Hurricane Fiona Exposes More Than Crumbling Infrastructure in Puerto Rico

Hurricane Fiona Exposes More Than Crumbling Infrastructure in Puerto Rico

By: Anna-Michelle Marie McSorley, PhD, MPH

Hurricane Fiona is the latest natural disaster to strike Puerto Rico, which has been a territory of the United States (U.S.) since 1898 [1]. While this storm has substantially and uniquely devastated the archipelago’s infrastructure, Fiona made landfall within a territory that has recently been navigating a multitude of consecutive natural disasters amidst a historically complex socio-political context; one that has been over a century in the making. This blog provides details on the events of Hurricane Fiona, background on Puerto Rico’s territorial status, and resources for how you can help Puerto Rican recovery efforts.

The Natural Disaster

Hurricane Fiona and the Aftermath in Puerto Rico

Hurricane Fiona made landfall in Puerto Rico on September 18, 2022 [2]. Although a seemingly less severe category-1 hurricane compared to Hurricanes Irma (category-5) and Maria (category-4), which wreaked havoc in Puerto Rico in 2017 [3], Fiona’s forces still managed to dump as much as 30 inches of rain in some areas of Puerto Rico [4,5]. These torrential rains, coupled with the damage that remained from the prior hurricanes, led to mass flooding and decimated many parts of the already compromised infrastructure. This resulted in disruptions to water services and territory-wide power outages that left 3.2 million residents weathering the storm in the dark. 

These interruptions in power and water services permeated across all sectors and contributed to the U.S. Department of Health and Human Services’ decision to declare a state of public health emergency in Puerto Rico [6]. Six days after the storm, over 37% of hospitals were still relying on unstable energy from generators as the restoration of power had only been confirmed for 94 of the 150 hospitals in Puerto Rico [7]. In some areas, the local health facilities had reopened, but flooding and landslides left people living in rural municipalities cutoff from the bridges and roads needed to access these facilities [8,9], which provide crucial medical treatment for pre-existing and hurricane-related ailments and injuries. Similarly, many residents continue to be unable to access other basic needs, such as food and bottled water, as well as the gasoline needed to power generators. Tragically, as residents continue to rely on candle-light and generator power, fires have increased, partially contributing to the estimated 16 hurricane-related deaths that have been reported, thus far [10].

More than a week later…

By Monday, September 26, 2022, over a week after the hurricane made landfall, data from the Puerto Rico Emergency Portal System managed by the Government of Puerto Rico, reported that over 41.5% (608,739/1,468,005) of customers were still without power and over 16% (212,439/1,327,740) of customers did not have water services [11,12]. Moreover, residents remain under a boil-water advisory [13], as water services are restored, and Puerto Ricans in the municipalities hardest hit by the storm are still largely without power. In Mayaguez, a municipality on the west coast of the main island, only 23% of customers had power restored to their homes as of 9/26/22 [7]. As Puerto Ricans move into the second week without these essential services, many residents can’t help but flashback to the events of Hurricane Maria and recall the poor federal response that left some Puerto Ricans living in the dark for as long as 9 months [14]. 

The Socio-Political Context

Puerto Rico is a U.S. Territory who’s 3.2 million residents are U.S. Citizens

The United States Commonwealth of Puerto Rico, as it is named in the U.S. Constitution, became a territory after the Spanish-American War of 1898 [1]. This magnificent collection of islands and islets in the Caribbean, including the main island of Puerto Rico, and the smaller inhabited islands of Vieques and Culebra, are home to an estimated 3.2 million Puerto Ricans who predominantly speak Spanish. In 1917, Puerto Ricans residing within the territory were granted U.S. citizenship [15]. In 1952, Puerto Rico was granted self-governing commonwealth status by the U.S. Congress [16]. However, as neither a state nor a sovereign nation, Puerto Rico remains under U.S. constitutional control. Similarly, while Puerto Ricans are U.S. citizens, those residing in the territory cannot vote in U.S. federal elections and their congressional representatives do not have voting power in the U.S. Congress [17]. In this sense, Puerto Ricans have limited power to influence the federal government that they rely on for aid during natural disasters.

U.S. Government Response to Latest Natural Disaster

On September 22, 2022, President Biden, in his remarks on the Hurricane Fiona Recovery Efforts, assured the residents of Puerto Rico that the U.S. federal government would be there to help. President Biden guaranteed “100 percent funding for debris removal, search and rescue, power and water restoration, and shelter and food for the month.” [18] This is vital federal support needed for Puerto Rico to recover from this latest natural disaster. However, the long-term plan for investment in shoring up the archipelago’s infrastructure recovery is unclear. Again, Puerto Rican residents have limited political power to influence these federal response efforts but those of us in the States do have the ability to help in several ways.

How you can help…

1. Vote in the upcoming midterm elections on Tuesday, November 8, 2022

   This year, all 435 seats in the U.S. House of Representatives and 35 of the 100 seats in the U.S. Senate will be contested. These seats represent the federal governing bodies that influence the socio-political context of the States and Puerto Rico. This November, exercise your right to vote in honor of those who do not have a voice in this upcoming election.

   Visit vote.org to find your local polling place.

2. Donate to local community organizations in Puerto Rico

• Fiona Community Response Fund - “The Fiona Community Response Fund is led by a coalition of community-led organizations working on immediate response to fulfill needs over the short- and long-term. It is a partnership of approximately 25 organizations.”

• Taller Salud - “Taller Salud is a community-based feminist organization dedicated to improving women’s access to health care, to reducing violence within the community and to encourage economic growth through education and activism.”

