CEOARE Racial Equity Implementation Framework

Introduction

For more than 400 years, structural racism has adversely impacted the health and well-being of Black Americans. Many federal, state, and municipal policies systematized, perpetuated, and normalized the effects of racial discrimination across all aspects of society, including key socioeconomic factors such as food and nutrition security, housing, healthcare, education, and criminal justice. Multiple studies have revealed that discrimination is associated with increased incidences of mental health disorders, hypertension, cardiovascular diseases, and mortality.[i] Such studies demonstrate the harms of discrimination, a key social determinant, on health and health outcomes. The COVID-19 pandemic and the tragic deaths of Breonna Taylor and George Floyd in 2020 helped illuminate these longstanding racial and health disparities and served as a catalyst for renewed public discourse and engagement on these issues. Clear and targeted actions are needed to address the effects of structural racism and advance solutions that mitigate its threat to the public health of communities of color.

In an effort to advance racial equity, 237 municipalities and states across the United States have declared racism a public health crisis as of March 2022.[ii] Importantly, declarations not only acknowledge historical injustices, but they also help to clearly define steps to address the root causes of racism to dismantle structural harm and build structural equity. Many municipalities and states have responded to this call by using these declarations to develop racial equity action plans to directly improve the health and well-being of Black and Indigenous people and people of color (BIPOC). CEOARE is working to expand support for these declarations at all levels of government to advance racial equity for Black Americans.

CEO Action for Racial Equity (CEOARE) is a fellowship of more than 100 companies working closely with community organizations, subject matter experts, nonprofits, government agencies, and legislators — that mobilizes a community of business leaders with diverse expertise across multiple industries and geographies to advance public policy in four key areas — healthcare, education, economic empowerment and public safety. Our mission is to identify, develop and promote scalable and sustainable public policies and corporate engagement strategies that will address systemic racism, social injustice and improve societal well-being. While we are focused on improving the well-being of the more than 47 million Black Americans, our work advances equity for Americans of all backgrounds, especially those who are most adversely impacted by the unfair social and economic circumstances perpetuated by racial and class discrimination.

We conducted a review and analysis of more than 200 declarations identified by the American Public Health Association (APHA)2 and compiled what we believe are the most critical elements of the declarations into a Racial Equity Implementation Framework (“Framework”). There are other published reports that have conducted analyses on declarations, for example from the University of Pittsburgh[iii], which provided recommendations on actions, and the APHA[iv], which categorized and provided examples on various declarations. We hope that our Racial Equity Implementation Framework can be a useful guide for municipalities and states to holistically consider key actions they can take as part of declaring racism a public health crisis, or in tandem with other racial equity initiatives.

To further inform our work, we collaborated closely with other organizations that are also working on racial and health equity initiatives to improve the quality of life of BIPOC communities. Some of the organizations that have performed detailed work related to municipal and state government declarations are the Network for Public Health Law, APHA, and Salud America! who assisted in providing feedback for this Framework. We also reviewed the racial equity toolkits and plans of organizations such as the Government Alliance on Race and Equity (GARE) and the American Medical Association (AMA) to incorporate their recommendations into this Racial Equity Implementation Framework.

Racial Equity Implementation Framework

Prior to formalizing racial equity action plans, we encourage government entities and organizations to establish principles and guidelines with community members to meaningfully inform how racial equity frameworks and action plans are developed and structured. These upfront collaborative efforts can help increase the efficiency and effectiveness of decision-making that can lead to desired outcomes for individuals and communities.

Our Racial Equity Implementation Framework consists of the following leading practices aimed at sustainably advancing racial equity. Please note that the recommendations within this Framework can be modified and selected by a municipal or state government organization given their own unique circumstances and needs:

  • Declare Racism a Public Health Crisis – Publicly acknowledge that the effects of structural racism are a public health crisis and include the local context within the respective jurisdiction to acknowledge specific measures that have adversely impacted the BIPOC communities being served. Declarations should include a commitment to incorporate racial equity as a core element of policies, procedures, programs, and action plans while encouraging other government entities and organizations to recognize and declare racism a public health crisis to commit to similar initiatives.[v] [vi] [vii] [viii]
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  • Engage and Empower Communities – Engage and work intentionally within BIPOC communities and with community-based organizations in decision-making, developing racial equity action plans, and managing available resources and programs that directly affect these communities.[ix] [x] [xi] [xii] It is important that this engagement and work be based on leading practices developed by community-based organizations and appropriately resourced.
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  • Increase Funding for Racial Equity Programs and Initiatives – Develop action plans that proactively utilize existing grants, funding programs, and budgets to help increase funding towards advancing racial equity.[xiii] Plans should include clear budgets, suggestions for funding requirements, goals, and timelines that help prioritize preventive measures that reduce reactive care and costs.[xiv]
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  • Evaluate and Address Social Determinants of Health (SDOH) – Identify SDOH needs and gaps across food and nutrition security, housing, healthcare, education, fair lending, infrastructure, transportation, broadband access, small business development, and community programs and services that promote healthier and safer lifestyles, to inform SDOH funding and strategies that improve health and economic outcomes.[xv] [xvi] [xvii] [xviii] SDOH data can be collected, tracked, utilized, and reported in an equitable and transparent manner to create and enhance evidenced-based solutions that reduce SDOH disparities and holistically address the needs of individuals.[xix] [xx] The performance of SDOH solutions should be tracked and assessed in order to properly fund and improve SDOH initiatives and programs that address the most pertinent needs of the communities being served.
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  • Establish a Racial and/or Health Equity Office and Advisory Committee – Establish or utilize an existing Office(s) that advances racial and health equity with an Advisory Committee that coordinates directly with cabinet members, councils, government departments, and decision-makers.[xxi] [xxii] The Office is designed to work with task forces, stakeholders, government officials, and communities to utilize racial equity impact assessments to create and help with the implementation of racial equity action plans and legislation that holistically improve the well-being of the communities being served.[xxiii] Funding should be explicitly provided and renewed so that the staff have the necessary resources to conduct their work. The function of the Office is to monitor, manage, and facilitate racial equity strategy, advocacy, funding, budgets, data collection and analysis, and performance metrics, and work closely with the Advisory Committee and government employees to communicate results, findings, and recommendations to decision-makers, government entities, and communities to continuously improve legislation, action plans, and equitable outcomes.[xxiv] [xxv]
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  • Create and Utilize Task Forces – Create and utilize task forces that have the capacity, expertise, and experience to conduct racial equity impact assessments to identify and propose structural changes to institutional laws, regulations, policies, and practices that have perpetuated inequitable sharing of power, access, and opportunity for underserved communities. Members of the task forces are to work closely with the entity focused on racial and health equity (e.g., Racial or Health Equity Office), the respective Advisory Committees, and decision-makers to assist in establishing clear racial equity goals and objectives with sufficient accountability metrics.[xxvi] [xxvii]
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  • Collect, Analyze, and Periodically Report on Data – Create an equitable data analysis framework and methodology to collect, track, and report disaggregated data based on race, ethnicity, gender, income, and SDOH, to identify root causes of racial and health disparities and to inform evidenced-based racial equity action plans and policy solutions that effectively address disparities.[xxviii] [xxix] The results and conclusions should be reported to the public in a transparent manner that meaningfully captures social, economic, and health metrics and outcomes.[xxx] [xxxi] [xxxii]
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  • Assess and Introduce Legislation that Advances Racial Equity – Assess, modify, and introduce legislation with a focus on racial equity, taking into consideration the lived experiences and perspectives of the racially diverse communities being served to improve their social, economic, and health outcomes. [xxxiii] This may include acknowledging past injustices and inadequacies of former and existing legislation to responsibly shape future policies while repealing legislation that has harmed BIPOC communities.[xxxiv] [xxxv] [xxxvi]
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  • Develop and Grow Collaborative Relationships – Develop, advance, and support meaningful racial equity coalitions, alliances, and collaborative networks with shared visions and goals to share data and reporting, measurable solutions and outcomes, key learnings, leading practices, and educational materials to increase and sustain overall impact.[xxxvii] [xxxviii] This may include building upon existing relationships within and across government departments. Governments may consider working with organizations across sectors to advance SDOH solutions through social impact investing initiatives that expand available resources and opportunities for communities being served.[xxxix] [xl] [xli]
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  • Reevaluate Internal Policies with a Racial Equity Lens – Establish education, support, and training programs and materials to help government employees better understand the principles of inclusion and equity to help them assess, modify, and create internal policies and procedures that help integrate racial equity as a core element in decision-making.[xlii] [xliii] [xliv] [xlv] [xlvi]
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  • Enhance Workforce and Cultural Diversity – Improve racially and ethnically diverse recruitment, interviewing, hiring, advancement, retention, and vendor selection practices while strengthening workplace culture that increases cross-cultural relationships and community building.[xlvii] [xlviii]
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  • Expand Public Awareness – Increase the public’s understanding of the root causes of racial disparities through media outlets and other public forums to raise awareness and garner support for actions that eliminate structural barriers to implement systemic change and achieve equity.[xlix] [l]

Conclusion

Racial equity work is an ongoing effort that requires a collaborative approach as well as adaptation and flexibility to achieve successful outcomes. We understand that addressing the action items within this Framework is a significant undertaking that involves substantial investment, collaboration, time, and energy. Therefore, to take on this important work requires allocating the proper resources and building the necessary capacity to make real, lasting progress.

