Reducing Racial Disparities
addressing Extreme Prematurity
Eliminating Sleep-Related Deaths
The following organizations hereby declare our commitment to undoing racism as it contributes to disparate health outcomes based on race:
We intend to eliminate racism by first examining our organizational practices and identifying ways for us to be more equitable and anti-racist in our operations.
We are determined to collectively adopt a shared approach that acknowledges racism as the most significant contributor to the racial disparities in birth outcomes.
We commit the combined strength and influence of our organizations to educate our respective constituencies, jointly advocate for change, hold each other accountable, expand the number of organizations willing to become a part of this effort and create tangible steps to root out racism wherever it exists.
We are ‘all in’ for shared accountability for addressing racism and eliminating racial inequities in MCH outcomes.
As national membership or public health advocacy organizations, our missions focus on creating environments that allow for the achievement of optimal health outcomes for all at the national, state, territorial, county, local and community levels. This goal cannot be realized unless we eliminate the racial disparities that exist in our communities by acknowledging racism as a public health crisis and identifying bold strategies to address it. Racism, and its influence on our systems, has a detrimental impact on our society and on health outcomes. The impacts of racism are irrefutable, when looking at the disparities in maternal and infant morbidity and mortality rates among Black/African American and Native American populations compared to their white counterparts. Although our nation has made progress in improving maternal and infant health outcomes, the success has not been experienced equitably across racial and ethnic groups and the pace of improvement has not progressed with the urgency this crisis demands.
For decades, the World Health Organization and other members of the international public health community have encouraged more of a focus on the social determinants – the conditions in which we live, work, learn and play – to enhance our understanding of factors that impact health outcomes. Simultaneously, the maternal and child health community has focused on the life course approach which indicates that a mother’s birth outcomes are impacted by her entire lifetime of experiences as well as the experiences of ancestral generations preceding her. While understanding these approaches has helped, we have politely tiptoed around the impact of racism. Structural and institutional racism directly impacts the environments in which people exist, plays a critical role in the experiences Black/African American, Latinx, and Native American families have throughout the course of their lives, and is the social determinant most responsible for the racial disparities that exist in our country. Failing to boldly acknowledge racism as the root cause of these disparate health outcomes results in merely addressing the symptoms of the problem rather than resolving the cause of the problem. Addressing the symptoms without addressing the cause allows the problem to persist. For example, if one has an infection, taking Tylenol may relieve the symptom of a fever caused by the infection, but leaves the cause of the infection to wreak havoc on the patient. Just as the underlying cause of an infection must be treated to truly cure the patient, racism must be dismantled.
In moving this work forward, the following statements provide foundational principles for our approach:
There is a distinction between racial equity and health equity. These terms have often been used interchangeably and although there may be overlap, we believe that health equity cannot be achieved without first achieving overall equity. According to Dr. Nancy Krieger, “Social inequality kills. It deprives individuals and communities of a healthy start in life, increases their burden of disability and disease, and brings early death. Poverty and discrimination, inadequate medical care, and the violation of human rights all act as powerful social determinants of who lives and who dies, at what age, and with what degree of suffering.” For that reason, we believe striving for overall racial equity is essential to achieving health equity.
Public health institutions have tremendous power and influence in disrupting structural inequities created by racism. Systems have used their power and influence to provide advantage to some of us while simultaneously subjecting others of us to disadvantage. For example:
We have to reconfigure these systems in a manner that results in equitable outcomes. While there is space for incremental change, it should not come at the expense of the transformation necessary to achieve equity.
We also understand that as individual organizations, we cannot achieve these goals alone. Our strength lies in our collective unity. As partners, we commit to convening quarterly to share measured progress, including best practices related to actions taken and obstacles overcome; and assist each other with ways to address current challenges.
Building on these aforementioned principles, we are committing to each other in three areas: internal processes, external work, and communications.
(1) We commit to examining our organizational internal processes and to complete the following action:
(2) We commit our organizations to influence and promote external work and to complete the following actions:
(3) We commit our organizations to develop and release communications to support this work and to complete the following actions:
The elimination of racism and the resulting inequities that exist in health outcomes, such as increased maternal and infant morbidity and mortality, will require a collective and focused effort. We are committed to bringing about meaningful change, measure our progress, and invite others to follow our example. The proposed efforts above will take time and resources to bring to fruition, but it is imperative that we do so. The magnitude of the situation requires a bold response. We are stronger together and capable of bringing about system transformation that will significantly improve the health of all of our constituents.
We look forward to sharing our progress and providing more detail on efforts in the future.
Association of Maternal and Child Health Programs (AMCHP)
National Healthy Start Association (NHSA)
National Institute for Children’s Health Quality (NICHQ)
Arthur R. James MD, FACOG
Jonathan Webb MPH, MBA
If you are “All In” to commit to anti-racism through public health strategies, please contact us to add your organization’s commitment or your individual commitment to help your organization. We cannot afford to go backward, we must be all in!
1 of 22