• Comedores Sociales - “Created in 2013, Comedores Sociales de Puerto Rico is a nonprofit organization that seeks to eradicate hunger in Puerto Rico through strategies of collective work and socialization of resources in favor of the majority of our people.”

• Techos Pa’ Mi Gente - “A non-profit organization dedicated to the construction of decent roofs and the rehabilitation of homes in communities affected by natural disasters. It contributes to improving the quality of life of the individuals that make up these communities. Promotes self-management and provides training in basic construction skills to build resilience.”

Please note: Websites in Spanish can be translated to English using the translation function within the Google Chrome browser.

Dedication: He escrito este artículo en honor de las mujeres Puertorriqueñas que me criaron y que siempre me han amado con todo su corazón.

Translation: I have written this piece in honor of the Puerto Rican women who raised me and who have always loved me with all of their hearts.

About the Author: Dra. Anna-Michelle McSorley (she/ella) is a Postdoctoral Scholar at the New York University (NYU) School of Global Public Health within the Center for Anti-racism, Social Justice, and Public Health. She received her MPH and PhD from the Fielding School of Public Health at UCLA. She is also a Faculty Affiliate of the UCLA Center for the Study of Racism, Social Justice and Health and a Co-Founder of the Anti-Colonialism Collective. Dra. McSorley is a health inequities researcher who studies the social determinants of health that act upon the life chances of marginalized communities, with a particular focus on the Puerto Rican population living in the States and Puerto Rico. Although she is a Brooklyn-born Nuyorican, her formative years were shaped by her experiences living a back-and-forth life between New York City and Puerto Rico. Today, most of her extended family lives in Añasco, one of the coastal municipalities that was most impacted by Hurricane Fiona.

You can find Dra. McSorley at the virtual sessions of the Anti-Colonialism Collective Book Club on the last Tuesday of every month. To learn more about Dra. McSorley and her work, visit amcsorley.com.

Acknowledgements: Thank you to Chandra Ford, Minelle David, and the Center for the Study of Racism, Social Justice and Health for welcoming this important commentary and for the mentorship I have received throughout the years. Also, a big thank you to Alexandra Rivera-González, MPH for her advocacy in Puerto Rico and for elevating the work of many of the community organizations that are listed in this piece.

References

1. Morales E. Fantasy Island: Colonialism, Exploitation, and the Betrayal of Puerto Rico. Bold Type Books; 2019.

2. Hurricane Fiona Makes Landfall in Puerto Rico, ABC News, World News Tonight.; 2022. Accessed September 24, 2022. https://www.youtube.com/watch?v=9BwEavDBUw0

3. RAND Corporation. Hurricanes Irma and Maria: Impact and Aftermath. Accessed September 26, 2022. https://www.rand.org/hsrd/hsoac/projects/puerto-rico-recovery/hurricanes-irma-and-maria.html

4. Finch A. Rainfall from deadly Hurricane Fiona tops 30 inches in Puerto Rico.https://www.accuweather.com/en/hurricane/hurricane-fiona-devastates-puerto-rico-with-heavy-rain-flooding-and-mudslides/1249326. Published Spetember 2022. Accessed September 24, 2022.

5. Hernandez A. Hurricane Fiona hit Puerto Rico as a Category 1 storm. Flooding still wrought havoc. Washington Post. https://www.washingtonpost.com/nation/2022/09/23/hurricane-fiona-puerto-rico-floods/. Published September 23, 2022. Accessed September 24, 2022.

6. HHS Press Office. HHS Secretary Becerra Declares Public Health Emergency for Puerto Rico after Hurricane Fiona. HHS.gov. Published September 21, 2022. Accessed September 24, 2022. https://www.hhs.gov/about/news/2022/09/21/hhs-secretary-becerra-declares-public-health-emergency-puerto-rico-after-hurricane-fiona.html

7. Government of Puerto Rico. Puerto Rico Emergency Portal System (PREPS). Accessed September 24, 2022. https://www.preps.pr.gov/

8. The Associated Press. In Puerto Rico, rescuers struggle to reach areas cut off by Hurricane Fiona. NPR. https://www.npr.org/2022/09/22/1124523267/puerto-rico-hurricane-fiona-people-stranded. Published September 22, 2022. Accessed September 26, 2022.

9. Andrews H. Public health emergency declared in Puerto Rico where most still without power, water after Hurricane Fiona. FOX Weather. https://www.foxweather.com/weather-news/public-health-emergency-puerto-rico-power-water-hurricane-fiona. Published September 22, 2022. Accessed September 26, 2022.

10. Sánchez LNP. Puerto Ricans Fear Extended Blackout After Hurricane Fiona. The New York Times. https://www.nytimes.com/2022/09/24/us/puerto-rico-power-outages.html. Published September 24, 2022. Accessed September 26, 2022.

11. Government of Puerto Rico. Puerto Rico Emergency Portal System (PREPS). Accessed September 26, 2022. https://www.preps.pr.gov/

12. Romo V. Puerto Rico has lost more than power. The vast majority of people have no clean water. NPR. https://www.npr.org/2022/09/20/1123984002/hurricane-fiona-puerto-rico-lost-more-than-power-vast-majority-no-clean-water. Published September 20, 2022. Accessed September 24, 2022.