We hope that this Racial Equity Implementation Framework can be used as a resource by municipalities, states, and other government organizations in a manner that helps promote successful and equitable outcomes in BIPOC communities across the United States. 

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References

[i] Perceived Discrimination and Mortality in a Population-Based Study of Older Adults. Am J Public Health. Jul. 2008. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424090/.

[ii] “Racism is a Public Health Crisis,” American Public Health Association, accessed March 23, 2022, https://www.apha.org/topics-and-issues/health-equity/racism-and-health/racism-declarations.

[iii] Dara D. Mendez, Jewel Scott, Linda Adodoadji, Christina Toval, Monica McNeil, and Mahima Sindhu, “Racism as Public Health Crisis: Assessment and Review of Municipal Declarations and Resolutions Across the United States,” Frontiers in public health vol. 9 686807, Aug. 11, 2021, doi:10.3389/fpubh.2021.686807

[iv] Analysis: Declarations of Racism as a Public Health Crisis, American Public Health Association, Oct. 2021. https://www.apha.org/-/media/Files/PDF/topics/racism/Racism_Declarations_Analysis.ashx.

[v] Analysis: Declarations of Racism as a Public Health Crisis, American Public Health Association, Oct. 2021. Page 1. https://www.apha.org/-/media/Files/PDF/topics/racism/Racism_Declarations_Analysis.ashx.

[vi] Resolution to Adopt a Resolution Proposed by the Mayor’s African American Advisory Council, Resolution 213-20, City of Fayetteville, Arkansas, Aug. 2020, https://www.nwahomepage.com/wp-content/uploads/sites/90/2020/09/Legislation-Text-3.pdf

[vii] Declaring racism a public health emergency in the City of Minneapolis, Resolution No. 2020R-193, Minneapolis City Council, July 2020, https://lims.minneapolismn.gov/Download/MetaData/17865/2020R-193_Id_17865.pdf

[viii] Declaring racism a public health crisis, Resolution No. 2020-115A, Ypsilanti City Council, Michigan, June 2020. Page 2. https://cityofypsilanti.com/AgendaCenter/ViewFile/Minutes/_06022020-1392

[ix] Equitable Community Engagement Plan, Boston Public Health Commission, 2019. Pages 1-13. https://www.bphc.org/whatwedo/racialjusticeandhealthequity/Pages/Community-Engagement.aspx#:~:text=What%20is%20Equitable%20Community%20Engagement,to%20achieve%20an%20equitable%20outcome.

[x] Racial Equity Toolkit: An Opportunity to Operationalize Equity, Local and Regional Government Alliance on Race & Equity (GARE), Dec. 2016. Page 9. https://www.racialequityalliance.org/wp-content/uploads/2015/10/GARE-Racial_Equity_Toolkit.pdf

[xi] City of Portland Racial Equity Toolkit, City of Portland Office of Equity and Human Rights, 2016. Pages 14-15. https://www.portlandoregon.gov/oehr/article/592297.

[xii] “A Guide to Using the Community Engagement Framework,” New York City Department of Health, accessed July 25, 2022, https://www1.nyc.gov/assets/doh/downloads/pdf/dpho/race-to-justice-action-kit-guide-community-engagement-framework.pdf

[xiii] “Mayor Walsh Declares Racism a Public Health Crisis,” City of Boston, June 2020. https://www.boston.gov/news/mayor-walsh-declares-racism-public-health-crisis.

[xiv] Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity, American Medical Association, 2021. Pages 19, 39. https://www.ama-assn.org/about/leadership/ama-s-strategic-plan-embed-racial-justice-and-advance-health-equity

[xv] Resolution of the NYC Board of Health Declaring Racism a Public Health Crisis, New York City Board of Health, October 2021. https://www1.nyc.gov/assets/doh/downloads/pdf/boh/racism-public-health-crisis-resolution.pdf

[xvi] “Plans for Advancing Racial Equity for Black Louisville,” Louisville-Jefferson County Metro Government, Dec. 2020, accessed March 23, 2022, https://louisvilleky.gov/government/mayor-greg-fischer/plans-advancing-racial-equity-black-louisville.

