How can state officials help dismantle structural racism? Lessons from New Jersey

Community & consumer engagement Strengthening ecosystems of care Policy & advocacy SDOH & health equity

Read the adapted welcome remarks by our CEO Kathleen Noonan for “Dismantling Systemic Racism in Pennsylvania State Agencies,” an immersion workshop sponsored by the Pennsylvania Office of Health Equity on March 23, 2021. This workshop was one of the Camden Coalition’s National Center’s 2021 regional convenings.

Thank you Governor Wolf and thank you Director Saunders for hosting this important event. I know Pennsylvania created their Office of Health Equity before the events of this past year, and I applaud your being out front on issues of racism and other inequities that, as we know, are quite literally matters of life and death. I am glad my time for remarks is brief because the work really happens with you. But, I am honored to be asked to provide some opening observations to guide this important discussion – acknowledging that what I share is very much from the vantage point of a person with immense privilege – a White woman who runs an organization.  

My colleagues that helped with this convening are supporting gatherings like this all across the country that are addressing our most critical public policy issues. One of those is the reality that communities of color bear a disproportionate burden of complex healthcare problems, which is strong evidence of the structural racism you are working to dismantle.

So how do we work together to do this, to dismantle structural racism? The word “dismantle” in my mind conjures up an image of a very large, unwieldy machine that has thousands of components. Where do you start? If we acknowledge that it has taken a great deal of power to create and maintain this machine, then it will take just as much and probably more of our power, collectively, to disassemble it and build new systems – systems we have not had before.  

I think these are some of the most difficult questions of our time, and I do not have all or even many of the answers. I do, however, have some observations about what we’ve seen at the Camden Coalition, which might provide food for thought.

Some of the dismantling will come from major public policy changes. One example we are advocating for now is changing state laws and rules around fines and fees that disproportionately burden people of color and the poor. In our everyday work in Camden and around the country, we see the burden of court fines and fees getting in the way of people with complex health and social needs’ ability to get healthier, recover from substance use disorders, and obtain housing and other benefits.

But some of it will come from fundamentally changing how we identify, talk about, and solve problems. I want to share an example from the Camden Coalition to show you what I mean.

When the COVID lockdown first happened, a few of the hospitals and our government partners that are part of the Camden Coalition decided to open a COVID testing site in a part of Camden city that neither we nor our Community Advisory Committee thought was a good place for a site: it was a drive-through site, it was not on public transportation, it was in a somewhat desolate part of the city, and it was the location of the city’s former jail.  

We shared our concerns, but the horse was already out of the barn. This was an instance where the hospitals and government had power and we did not. We could not stop their train.  

Observation one: sometimes you have to stop the train, even when the tickets have been collected and it is pulling out of the station. You as government officials are often in the best place to do that. In our case, we were not part of the first set of discussions where the decision was made about the location for a COVID testing site. When we first gave our feedback, it seemed like no one thought they could walk back the decision. But they could. I am sure they could.  

I can tell you that when you, as state agency representatives, based on solid and reasonable feedback from people closest to the problem, decide to change course or support a county to change course, you will have the capacity and opportunity to dismantle structural racism and inequity. 

Luckily, we had another chance. Our Coalition structure means that we meet regularly as a diverse set of stakeholders. Over the summer, when things were a bit less stressful, we used the opportunity to discuss what went well with COVID testing in the city, and what didn’t.   

And, because we are a Coalition that works and talks together more regularly, our partners acknowledged that the site they chose had not worked as well as they had hoped. More than half of the people that used it were from the suburbs. Those who needed it the most — especially people of color — often lacked access. 

This fall, our government partners and hospitals came to us to help them identify sites for COVID “pop up” testing in community-based locations that were more accessible and embedded in neighborhoods with high positivity rates, neighborhoods that are mostly Black and brown people, and are severely under-served.

Observation two: if you, as state agents, want to dismantle existing structures, you need ongoing and routine forums for problem-solving among a diverse set of stakeholders including people affected by the problems you are trying to solve. This isn’t one-time public meetings or opportunities to give testimony – that is not sufficient. This is in part why the Camden Coalition’s National Center created Amplify, a “consumer voices bureau” of people with lived experience who can share their knowledge with people who are working to develop public policy solutions. 

In addition, having a non-profit intermediary like the Camden Coalition enabled Camden and NJ officials to identify and address in concrete ways barriers to access that were critical to our community – barriers that the larger system had not initially considered.   

It is possible that you might conclude as state agents that to be effective you need to create new meeting forums or governance structures in law. For example, in February, right before the pandemic hit, New Jersey’s Governor Murphy recognized the value of the Camden Coalition and three organizations like us in New Jersey, and codified in state law a role for what are called “Regional Health Hubs” – nonprofit organizations that are required by statute to convene multi-sector partners including consumers around regional priorities and serve as a local expert and conduit for state priorities. We report to the New Jersey Medicaid Office of Innovation on this work. 

We certainly have a long way to go, and I can’t say we have solved these issues in New Jersey or in the sites where we are working across the country, but as you talk together today about dismantling systemic racism in Pennsylvania state agencies, I encourage you to think about examples of when you stopped a train or wished you did after you received input from community stakeholders, and whether you have today the right forums to dismantle, build, and problem-solve in a new way. 

Thank you so much for the opportunity to speak with you today. You will know your discussions have been successful if they are hard. I wish for you an abundance of patience, relentless persistence, and a vision that better is possible.