13. Comunicaciones AAA (@ACUEDUCTOSPR) / Twitter. Twitter. Accessed September 24, 2022. https://twitter.com/ACUEDUCTOSPR

14. Willison CE, Singer PM, Creary MS, Greer SL. Quantifying Inequities in US Federal Response to Hurricane Disaster in Texas and Florida Compared with Puerto Rico. BMJ Glob Health. 2019;4(1):1-6. doi:10.1136/bmjgh-2018-001191

15. Library of Congress Hispanic Division. Jones Act - The World of 1898: The Spanish-American War. Accessed July 16, 2021. https://www.loc.gov/rr/hispanic/1898/jonesact.html

16. Foreign Relations of the United States, 1952–1954, United Nations Affairs, Volume III - Office of the Historian. Accessed September 27, 2022. https://history.state.gov/historicaldocuments/frus1952-54v03/d902

17. Deibert M. Puerto Rico’s Colonial Model Doesn’t Serve Its People. Foreign Policy. Accessed August 25, 2021. https://foreignpolicy.com/2020/07/31/puerto-rico-united-states-colonial-model-ricardo-rossello-wanda-vazquez-statehood-referendum/

18. House TW. Remarks by President Biden on Hurricane Fiona Recovery Efforts. The White House. Published September 22, 2022. Accessed September 24, 2022. https://www.whitehouse.gov/briefing-room/speeches-remarks/2022/09/22/remarks-by-president-biden-on-hurricane-fiona-recovery-efforts/

From the Director...

Warmest greetings, everyone! Welcome to the 2022-2023 academic year. At least for now, we are meeting in person. It is wonderful to see friends and colleagues whom I've missed over the months. To all new students, welcome! Please explore opportunities to push yourselves beyond your comfort zone as you embark on this next phase of your life.

It has been a long and busy summer for our COVID-19 Taskforce on Racism & Equity, which has been focusing social injustices in the COVID pandemic.

There is plenty to do! We look forward to involving you in upcoming activities: journal clubs, sponsored talks, etc.

Please look for our special collection of papers in the Rapid Assessment of COVID Evidence (RACE Series), which is being published in Ethnicity & Disease. The next issue, which is scheduled for release the week of October 20th, responds to the health equity implications of the Supreme Court's recent decision restricting reproductive rights.

Do keep us posted on news on your organizations and communities!

In struggle for health equity,

Chandra

Chandra L. Ford, PhD, MPH, MLIS

Professor and Founding Director

Center for the Study of Racism, Social Justice & Health

Department of Community Health Sciences

UCLA Fielding School of Public Health

Guest Blog: “Lessons Learned: Preparing Racial Unrest and Mental Health Educational Materials”

Lessons Learned: Preparing Racial Unrest and Mental Health Educational Materials

Jennifer Duan, B.A. (1), Kimberlye E. Dean, Ph.D. (2)

(1) Massachusetts General Hospital

(2) Massachusetts General Hospital/Harvard Medical School

Amid the COVID-19 pandemic, we have seen a rise in targeted, racially motivated violence and open aggression towards people of marginalized groups (FBI Uniform Crime Reporting Program, 2022). To illustrate, race and ethnicity-based hate incidences increased by 16% from 2019 to 2020, along with an increased rate of hate incidents in Asian Americans[i], Black Americans[ii], and Hispanic[iii] individuals from 2018 to 2020. Individuals across racial groups have thus experienced a growing trend of negative mental health consequences (Twenge, J. M. et al., 2021). Furthermore, these events have contributed to an exacerbation of previously unmet mental health needs across racial groups (Conroy, J. et al., 2021). Given these significant challenges, it is imperative that the current clinical workforce be equipped to manage symptoms exacerbated by racially motivated violence.

To equip the clinical workforce with actionable tools to mitigate lasting impact of racially motivated violence, we prepared a presentation highlighting the rise of mental health issues among racially and culturally diverse communities due to growing racial unrest. Our audience included clinicians working in an urban teaching hospital. To accommodate various background levels of understanding race, we were intentional in creating materials for this topic. Thus, we created the following guidelines to inform interested scholars of our process on navigating racial health disparities and to serve as a resource for anyone interested in diving deeper.

This decision was made following input from all coauthors including: (1) first author, a Chinese American woman with research interest in mental health disparities and cultural psychology; (2) second author, a Black American woman with a research focus on equity in mental health care accessibility and the intersection of trauma, substance use, and racism.

Our Objectives

In preparation for this presentation, our team consisted of three women of color from diverse educational backgrounds (one BA, two PhDs). This presentation focused on historically underserved communities, which includes Asian Americans, Black Americans, Hispanic people, and Indigenous people[iv]. Our presentation links the current political climate of increased racial hate incidences to poor mental health outcomes and then establish steps for clinicians to better serve their clients/patients of color. While the presentation was prepared for clinicians, this guide is intended for everyone interested in learning more about race and health disparities.

Our responsibilities were divided into three categories: (1) the first author was responsible for researching statistical trends of hate incidences, mental health outcomes, and access to mental health resources for minority groups; (2) the second author was responsible for establishing how providers can take actionable steps to approach client experience of racism at the clinic; (3) another researcher in our team provided overarching expertise in implementation science, community work, and planning support, but unfortunately had to step back due to other time commitments and responsibilities.

Our Approach

When initially developing our content, we used the following theories as part of our foundational framework: Bronfenbrenner’s ecological systems theory (Bronfenbrenner, 1992) and the minority stress theory (Meyer, 2003). Bronfenbrenner’s theory brought in the framework that an individual’s development from an early age is affected by multi-level systems (ex., family, access to healthcare, culture). While the minority stress theory was originally established for the LGBTQ+ community, this framework can examine how stress affects people of color and historically underserved communities (Shagani et al., 2019). By utilizing these frameworks, we made sure that our source materials aligned with viewing racial identity and health disparities as multifaceted and nuanced.