[xvii] Resolution Declaring Racism as a Public Health Crisis in Montgomery County, Resolution No. 20-0759, Montgomery County, Ohio, June 2020. https://www.mcohio.org/news_detail_T6_R485.php

[xviii] Racism: A Public Health Crisis Position Statement, Peoria County Board of Health, Illinois. July 2020. Page 3. https://www.pcchd.org/DocumentCenter/View/1192/7-20-20-Racism-Position-Statement-PDF?bidId=

[xix] Resolution to Adopt a Resolution Proposed by the Mayor’s African American Advisory Council, Resolution 213-20, City of Fayetteville, Arkansas, Aug. 2020. https://www.nwahomepage.com/wp-content/uploads/sites/90/2020/09/Legislation-Text-3.pdf

[xx] A Joint Order Declaring Racism an Emergency and Public Health Crisis in the City of Framingham, Order No. EO2020-04, City of Framingham, Massachusetts. June 2020. Page 2. https://www.framinghamma.gov/DocumentCenter/View/38352/Joint-Order-on-Racism-and-Public-Health

[xxi] Resolution to Adopt a Resolution Proposed by the Mayor’s African American Advisory Council, Resolution 213-20, City of Fayetteville, Arkansas, Aug. 2020, https://www.nwahomepage.com/wp-content/uploads/sites/90/2020/09/Legislation-Text-3.pdf

[xxii] A Resolution concerning Racism as a Public Health Crisis, Resolution No: 20-15, The City of Frederick Mayor and Board of Alderman, Frederick, Maryland, July 2020. Page 3. https://www.cityoffrederickmd.gov/DocumentCenter/View/18164/20-15-Concerning-Racism-as-a-Public-Health-Crisis?bidId=

[xxiii] A Resolution declaring racism a public health crisis, Resolution No. 20200729-113, Austin City Council, Austin, Texas, July 2020. Page 5. https://www.austintexas.gov/edims/document.cfm?id=344245

[xxiv] Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity, American Medical Association. 2021. Pages 53-54. https://www.ama-assn.org/about/leadership/ama-s-strategic-plan-embed-racial-justice-and-advance-health-equity

[xxv] Resolution Declaring Racism a Public Health & Safety Crisis, Resolution No. 20-08-03, Buncombe County Board of Commissioners, North Carolina, Aug. 2020, https://www.buncombecounty.org/common/publicRelations/Reso-Declaration%20Racism%20as%20a%20Public%20Health%20and%20Safety%20Crisis%208-4-20.pdf

[xxvi] A Resolution of the Board of Supervisors of the County of Riverside Declaring Racism and Inequity as a Public Health Crisis, Resolution No. 2020-179, The Board of Supervisors of the County of Riverside, State of California, Aug. 2020, http://rivcocob.org/proceeds/2020/p2020_08_04_files/03.71001.pdf

[xxvii] AN EMERGENCY RESOLUTION Declaring racism a public health crisis and establishing a working group to promote racial equity in the City of Cleveland, Resolution No. 296-2020, Cleveland City Council, June 2020, https://cityofcleveland.legistar.com/LegislationDetail.aspx?ID=4348675&GUID=32569022-4E96-4EDA-AF9F-398FE74D1179

[xxviii] Hennepin County Declares Racism a Public Health Crisis, Resolution 20-0242, Hennepin County, Minnesota, June 2020, https://hennepin.novusagenda.com/agendapublic/CoverSheet.aspx?ItemID=9340&MeetingID=1024

[xxix] Declaration of Racism as a Public Health Crisis, Douglas County Board of Health, Douglas County, Nebraska, June 2020, https://www.douglascountyhealth.com/images/COVID-19/Resolution_Declaring_Racism_a_Public_Health_Crisis_approved_and_recorded.pdf

[xxx] Racial Equity Toolkit: An Opportunity to Operationalize Equity, Local and Regional Government Alliance on Race & Equity (GARE), Dec. 2016. Pages 8, 11. https://www.racialequityalliance.org/wp-content/uploads/2015/10/GARE-Racial_Equity_Toolkit.pdf

[xxxi] City of Portland Racial Equity Toolkit, City of Portland Office of Equity and Human Rights, 2016. Pages 12-13, 20. https://www.portlandoregon.gov/oehr/article/592297.

[xxxii] Declaring racism a public health emergency in the City of Minneapolis, Resolution No. 2020R-193, Minneapolis City Council, July 2020, https://lims.minneapolismn.gov/Download/MetaData/17865/2020R-193_Id_17865.pdf

[xxxiii] A Resolution Declaring Racism a Public Health Crisis in Erie County, Resolution No. 43, Erie, Pennsylvania. Sept. 2020. Page 5. http://public.eriecountypa.gov/councildocs/resolutions/2020-43.pdf

[xxxiv] City of Portland Racial Equity Toolkit, City of Portland Office of Equity and Human Rights, 2016. Page 14. https://www.portlandoregon.gov/oehr/article/592297.

