The societal distribution of the necessities of life – housing, education, food, health care, employment – are the fundamental cause of patterns of health and disease. Creating a healthier and more equitable city will ultimately require changing current policies and political and economic structures that result in the inequitable allocation of these pillars of health.
Reducing the Impact of Systemic Racism on Health in New York City by 2025
Social policy and public health practice are always guided by values. The authors articulate the core beliefs that shape their recommendations for reducing health inequities in New York City and invite recommendations from those who share these values.
1. Equity at the center
2. Make protecting vulnerable populations a priority.
Gaps in premature deaths and preventable illnesses between Black, Latino, and other populations of color and whites in New York City and between wealthier and less privileged groups reflect the history and current practice of systemic racism and other forms of oppression. By dismantling the systems that perpetuate inequity and ill health and replacing them with more equitable policies, the city can bring benefits to the vast majority of New Yorkers, starting with those most harmed by the status quo.
3. Recognize leadership of activists and movements.
Throughout history, social movements, community organizations, young people, and reform groups have played a crucial role in improving health and promoting a more just society. Strategies to close racial/ethnic and other gaps in health today must create opportunities to recognize and nurture the leadership of the many groups now active in seeking such changes. Community residents can play a vital role in documenting health and social problems and mobilizing for change. Effective strategies for improving health rely on recognizing this key asset.
4. Beyond business as usual.
In the last 20 years, New York City mayors and the City Council have launched numerous initiatives to improve health and reduce inequality. We recognize and celebrate the many successes of these efforts. At the same time, public health evidence and our own observations show that these efforts are often inadequately coordinated, insufficiently funded, and rarely address the fundamental, root causes of the city’s most serious health and social problems. As a result, they do not achieve the desired results and are seldom sustainable. More of the same will not be sufficient to achieve different results.
5. Develop whole of government approaches.
New York City government, together with state and federal policies that support their health functions, are another critical asset for improving health and health equity. Public health professionals can contribute evidence to develop and strengthen these initiatives and to overcome the organizational and resources obstacles that limit their effectiveness. Promoting “whole of government approaches” that integrate and coordinate interventions across categorical boundaries can also increase their impact.
6. Emphasize economic and social benefits of more equitable health policies.
Preventing hunger, homelessness, lack of access to health care, and inadequate education brings economic and social benefits to all New Yorkers. Such policies contribute to more thriving and prosperous communities, reduce the high costs of premature deaths and preventable illnesses, and enable more New Yorkers to achieve their full potential.