Challenges

1.      Tailoring an interdisciplinary topic to a specific audience

Research can be inaccessible to a general audience, especially with complex jargon. Since we did not know our audience’s background on racial health disparities, we ensured that our presentation covered a baseline of foundational material and minimized jargon. The presentation had a 30-minute time limit, which was challenging for an extensive topic like racial health inequity. Therefore, we carefully considered which concepts to expand upon and omit. When speaking or writing about race, it is important to acknowledge the definition of race[1] and its nuances, as well as the difference in how race is interpreted and utilized in different fields, such as within public health, psychology, and ethnic studies. When working together, we also had to be mindful of balancing the presentation. The presentation started by establishing a background of current events, which involved headlines of racially motivated hate incidents scattering 2019 to early 2022 across underserved groups. To prioritize our time, we emphasized microaggressions and functional health outcomes, while cutting down material on differentiating race and ethnicity, as well as racial traumatic stress theory.

2.      Scattered data

Pulling data from multiple reputable sources is a tedious but necessary part of the literature search. Since there was no centralized open-source database that encompasses health disparities from all racial groups, we encountered the issue of scattered data and having to create our own graphs from multiple sources (Figures 1 & 2). As we include multiple racial groups in our presentation, being intentional about sourcing from inclusive research articles is a must. We had to be mindful of other external factors increasing mental health disorders, such as the ongoing COVID-19 pandemic affecting disadvantaged communities. We also recognized that not all statistics will match the claims we are looking for – and that is okay. In this case, we found that there was not an increase in reported racial hate incidents for Indigenous people, according to the FBI. To be true to the literature search, including data that may counter our initial claims is just as important.

3.      Importance of actionable steps

Actionable steps are especially important in educational materials. Based on our team’s presentation feedback, we noticed that participants (clinicians) found it helpful to identify actionable ways to address one’s own racial bias in a patient-provider setting.

Actionable steps for our audience included:

1.      Navigating discussions of race in treatment instead of avoiding it – self-reviewing pros and cons

2.      Interacting with patients from diverse backgrounds with empathy and an open mind

3.      Developing and implementing trainings in racially and culturally based frameworks

4.      Reviewing books that discuss the history and current events of race-based stressors

Tips Before Researching and Writing

Finally, we want to introduce actionable steps before exploring your own curiosity towards racial health disparities, which can aid your writing process as well.

1.      Know your audience

We recognize that our audience for this piece may already be interested in racial disparities. While there is potentially a range of knowledge and educational backgrounds, this audience has a commonality of genuine interest and curiosity. In contrast, presenting information to an audience with little knowledge of racial health disparities requires a different approach. For a newer audience, there may not be enough time to explore the depth of your findings. Consider what fundamental frameworks can guide your team and support your goals (ex., Bronfenbrenner, Critical Race Theory).

Talking about race can elicit different emotional responses depending on an individual’s comfort, identity, and cultural background. Depending on the racial group, recognizing and connecting to one’s racial identity has been shown to have varied effects on one’s mental health (Woo, et al. 2019). Be prepared to expect a range of emotional reactions when presenting your work; do not be discouraged by fear and dampen the message of your work.

2.      Recognize your own biases

Even in a diverse team, personal biases may guide us towards a specific research direction outside of inclusivity, and it is important to hold each other accountable. However, different perspectives can yield nuanced discussions, as well as opportunities to fill in any gaps, such as carefully representing different racial groups and making sure all voices are heard.

Additional Readings

As navigating racial disparities can be daunting, we hope these resources can provide a steppingstone in learning about this interdisciplinary and growing field:

• Crenshaw, ‎K., Gotanda, N., ‎and Peller, G. (1995). Critical Race Theory: the key writings that formed the movement. The New Press.

• Kendi, I. X. (2019). How to Be an Antiracist. One World.

• DiAngelo, R. (2018). White Fragility: Why It's So Hard for White People to Talk About Racism. Beacon Press.

Having a foundational framework to drive one’s research or presentation is crucial to grounding one’s own understanding of the topic and communicating with an audience. We hope this guide can aid future readers and presenters in navigating race and health. 

References

Bronfenbrenner, U. (1992). Ecological systems theory. Jessica Kingsley Publishers.

Bird, M. Y. (1999). What we want to be called: indigenous peoples’ perspectives on racial and ethnic identity Labels. American Indian Quarterly, 23(2), 1–21.

Crime Data Explorer. https://crime-data-explorer.fr.cloud.gov/pages/explorer/crime/hate-crime

FBI Uniform Crime Reporting Program (2022).  Federal Bureau of Investigation

Conroy, J., Lin, L., & Stamm, K. (2021, April). The demographics of unmet need for mental health services. Monitor on Psychology, 52(3). http://www.apa.org/monitor/2021/04/datapoint-mental

Junn, J., & Masuoka, N. (2008). Asian American Identity: Shared Racial Status and Political Context. Perspectives on Politics, 6(4), 729–740. http://www.jstor.org/stable/20446825

Lopez, M. H. (2020). Three-Fourths of Hispanics Say Their Community Needs a Leader. Pew Research Center. Retrieved June 29, 2022, from https://www.pewresearch.org/hispanic/2013/10/22/3-hispanic-identity/

Meyer I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological bulletin, 129(5), 674–697.

Shangani, S., Gamarel, K. E., Ogunbajo, A., Cai, J., & Operario, D. (2020). Intersectional minority stress disparities among sexual minority adults in the USA: the role of race/ethnicity and socioeconomic status. Culture, health & sexuality, 22(4), 398–412.

