Young Woman Is Discovering Through Community Grand Rounds How Systemic Racism Is Causing Poor Health in Her Hometown

 

BENTON HARBOR, Mich. – It can be eye-opening when what you learned in your college classroom comes true in real life, explaining a mystery.

And when the mystery concerns something as significant as your health, the health of your family and of the whole community you live in, the explanation can strike you with a profound sense of awakening.

Kyndall McCoy has been in the awakening mode recently. This African-American woman in her late 20s is beginning to understand, from a macro viewpoint, the predictable connections between a community’s lack of resources and its bad health outcomes. In particular, she is realizing just how much a role systemic, structural racism has played in communities like hers.

Her town is the predominantly black community of Benton Harbor, where the median household income is about $20,200 and 48 percent of the residents live in poverty. The city of about 9,800 people in southwest Michigan has no large grocery store where people can buy fresh fruits and vegetables. Many people don’t have cars, and public transportation is inadequate. The school system in the spring of 2019 came under pressure from the state for possible closure. Benton Harbor and its outlying neighborhoods suffer disproportionately high rates of chronic diseases and premature deaths compared with the rest of Berrien County.

“Crazy thing, right?” McCoy said in an interview. “I went to school to become a social worker and we talked about some of these issues.” But it wasn’t until she became involved in a project called Community Grand Rounds: Healing the Trauma of Racism, and one of its Brave Talks groups that she really started to make the cause-and-effect connections. The lessons from her classes at Western Michigan University in Kalamazoo were suddenly taking on new dimensions.

“Community Grand Rounds and Brave Talks definitely put it in a different perspective, different light for me,” said McCoy, who completed her master’s degree in April 2019. “It was almost like it was bringing my class work to reality.” McCoy is helping to lead CGR, which is a collaborative effort between the Todman Family Foundation and Spectrum Health Lakeland.

 

‘Why, Why, Why?’

Experts say the chronic stress of racism reaches down to the cellular level. It takes a toll on the bodies of black Americans and can shorten lifespans. That stress can even be passed on genetically to children and grandchildren. For McCoy, this knowledge has personal implications. She recalled how her older brother and sister had been lucky to know their grandmothers when they were healthy and vibrant. But McCoy only remembers two chronically ill women who are now deceased. 

McCoy worked for two years on the WMU campus as a sexual health coordinator at a social service agency. She has been interested in health since she was young. 

“Over the years, working with sexual health, I always wanted to find the root cause of things: Why, why, why?’ I’ve always been like ‘why? Why is this?’” When she learned from Lynn Todman, Ph.D., Spectrum Health Lakeland’s executive director for population health and the leader of Community Grand Rounds, that CGR’s overarching message would be how racism affects health, McCoy was intrigued.

 “I was just like, ‘Man, this is something new to me,’ because I had never looked at it in light of racism impacting health, and so that’s one reason why I really got involved.” McCoy found herself wondering: “Hmm, is this really a root cause of why our communities are sick — like the reasons why African Americans have high rates of diabetes and hypertension and obesity and cardiovascular disease? All of those run in my family. I started to ask, ‘Is this really the root cause?’”

 

Fear of Medical Treatment

It’s been interesting for McCoy to see the link between structural racism and health. She said black people have for a long time recognized the health problems they suffer, “But we don’t know the root cause of the issues. We’ve heard about the stories of the Tuskegee airmen and Henrietta Lacks and black girls being sterile so they won’t have any more kids. But I don’t think that people have ever framed it as: ‘This was structural racism.’ And I think this is why African Americans don’t like going to the doctor until it’s too late, or until we must go.”

McCoy’s father, who is a minister, grew up in Benton Harbor, too. He was at first surprised to learn from his daughter of the connection between racism and health. Her conversations with him about what she was learning led to his own “Aha!” understanding. 

The point is that the policies and structure of a person’s community — the structural or systemic factors — can greatly influence options and choices. If, for example, a person doesn’t have easy access to transportation, it’s hard to get fresh fruits and vegetables, those are systemic problems of the person’s environment. So, McCoy said, maybe an unhealthy person is “not a bad individual.” It’s just that this person makes decisions, good or bad, based on the options available.