[xxxv] Resolution of the NYC Board of Health Declaring Racism a Public Health Crisis, New York City Board of Health, October 2021. https://www1.nyc.gov/assets/doh/downloads/pdf/boh/racism-public-health-crisis-resolution.pdf

[xxxvi] Declaration of Racism as a Public Health Crisis, Douglas County Board of Health, Douglas County, Nebraska, June 2020. https://www.douglascountyhealth.com/images/COVID-19/Resolution_Declaring_Racism_a_Public_Health_Crisis_approved_and_recorded.pdf

[xxxvii] A Resolution concerning Racism as a Public Health Crisis, Resolution No: 20-15, The City of Frederick Mayor and Board of Alderman, Frederick, Maryland, July 2020. Page 4. https://www.cityoffrederickmd.gov/DocumentCenter/View/18164/20-15-Concerning-Racism-as-a-Public-Health-Crisis?bidId=

[xxxviii] Declaring racism a public health crisis, Colorado Department of Health & Environment, Apr 2021. Page 3. https://drive.google.com/file/d/1SzfKPoGGTG_kCxwiq9JNqigampF0174I/view

[xxxix] Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity, American Medical Association. 2021. Pages 9, 42, 47, 63. https://www.ama-assn.org/about/leadership/ama-s-strategic-plan-embed-racial-justice-and-advance-health-equity

[xl] Declaration of Racism as a Public Health Crisis, Douglas County Board of Health, Douglas County, Nebraska, June 2020, https://www.douglascountyhealth.com/images/COVID-19/Resolution_Declaring_Racism_a_Public_Health_Crisis_approved_and_recorded.pdf

[xli] Office of the West Haven City Council, West Haven, Connecticut, Dec. 2020. Page 2. http://www.cityofwesthaven.com/DocumentCenter/View/2875/Resolution-Declaring-Racism-a-Public-Health-Crisis-PDF

[xlii] Governmental Use of Racial Equity Tools to Address Systemic Racism and the Social Determinants of Health, The Institute for Healing Justice & Equity. November 2021. Pages 24-25. https://ihje.org/governmental-use-of-racial-equity-tools/

[xliii] City of Philadelphia Racial Equity Action Plan, Philadelphia City Council. 2016. Pages 17-18. https://phlcouncil.com/wp-content/uploads/2019/04/Grants-Attachment-Racial-Equity-Action-Plan.pdf

[xliv] Recognizing that racism is a public health crisis in Virginia, HJ537ER, Virginia General Assembly. February 2021. https://lis.virginia.gov/cgi-bin/legp604.exe?212+ful+HJ537ER

[xlv] Hennepin County Declares Racism a Public Health Crisis, Resolution 20-0242, Hennepin County, Minnesota, June 2020, https://hennepin.novusagenda.com/agendapublic/CoverSheet.aspx?ItemID=9340&MeetingID=1024

[xlvi] A Resolution to Make Eliminating Racial Disparities and Income Inequality Public Priorities within the City of South Fulton, South Fulton, Georgia, May 2021. Page 2. https://www.khalidcares.com/uploads/6/5/4/7/65477973/south_fulton_racial_and_income_inquality_resoluton__25may2021_.pdf

[xlvii] Health Equity Resolution Declaring Anti-Black Racism a Human Rights and Public Health Crisis in San Francisco, Resolution No. 20-9, San Francisco Health Commission. July 2020. https://www.sfdph.org/dph/hc/HCRes/Resolutions/2020/20_09HealthEquityResolutionDeclaringAntiBlackRacismAHumanRightsAndPublicHealthCrisisInSanFrancisco.pdf

[xlviii] Hennepin County Declares Racism a Public Health Crisis, Resolution 20-0242, Hennepin County, Minnesota. June 2020, https://hennepin.novusagenda.com/agendapublic/CoverSheet.aspx?ItemID=9340&MeetingID=1024

[xlix] City of Portland Racial Equity Toolkit, City of Portland Office of Equity and Human Rights, 2016. Page 14. https://www.portlandoregon.gov/oehr/article/592297.

[l] A Resolution of the Board of Supervisors of the County of Riverside Declaring Racism and Inequity as a Public Health Crisis, Resolution No. 2020-179, The Board of Supervisors of the County of Riverside, State of California, Aug. 2020, http://rivcocob.org/proceeds/2020/p2020_08_04_files/03.71001.pdf

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