Twenge, J. M., McAllister, C., & Joiner, T. E. (2021). Anxiety and depressive symptoms in U.S. Census Bureau assessments of adults: Trends from 2019 to fall 2020 across demographic groups. Journal of Anxiety Disorders, 83, 102455.

Woo, B., Fan, W., Tran, T. V., & Takeuchi, D. T. (2019). The role of racial/ethnic identity in the association between racial discrimination and psychiatric disorders: A buffer or exacerbator?. SSM - population health, 7, 100378.

Notes

[1] The American Psychological Association defines race as "a socially defined concept sometimes used to designate a portion, or “subdivision,” of the human population with common physical characteristics, ancestry, or language.

[i] "Asian American" was coined in 1968 by Yuji Ichioka and Emma Gee, UC Berkeley students and founders of the Asian American Political Alliance, who wanted to encourage pan-Asian amongst political turmoil (Junn & Masuoka 2008). "Asian American" now encompasses all Asian ethnicities, including East Asian, South Asian, and Southeast Asian groups. While our sources and the U.S. census have used “Asian” to describe this demographic, we wanted to specifically note that this population is within the U.S.

[ii] "Black Americans" includes individuals with ancestry tied to enslaved Americans, immigrants from Africa or the Caribbean to the U.S, and other individuals from the African diaspora. The term has been used to be inclusive of the Black experience in America.

[iii] "Hispanic" refers to individuals who are "a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race," according to the U.S census. While this is a more cultural term, we decided to include this due to our sources using this term. According to Pew Research Center (2013), "Hispanic" was the most popular preference for the community to describe themselves.

[iv] “Indigenous people” refers to the descendants of culturally distinct ethnic groups who first inhabited a specific land, in this case the United States. According to the Smithsonian National Museum of the American Indian, Indigenous people prefer being called by their tribe's name. While "American Indian" is used in the U.S. census and "Native American" has been used throughout our sources, we intentionally researched opinions of scholars with this identity, where most participants (Yellow Bird, 1999) preferred another term other than “American Indian” or “Native American.” "American Indian" was coined during a period of colonialism, and "Native American" has been used by people who are not indigenous to the United States. Since “Indigenous” is the more inclusive of all tribes, we decided on this term.

Disclaimer: The opinions expressed in this guest blog are those of the authors. The authors do not purport to reflect the opinions or views of the Center.

From the Director...

From the Director

June 10, 2022

The academic year at UCLA comes to a close today. I feel a deep sense of gratitude to everyone who has helped in some way to advance the mission of the Center during the pandemic. Our mission is to promote health equity through rigorous research, innovative teaching, and community engagement. The last few years have been devastating on multiple fronts for so many people. We offer prayers and condolences while we continue to target the root causes of health inequities.

Alongside the difficulties of this period there have been many notable accomplishments. Below are just a few of the Center’s activities of this academic year:

• The brilliant distinguished quarterly lectures delivered by Dr. Monica McLemore and Dr. Ugo Edu

• A COVID justice panel with community partners Black Alliance for Just Immigration (BAJI) and Youth Justice Coalition (YJC) organized by the COVID Task Force on Racism & Equity (Chair, Bita Amani)

• A national workshop on racial healing organized by Kia Skrine Jeffers, Associate Director for the Arts, on behalf of the American Public Health Association’s Public Health Nurses caucus

• Monthly journal club and book club meetings (see ACC book club below)

• Co-sponsorship of the 2022 Thinking Gender Conference, which focused on Transgender Studies at the Intersections this year

• Co-sponsorship of the UCLA Thurgood Marshall Lecture delivered by the honorable Keith Ellison

Please check out our current projects, which include:

• Project REFOCUS - through which we are developing a novel set of technology-based interventions to promote pandemic equity. This project, which is funded by the CDC Foundation and CDC, is a collaboration between the Center and Howard University (Monica L. Ponder, co-lead).

• COVID Storytelling Project – A two-part study that involves the rapid collection and analysis of social media (e.g., Twitter) and focus group data regarding injustices occurring over the course of the pandemic.

• The RACE Series – A special collection of articles published open access (i.e., freely available to the public) in the journal Ethnicity & Disease. The series is supported with funding from the Robert Wood Johnson Foundation. The papers in the collection report key research findings as they are produced (i.e., hot off the press) from research conducted over the course of the pandemic. Much of this research is ongoing. You can learn more about both Project REFOCUS and the COVID Storytelling Project from papers published in this series.

Celebrating Students

As shared in 2020 in opening remarks at the book launch for Racism: Science & Tools for the Public Health Professional (American Public Health Association [APHA] Press, 2019), I believe our graduate students represent the vanguard of the field and I predicted they would lead the field of public health in advancing health equity work that engages Critical Race Theory (CRT), sustains participation in community-engaged social justice efforts and develops novel methods for conceptualizing and investigate the myriad of ways racialized oppressions harm health. I feel even more confident making that assertion today. Those who are graduating this year will arrive at their new appointments in many ways already prepared to lead the field in this area. They follow our inaugural cohort of postdoctoral fellows, Dr. Paris Adkins-Jackson, now at the Columbia University Mailman School of Public Health, and Dr. Mienah Sharif, now at the University of Washington which recently launched ARCH: the Antiracism & Community Health Center, as well as Anna Hing (now at the recently launched Center for Antiracism Research for Health Equity at the University of Minnesota), John Pamplin (Columbia University Mailman School of Public Health), and Brittney Butler (Harvard FXB Center Health & Human Rights Fellow).

