Health Equity Is On The Table. Why Should We Care?

By Jessica Bonham-Werling, Ashley Craig, Angela Kokinakos, and Matt Miller

Part 5: Conclusion We assert that to truly address power imbalances inherent in health, organizations that operate within the systems that impact health must change.

This series took a dive into understanding the private sector's role in shaping the living conditions of our communities, the resultant health inequities that have rendered the United States one of the least healthy wealthy nations on the planet, and prospective recommendations to ameliorate these conditions. We can’t continue to operate “business as usual” without the potential of destroying the very arena in which businesses operate.

The relationship between individuals and the conditions in which they live is like fish living in an aquarium. When the aquarium is dirty, or the fish are poorly fed, they will never reach their full health potential, despite any individual effort. While this aquarium analogy is simplified, it nods at our own environments which are made up of physical conditions (e.g., exposure to toxins), economic and working conditions (e.g., employment and income), social conditions (e.g., the experience of racism, class, gender), and service conditions (e.g., education), all of which are heavily influenced by community policies and institutions. Unequal living conditions lead to problems like poverty, unemployment, poor education, inadequate housing, fractured transportation, exposure to violence, and neighborhood deterioration (social or physical). These conditions ultimately influence choices and behaviors over a lifetime and over generations, all contributing to health outcomes...and right now, those outcomes are markedly inequitable.

This series has also been a call to action for the private sector to join a fight that has been going on without them, somewhat unsuccessfully, for over 30 years. We need their power, participation, and purpose to substantially move the dial on these issues. When the GKS team began researching and writing, we each believed that businesses could correct the impacts they have on environmental, economic, social, and service living conditions in our communities while also reaping significant financial rewards. After spending the last 6 weeks researching and writing, we now believe they must. Our purpose here was then to demonstrate how simple and effective these changes can be, some of them requiring merely a greater mindfulness during decision-making, and others requiring a change in structure and function of practices, but all of them benefitting not just the socio-economic climate in the geographical and virtual sphere of the business’s operations, but also the business itself. No business leader could fail to see the positive implications of these changes; we can’t imagine ignoring this evidence.

The Physical Impact: We assert that the private sector creates or reinforces the conditions that lead to health disparities through the impact of their operations and products on the environment.

Just two weeks ago, Shell, Chevron, and Exxon, the world’s three largest oil companies, made headlines on the same day. All are being held accountable, in some way, for their impacts on the physical environment. In recent years, fossil fuel companies have touted their commitment to reducing the impact of their operations on the climate, but they may now be legally responsible for the impacts of their products as well, which are directly linked to more than a third of all greenhouse gas emissions. This is a signal to all companies, not just the fossil fuel industry, that they will be held accountable for the environmental impacts of their operations and products. Producers of plastic products and/or those with plastic packaging should take particular notice. Canada began paving the way for plastics restrictions, declaring it a toxic substance with legislation passed in mid-May. Change has been painfully slow, but momentum is growing. Companies will no longer be permitted to freely pollute communities and/or produce products that put our health at risk without suffering any consequences. Implementing changes now puts change leaders ahead of the curve, with an opportunity to reap any benefits of that position.

The Economic & Work Impact: We assert that the private sector creates or reinforces the conditions that lead to health disparities through the impact of the way they operate.

Companies would also be wise to rethink their human resource practices, which shape the economic and work environments of our communities. Last week, the Society for Human Resource Management released a report revealing that in the last year alone, racial inequity has cost U.S businesses $58.7 billion in lost productivity and $54,1 billion in absenteeism. Reimagining and replacing recruitment and retention policies with more equitable, inclusive practices could have a substantial impact on the bottom line, while also helping to alleviate the economic disparities that contribute to poor health. How much of that $112,8 billion does your company want to retain?

The Social Impact: We assert that the private sector creates or reinforces the conditions that lead to health disparities through their impact on media, marketing, and culture.

We would be remiss if we did not acknowledge the substantial progress that has been made in the social environments of our communities in the past year. The pandemic and George Floyd’s murder mobilized companies in unprecedented ways that have begun to chip away at systemic racism. Companies have committed to recruiting and retaining diverse talent, have hired diversity and inclusion officers, changed branding and logos, and launched marketing campaigns that call for inclusion and action against racism. Now comes the harder part – fulfilling the commitments while amplifying and sustaining this change. A sustained push toward equity is the right thing to do for society, but it is also the right thing to do for a company’s bottom line. According to a 2020 Kantar report, brands like Nike, UPS, and Toyota that are recognized for their high commitment to purpose have grown at more than twice the rate of others.

Krystle Watler, Managing Director of Virtue, the creative agency born from VICE.

The Service Impact: We assert that corporate donations and financial engagement strategically focused on improving conditions in the communities where organizations operate will ultimately lead to economic benefits for the organizations themselves.

Private sector financial power has the potential to bring change to the poorly funded education, healthcare, and social service environments in our communities, and when done strategically, can also provide a competitive advantage. It seemed that this power might finally be harnessed for good when American corporations pledged a collective $50 billion toward racial equity causes after Floyd’s murder last year. Unfortunately, few have followed through on their commitments. According to an analysis by Creative Investments Research, less than 1% of that has actually been fulfilled. To move the dial, we need more than just words and empty promises. When communities and organizations don’t receive the funds, the cost of the fallout and loss of credibility could have a greater financial impact than the amount that was promised. Conversely, building trust in the community increases brand loyalty and customer appreciation, creating relationships with consumers that are impossible to buy with marketing tools.

One Course At A Time...

While we have served up multiple courses in this series, we do not intend that a business try to consume them all at once. Like any good meal, we believe the private sector would be best suited to start with a cocktail hour where they can gain an understanding (and trust) of the communities that they operate in, employ in, and sell in by mingling with the individuals and organizations that have been at this dinner party for decades. The Institute for Healthcare Improvement suggests increasing contact with people who are different from yourself to begin reducing implicit bias. By building bridges with people from other communities, backgrounds, and identities, we can see each other as more than our racial or cultural stereotypes - we begin to see each other as fellow humans. This understanding will help to identify the community challenges and opportunities that a business is best suited to impact through changes to its internal operations, the products it produces, the way it markets itself, and/or contributes to the local community.

Hubert Joly, former chairman and CEO of Best Buy

If we want our fish to be healthy and swim in a clean aquarium, we have to change the way we care for them. We challenge the private sector to bring their social, political, and financial capital to bear on making and sustaining changes that support the well-being of both individuals and communities by collaborating with advocacy groups to effect change in systems that reinforce division. The paradigm shift's leading-edge is fixing power imbalances where none ought to exist, as in the health care disparities that disproportionately affect immigrants, people in poverty, the LGBTQ+ community, and people of color. Listen and learn from black and brown voices advocating to illuminate the importance of antiracism and social justice, such as Ijeoma Oluo, Ibram X. Kendi, Michelle Alexander, and Lace Watkins. Businesses that are committed to understanding why people are angry and feel disenfranchised can learn how to begin healing from their collective infection of implicit bias, start using their relative privilege to be a force for social justice, and reap the civic and economic rewards.

The system is broken, and we aim to fix it. Take your seat at the table and dig in.

Thank You For Joining Us. Previous Episode: Part 4. Back to the Beginning: Introduction.

Photo collage elements courtesy of Ahmed Zayan and Annie Spratt on Unsplash.

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