McCoy emphasized the difference between structural or systemic racism on the one hand, and, on the other hand, implicit bias leading to racism.  She said many times people intertwine and confuse the two causes. One example of implicit bias would be a white teacher who unconsciously has lower expectations of her black students.

The expert speakers who are addressing Community Grand Rounds audiences are underscoring the huge role systemic racism plays in health. The Brave Talks in people’s homes are also centered on root causes in the way American society is structured, and usually these discussions are based on participants having a common foundation. For example, they may have read the same book or attended the same presentation, or they may even discuss news accounts about a racially charged matter in the community.

 

What Options Do People Have?

Still, it is humanly tempting to view an individual’s health problems in isolation, dismissing the problems by saying the person simply has made bad choices for a long time. While good choices and decisions are of course essential, McCoy underscored the importance of a person’s overall environment in the options available to that person. 

Harking back to her work as a sexual health coordinator, she said high rates of sexually transmitted infections are sometimes explained as the result of people not using condoms. “But why are people not using condoms?” She said that is the real question. At that point, she said the discussion typically turns complex and focuses on possible barriers. Many questions come up, such as: Are people educated about condoms? Do they have access to them? When is the right age for someone to be told about condoms? “Are we talking about this on a normal basis?” (She said the answer is no to all of these questions.)

McCoy said these complex discussions often involve blaming individuals, when instead the best approach would simply be to educate people and provide them condoms. 

McCoy was asked if one reason people don’t use condoms when they should is they have more pressing matters — like food and rent — on their minds. “Exactly,” she responded. Condoms aren’t a priority when a person’s essential needs aren’t being met.

She expanded this structural thinking to the example of a child who is chronically late to school. Why is this happening? Maybe transportation is a barrier for this family.

“So I think we always look at the individual, and not necessarily at the structure: What can we do as a community to help?” McCoy asked. “Realizing that if one person is struggling with it, maybe there are multiple people that might be struggling with it, and we just don’t know about it.”

 

Sees Brave Talks Expanding

McCoy was asked if she has found hope in Brave Talks (the full title is Brave Talks: Addressing the Impact of Racism.) In a word, yes. Because “race has been such a taboo topic for so long,” she has been happily surprised by participants’ willingness to talk about racism and how it harms health, and by their dedication to “understand themselves and their biases,” as well as other people’s biases. She thinks Brave Talks will expand as other people feel “this will be a great conversation to have in my living room with my peers.”

She finds hope in the fact people are starting to really understand certain concepts. “I think we’ve heard the terms privilege, power, structural racism, institutional racism for so long but never really understood how they really impact individuals and how they play a part in our community as a whole.” She senses that CGR’s series of speakers, the information with concrete examples and data about structural racism and its impact on health, and book discussions spurred by Brave Talks are all making an impact.

“My goal is to continue to open up dialogue with people that I might not necessarily know, or being courageous enough to call somebody out for a statement or a comment that they have made,” McCoy said.

“My goal is to continue to open up dialogue with people that I might not necessarily know, or being courageous enough to call somebody out for a statement or a comment that they have made,” McCoy said. This means going beyond her circle of friends, because they are people who “understand it and get it, so it’s like preaching to the choir, right? So I’m just trying to find groups of people who don’t necessarily understand it or get it, or want to understand and get it but haven’t gotten there yet.”

 

Hope Tempered by Reality

On the national level, McCoy is heartened by what happened in the 2018 mid-term elections, with more women elected to the House and Senate. She was encouraged recently to encounter white students at Western Michigan University, from all-white backgrounds, who were questioning their conservative views and who no longer felt comfortable being back at home because they don’t feel the same way as their family or community feels. Students in class talked about challenging racist and sexist comments fellow students made. This self-awareness of young people gives her hope for society.

She said, “the generation that’s coming up” is starting to realize “what’s really affecting individuals” — certain laws and policies — and “there’s starting to be a shift on the larger scale.”