Rebekah Israel Cross and Natalie Bradford were the Center’s founding student affiliates and two of its core staff members. They each contributed a section to Racism, and Rebekah published the first (and perhaps still the only) student perspective on advancing CRT-based approaches in public health. Having successfully defended innovative, policy-relevant dissertations, they will now head off to postdoctoral fellowships at the University of North Carolina Gillings School of Global Public Health and University of Texas at San Antonio College for Health, Community and Policy, respectively. What were they studying? Here are their dissertation titles:

•  Gentrification, Residential Mobility, and Preterm Birth among Black Women: A Mixed Methods Study of Racial Resegregation in Northern California by Rebekah Israel Cross

• This Ain’t Yo Laboratory: Centering Home to Examine the Relationship Between Racial Residential Segregation, Medical Underservice, and Community Health Center Expansion Nationally and Locally by Natalie J. Bradford

Congratulations Dr. Israel Cross and Dr. Bradford! We are inspired by you and excited for the next phase in your journey.

Other student affiliates who have completed dissertations and are moving forward include Anna-Michelle McSorley, who first approached the Center about how to study anti-colonialism within public health . After several thoughtful conversations, she came up with the idea of the Anti-Colonialism Collective (ACC). This book club has become a vital source of connection for center affiliates and for people not otherwise connected to it. We thank the donors who appreciated the topics being covered and Anna-Michelle’s anti-hierarchical approach to facilitating the book club. Having successfully defended her dissertation, Dr. McSorley will join the Center for Anti-racism, Social Justice, & Public Health that is in development at New York University.

Millicent Robinson and Adrian Bacong served as chair and co-chair (with Ale Cabral), respectively of our annual Minority Health Conference in prior years, and Millicent also served as center coordinator during the stormy early months of the COVID pandemic. Her role then was critical and invaluable given how destabilizing, uncertain and exhausting that period was for everyone. They, too, have successfully defended their dissertations and accepted postdoctoral appointments at Stanford University (Dr. Bacong) and the University of North Carolina (Dr. Robinson). Thank you and congratulations to each of you! And, congratulations to all graduating students!

Celebrating our Partners

If you appreciate our work, we urge you to support our partners who are leading critical social justice work often with limited resources. Five of our key partners include:

• Black Alliance for Just Immigration (BAJI) - https://baji.org/

• Black Coalition Fighting Back Serial Murders - https://www.blackcoalitionfightingbackserialmurders.net/

• Healthy African American Families - https://www.haafii.org/

• Stop LA Police Department (LAPD) Spying - https://stoplapdspying.org/

• Youth Justice Coalition - https://youthjusticela.org/

I thank the many others of you who continue to support our work through donations of time, information or resources. There are many to name, so allow me to highlight just two examples of the kind of support for which we are grateful.

• The 2022 Minority Health Conference, which as always was in partnership with the UNC Gillings School of Global Public Health, featured archival video and audio recordings of health equity champions and elders from the personal archives of Dr. Victor J. Schoenbach. This digital media project would not have been possible without the generous support and assistance of Dr. Schoenbach.

• So that people could participate in the ACC book club meetings even if they could not afford the books, forward-thinking donors reached out and made donations so that the center could make the books available to participants for free.

Expressing Gratitude

I am deeply grateful for the dedicated staff, graduate students, postdoctoral scholars, executive board members, faculty and staff on whom the center relies. Thank you for your commitment, vision and enthusiasm. Thank you for your insights. Thank you for your service.

I thank the leadership of the center, including Bita Amani, under whose leadership the COVID Task Force on Racism & Equity, which is a collaboration between Charles R. Drew University (CDU) has been tirelessly engaged in research, community organizing and information sharing with community partners. You can learn about some of this work in a short video about it here. I also thank E. Minelle David, who has been an extraordinary Center Coordinator. Her commitment to health equity is palpable. I appreciate her attention to detail and all the ways she quietly holds so much together on behalf of the Center in order to advance our mission. Thank you, Minelle! You are seen and loved. :)

Finally, the work of the center would not be possible without the material support we receive from people like you. Thank you to our volunteers. Thank you to our donors. Your donations primarily support the education and training of our students and postdoctoral scholars. They also cover some of the activities with partners—both community partners and academic partners—that research grants typically do not support (e.g., co-sponsored talks). Thank you to those of you who participate in our activities. A special thanks to the very supportive staffs of the UCLA Department of Community Health Sciences—especially Melba Tolbert, Jamie Raiss and Kathy Yi—and the Fielding School of Public Health’s office of the dean. We appreciate being able to draw on your expertise. We also celebrate executive board member, Gilbert C. Gee, on becoming the next chair of the department.

Sadly, remarks from 2020 resonate still. So, I close with those remarks here.

The circumstances of the present—the hostile political climate, the deadly COVID-19 pandemic, and the persistence of “state-sanctioned and extra-legal” killings of black, indigenous and other people of color—have made this an extraordinarily difficult time. I am particularly concerned about its impact on our students.

The students involved with this center are phenomenal. Their brilliant analyses connect dots intellectually across disciplines, theories, and methods. These students are bold, courageous, introspective and creative. They insist a better world is possible, and they work toward manifesting it. They are generous with one another and with me, modeling what it is they wish to see in the world. They are the next generation of leaders. Faculty, are we doing all we can to help them become their very best?

