Resource: Best Practices in Equitable Vaccine Administration
Ensuring Equal Access to Telehealth
OCR, with the Department of Justice Civil Rights Division, issued guidance on nondiscrimination in using telehealth. It provides information to health care providers about their service obligations and practical tips about how to provide accessible telehealth.
Additional Resource: Health Equity in Telehealth
Promoting Reproductive Health Care
After the Supreme Court’s Dobbs decision overruling Roe v. Wade came out, HHS launched reproductiverights.gov. Recognizing the high maternal mortality rate of Black women and how the Dobbs decision exacerbates these inequities and disparities, OCR issued multiple guidance documents so that health care providers understand their obligations and patients understand the protections of federal laws.
Additional Resources: Reproductive Health Care Rights and Social Current’s statement on the overruling on Roe v. Wade.
“If you’re an African-American… your risks of dying in childbirth are three to four times higher than if you’re white…. It’s not tied to income. It’s not tied to education…. It’s something about the lived experience of being African-American,” says Dr. Neel Shah, assistant professor at Harvard Medical School and obstetrician/gynecologist at Beth Israel Deaconess Medical Center in Boston. (ABC News, 2018)
Civil Rights Laws Are Necessary, but Not Sufficient
Despite gains from decades of legislation and policy rules to reduce discrimination and increase access to services and resources, it’s clear that health care for racial and ethnic minorities remains separate and unequal in the United States.
Health policy and legal experts acknowledge the challenges to reducing discrimination and health inequity through existing civil rights laws and consider whether enforcing more of the existing civil rights legislation could help overcome these challenges. A common conclusion is that stronger enforcement (e.g., through executive orders to strengthen enforcement of the laws and congressional action to allow private individuals to bring lawsuits against providers who might have engaged in discrimination) would improve minority health care. But this approach is limited in what it can achieve, mainly due to the challenges for underserved communities to access enough financial and legal resources required. Rather, complementary approaches outside the legal arena, such as quality improvement efforts and direct transfers of money to minority-serving providers (pay-for-performance initiatives) might prove to be more effective.
Commitment to Health and Well-Being Practice and Policy
Social Current’s commitment to a healthy and equitable society is evident in our social sector partnerships focused on bridging historical barriers and persistent challenges with contemporary solutions and best practices to end racism, inequity, and poverty. This commitment recognizes BIPOC families as the experts in what is important to realizing their full potential, as well as the importance of cross-sector approaches to advancing equity, partnering with purpose, and building on successes in improving health equity and the social determinants of health.
Here are some ways to join our work on equity, diversity, and inclusion today:
- Participate in workshops, learning collaboratives, and consulting services
- Connect with peers and industry experts with SPARK Exchanges
- Enroll in learning opportunities on building community health and well-being
- Subscribe to policy and advocacy updates
- Get health equity research and resources from the Knowledge and Insights Center