If you’ve ever wheeled a stroller or suitcase down a sidewalk, let alone navigated one on crutches, congratulations: You’ve benefited from equity work. Curb cuts—the graded ramps connecting sidewalks to street level at every corner—were introduced in the United States in the mid-20th century, often by activists with disabilities, with the goal of enabling urban mobility for wheelchair users. As it happened, these innovations in structural access made life easier for everyone: parents trying to cross the street no longer had to jostle their children up and down, shoppers and delivery people faced less damage to their packages, elderly strollers risked less chance of falling and travelers didn’t strain their arms hefting gear.
This practical, real-world model of what happens when barriers to health and well-being are addressed stands in contrast to rhetoric that frames “equity” as a zero-sum game, where gains for one group mean losses for another. The “curb cut” model, attendees noted Tuesday at the George Washington University’s “Exploring Community-Driven Solutions that Promote Health Equity” convening, is a powerful example of the wide-ranging impact of fostering equity. The gathering, hosted by GW’s Institute for Racial, Ethnic, and Socioeconomic Equity (Equity Institute), provided a space for collaborators in public health, law, philanthropy and community to make connections, share tools and build strategies.
In opening remarks, GW President Ellen M. Granberg pointed out that there is no contradiction between working to address the effects of systemic inequities that drive disparities in health and growing a strong, innovative economy for everyone.
“Reducing health disparities in our nation is good for us morally, but also economically and materially,” Granberg said. “It will open up new pathways for innovation. It will release the energy of a whole group of people who currently are dealing with health disparities that make it harder to get an education, to get a job, to start a business, to raise a family. As a result of that, it has the potential to grow our economy and create more opportunities.”
“At GW, we remain steadfast in our mission, which is to serve as a catalyst for bold research, for rigorous dialogue, for real world impact. We're a globally recognized institution in the heart of the nation's capital, and because of that, we're uniquely positioned to convene the brightest minds to influence policy, to translate ideas into action. We don't just study inequities, we drive solutions that shape policies that transform communities and that create a more just and equitable society. And it's our goal to do everything we can to keep those ideas alive here in D.C.”
Equity Institute Director Wendy Ellis, an assistant professor of global health in the Milken Institute School of Public Health and founding director of the Center for Community Resilience (CCR), opened the day’s first panel with a rundown of “systems thinking,” which examines the ways community environments shape health inequity more strongly than individual choice and addresses the root causes, rather than the symptoms, of that inequity.
A simplistic linear analysis—“If you eat better, you’ll have a better life,” for instance—doesn’t necessarily provide a useful way forward, Ellis said. Does the person in question have access to healthy food? If not, do they have the time and resources to travel what may be a significant distance to get it? What stress constraints are they under?
“Say you’re living in a household with three children, but you can only afford childcare for one, which means you have tough decisions that you have to make, which means that there's more household stress, which—guess what—leads to inflammatory conditions such as obesity and cardiovascular disease,” Ellis said. In that case, “You can eat as healthy as you want, but if you're not reducing that stress…then it is not simply what you eat, it's what's eating you.”
A number of systems and their intersections influence a community’s environment and the inequities it experiences, Ellis said, most powerfully criminal justice, education and housing. Thinking “specifically and strategically” about inequity requires unpacking a community’s relationship with those systems. Structural inequity also rests on three “weight-bearing pillars,” she said: the policies that produce unequal outcomes, the practices that reinforce those policies and the dominant narratives that justify investment in both.
The Equity Institute’s most recent work with the Center for Community Resilience is the Closing the Wealth Gap framework, which brings together city leaders with community residents to provide a blueprint for public-private partnerships that foster systemic equity using a place-based approach. EI and CCR are currently seeking partners to scale this framework to cities across the U.S., Ellis said.
In the afternoon, participants broke into groups to discuss the gaps they were endeavoring to close in their own work, which ranged from nutrition to medical practice to digital communications. When the groups reconvened to present what they’d discussed, some found themselves making connections, discovering others in unexpected fields who were struggling to address the same problems. “We’ll talk after,” one presenter called to another, prompting laughter.
At a closing panel moderated by GW Law Dean Dayna Bowen Matthew, three experts discussed how to keep doing equity work in the face of opposition. Marshall Chin, the Richard Parrillo Family Distinguished Service Professor of Medicine at the University of Chicago, brought up the “curb cut” model of equity. “There are ways to serve the mission in ways that do serve everyone’s needs and the overall health of the public,” he said.
Marla Dean, senior director of the Health Equity Fund at the Greater Washington Community Foundation, shared her own experience citing specific access disparities in Washington, D.C. She lives east of the Anacostia River, in a community with three grocery stores for about 170,000 people. By crossing a bridge into wealthier Ward 6, she enters a community with eight grocery stores for a smaller population. “I see that because I have to travel that route every single day,” she said.
Tiffany Williams, president and CEO of D.C. community mainstay Martha’s Table, told her audience not to be sidetracked by zero-sum thinking. Rhetoric that pits suffering people against one another is “a tactic that’s old as dirt,” she said.
“Don’t get distracted,” she said. “Don’t get caught up on words. Continue to do the work.”