To my students, you inspire me, and you touch the lives of many others. This is an extraordinarily difficult time, especially for those of us who come from the margins of society. Today you are nearing the finish line of another academic year. It may not feel like much of a victory, but it is. Each day that you get up and choose to keep moving forward is a victory. It is a victory not only for you, but also for everyone who loves you and for those who draw inspiration from you. As much as I admire you for your strength, please remember that you are also human. You deserve the compassion you so generously share with others. You need to rest. You need to laugh and to have fun. You need a break from peers who exclude you and faculty who underestimate or overlook you, while at the same time “picking your brain” on matters of diversity. You need trustworthy friends who will challenge you when it is appropriate to do so. You need your families even if you also need space from your families. Finally, you need to know that faculty and senior scholars stand with you. We are sharing this journey with you. We see you. We appreciate you. We celebrate you.

 With humility and gratitude,

 Chandra L. Ford

Equity and Justice Quotient: A New Approach to Structural Anti-Racism

The Center for the Study of Racism, Social Justice & Health is pleased to share a guest blog by Dr. Collins O. Airhihenbuwa, professor of public health at Georgia State University. This piece was originally published on U-RISE, whose mission is to promote collaboration at the intersections of identity, culture and value in order to train leaders to engage communities and institutions in generating innovative solutions that are socially, culturally and structurally sustainable.

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We die. That may be the meaning of life. But we do language. That may be the measure of our lives.

~Toni Morrison

The opposite of poverty is not wealth. The opposite of poverty is justice.

~Bryan Stevenson

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Today:  Today’s leaders of industries and educational organizations are increasingly looking for tomorrow’s leaders with a healthy dose of curiosity and imagination. Tomorrow’s leaders are believed to be those who are likely to advance new disruptive innovations to improve efficiency in human productivity, relations and connections, and hence a premium in estimating their curiosity. Curiosity quotient (CQ) has become a new measure of success in leaders, as distinct from Intelligence quotient (IQ) and Emotional Quotient (EQ). CQ may draw on attributes of emotional capital in EQ and cognitive measures in IQ without necessarily relying on their full development to generate new ideas that may benefit society. For example, while IQ (the intellect that occasioned vaccine development) and CQ (the novelty of developing messenger RNA technology in a relatively short period) may be credited for the rapid development of the COVID-19 vaccine, it would take a leader with a high EQ to undertake a mass distribution that would save lives. Yet, what all these efforts to mitigate COVID-19 have revealed is that individual-based quotients, no matter how accurate in predicting specific individual performances, would be inadequate to predict, measure, and offer solutions to inequity and injustices that are threats to population health and general wellbeing. For there to be an adequate response to dismantling structural racism, there has to be a new quotient that goes beyond measures of individual performance. Indeed, systemic solutions demand new measures of institutional performance and hence a need for what I term the ‘Equity and Justice Quotient’ (EJQ).

The Morning Dawn: April 20, 2021, marks a new beginning in the quest for racial justice. The guilty verdict for the killing of George Floyd by a white police officer has become the turning point in the long-fought battle for systemic reforms to address structural racism. The much-welcomed verdict signifies a historic moment that marks the beginning of reforms toward justice following years of police killings of Blacks. However, the work of translating the verdict into new approaches for systemic anti-racism does not begin and end with policing across the nation alone. A new approach should also be the beginning of processes and metrics that could predict institutional readiness for social justice in the knowledge production industry of our educational systems, particularly in our system of higher education. A key goal of transforming our system of higher education is to address structural racism by examining the institutional policies and practices that perpetuate structural racism in higher education. To do so means going beyond the individual-based performance measures of yesterday.

Yesterday: Traditionally, academic and organizational achievements have been measured based on tests to predict individual performance. Based on results achieved when specific tests are taken and/or certain tasks are performed, these performances are believed to be predictive of one’s intelligence. The merits of the importance of intelligence quotient (IQ) in predicting performance remains highly valued by many yet questioned by others, particularly given the limit of these tests to predict one’s potential contribution to structural solutions that will advance social justice. The emergence of mindfulness, for example, as a measure of emotional intelligence in the 1990s underscored the limit of singular reliance on IQ to predict the potential for individual positive relational achievement and leadership. Today, in terms of self-awareness, motivation, and regulation, the importance of emotional intelligence in predicting successful performance and achievement is no longer ignored. In these moments of racial reckoning, one’s readiness to overcome unconscious bias, for example, is likely to be the result of one’s EQ rather than IQ. Enhancing one’s emotional capital draws on spiritual investment in empathy which benefits from EQ even in this era of unprecedented investment in innovation and reliance on CQ. Yet, despite the investment in disruptive technology to improve efficient advancement of goods and services, individual-based performance measures are insufficient to address structural racism as a threat to public health, as declared by the CDC director and other leaders. What we need now is a new quotient based on institutional trustworthiness to achieve equity and social justice.

Tomorrow: To measure progress toward institutional and structural anti-racism, I am introducing the Equity and Justice Quotient (EJQ). I want to shift the language and measure of anti-racism from an individual-based performance measure to institutional measures of openness and commitment. In measuring EJQ, I consider organizational openness as the doorway that provides entrance to equitable services offered by the organization. The inviting nature and welcoming structure of the open doorway are the keys to measuring institutional commitment to justice rather than the conventional reference to individual access to services, focusing on minoritized groups’ opportunity to obtain services. Indeed, the organizational Equity and Justice doorway is the foundational apparatus for institutional trustworthiness necessary for equity and justice in service provision. Employing EJQ, for example, shifts the focus of vaccine distribution from the question of individual access to vaccines towards institutional and organizational trustworthiness measured by a commitment to anti-racism, equity, and justice.  Moving from a language of individual distrust to institutional trustworthiness shifts the responsibility for building trust away from individuals and minoritized groups who shoulder the burden of inequity. The new EJQ focus should be on changing the lack of institutional trustworthiness into commitment and responsibilities for promoting social justice. When using the Equity and Justice Quotient, it is less about whether individuals rate well on performance measures of intelligence, emotion, or curiosity but whether institutions have evidence-based trustworthiness in their policies and practices. These policies and practices should be measured by their openness in welcoming everyone to equitable services regardless of one’s identity and economic status. Currently, the conventional discourse on vaccine access makes it difficult to disentangle the reality of inequity in vaccine access to minoritized groups from the narrative of vaccine hesitancy. The latter is presumed to define the former. We need to unpack the degree to which the current lack of institutional trustworthiness contributes to population doubts and questions about vaccines as an indication of systemic injustice.

Beyond Personal Biases: EJQ also shifts attention away from focusing on an individual solution to dismantle racism. For example, addressing unconscious bias appears to be considered the standard solution to addressing inequity. Indeed, critical processes of how one deals with unconscious bias will likely benefit from the emotional quotient. Indeed, interventions about unconscious bias tend to focus on improving individual emotional intelligence in the hopes that this translates to bridging gaps in inequities and injustices. While individual soul healing efforts may offer space for improved relational habits, these improvements will not automatically transform the institutional framework into an open doorway for equity and justice for all. A call for individual growth in their emotional capital to address their own unconscious bias must be located within a broader call to address structural racism.  Otherwise, training to overcome individual biases and microaggression risks offering a space for individuals to soul-search a path to their healing at the cost of not directly confronting systemic racism, which is at the core of racial injustices and health inequity.

A Call for Systemic Action: In the wake of the April 20 verdict in which many were able to breathe, even if for a moment, what is clear is that the quest for systemic equity and justice underlies today’s structural imperative to address racism. To do so requires a different set of measures that move from individual performance measures to a focus on structural and systemic performances based on institutional equity and justice quotient. We have much to learn from younger generations that are leading the way for equity and justice, as past generations of their age cohort have shown during their time of calling for systematic equity and justice, such as the civil rights movement. If we are to dismantle structural racism globally, we must heed the voice and learn from the courage of Darnella Frazier and her generation. The time is now for an institutional-based Equity and Justice Quotient.

By: Collins O. Airhihenbuwa, originally published in U-RISE.

From the Director...

From the Director…

We are approaching the close of an extraordinary and challenging year. Are you still standing?

Some of you have lost loved ones. I extend my warmest condolences. Others have suffered emotionally, financially or in other ways. May you find the comfort and support we all deserve.

Grief, sorrow, loss, fear, anger, and despair continue to surround us. But so, too, do little blessings if we open ourselves to them.

For more than a year, we at the Center for the Study of Racism, Social Justice & Health have been putting in grueling hours all day nearly everyday focused on illuminating, studying and fighting links between COVID, racism and other social injustices.

We have been carving our way along a difficult path for years now. I am so fortunate to share the journey with awesome, dedicated partners in the struggle. To you all—and you know who you all are—I say this. Although it is difficult to fight racism in society while challenging the field of public health from within, you all make the journey memorable and, at times, even fun. What a privilege to work so closely with Bita Amani of our COVID Task Force on Racism & Equity, the student leaders and volunteers who have remained steadfast Center champions throughout this period, Associate Directors Kia Skrine Jeffers and Terence Keel, and many others who have been contributing to the work of the center.

I also feel thankful to everyone who has shared a financial or other gift with the Center. What a privilege. You should know that we strive to be good stewards of all resources shared with us. This year, donations supported the purchase of books for the anticolonialism collective (ACC) book club, which was launched in the spring and remains open to anyone wishing to read together with others. They also sponsored center affiliates to learn transcendental meditation (TM), which is helping some center affiliates find healthier ways to cope while engaging in anti-racism work during the pandemic.

Research institutes often focus solely on faculty and students, but I am incredibly grateful for staff who assist the Center in so many ways, often voluntarily. I am deeply grateful for the generosity, time, expertise and encouragement that staff in the Department of Community Health Sciences as well as some in the Fielding School of Public Health more broadly share with us. Within the Center, I thank all who have served as staff and extend particular debts of gratitude to Minelle David and Consuela Abotsi-Kowu. As you both know, it is a joy to work with each of you.

The movement for health equity continues to expand rapidly and we invite you all to join us in the new year. Check out our calendar for upcoming events. Look out for our projects; some of them may be coming to a community near you. We are particularly excited about Project REFOCUS, a collaboration with Howard University, which will begin reaching out to communities in coming months. Finally, we are delighted to announce the publication of an open access series called the Rapid Assessment of COVID Evidence (R.A.C.E.) Series in the journal Ethnicity & Disease from January 2022 through January 2023. The R.A.C.E. series will present recent findings from the Center’s ongoing research “hot off the press”. Our goal is to share the findings with community as rapidly as possible while ensuring that any findings shared with community have been subjected to the peer-review process.

In closing, I hope we choose to learn the lessons that 2021 tried to teach us. May we leave behind the negative it shared with us, and embrace the promise of the new year.

In struggle for equity,

Chandra

Chandra L. Ford, PhD, MPH, MLIS

Professor and Founding Director

Center for the Study of Racism, Social Justice & Health

Department of Community Health Sciences

UCLA Fielding School of Public Health

RacialHealthEquity.org