BENTON HARBOR, Mich. – How do you help move thousands of people toward healthier lives? And how do you encourage people across the black-and-white racial chasm to work together to help reduce health inequities?
These are daunting goals, and not for the fainthearted. They are among the challenges facing Berrien County Health Officer/Director Nicki Britten, both in her work at the health department and also with other leaders of a long-term effort called Community Grand Rounds: Healing the Trauma of Racism.
Such complex problems, requiring multipronged and sustained work over many years, could certainly cause a person to feel discouraged. Or they might cause someone to reach for a hopeful metaphor.
County ‘on the Brink of Boiling’
Britten recently reached for the metaphor of a boiling pot. It came in July 2018 during a video address to audiences as a prelude to a CGR presentation by Harvard sociologist Dr. David Williams.
Britten compared Berrien County with a pot of water. To make a big change—in this case from the liquid to the gas phase—you need to apply heat. Small bubbles form, and you hear sounds. Then more bubbles form, and the sounds become louder. The water starts splashing.
“Things look pretty chaotic and unpredictable in the pot,” Britten said. Your instinct might be to turn down the heat, but she cautioned that giving in to the uncomfortable feeling would end the progress. You must remain uncomfortable for a while. The pot must reach a full, roiling boil.
“I believe that Berrien County is on the brink of boiling when it comes to changing phases of population health in our community,” she said. The community and health system “have started doing things to apply heat to the water.”
Among the actions she cited was the publication of the Community Health Needs Assessment. The CHNA is a statistically rich, 106-page document that gives an appraisal of the health of Berrien County residents. It also graphically illustrates the disparities of health outcomes between black and white residents.
Racial Health Inequities ‘Top of Mind’
Britten also said local officials have started examining policies and practices concerning how health care is delivered. “We’ve broadened community collaborative partnerships,” including ones focused on food access, education, transportation and housing.
“We are starting to see small bubbles forming on the bottom of the pot.” But she said leaders need to “confidently keep the heat up.
“From where I sit, as the health officer, racial health inequities in this community are top of mind in my organization—daily,” Britten said in the video. “And we know that narrowing that gap will be critical to moving the needle on some of the biggest health issues our community faces.
“It’s important for us to see the larger themes behind the lived experience of some of our friends and neighbors throughout Berrien County,” Britten said. She asked her audience to “be open to that discomfort and chaos and the unpredictability that comes with seeing things in new light, seeing health outcomes differently.”
She asked them to view “with a new lens” the policies and practices they may be perpetuating on a daily basis that inadvertently continue harmful patterns, and instead to use “innovative methods to move our community forward.
“We need to resist the urge to turn down the heat when we can’t conceptualize what is happening in the broader community or even within our institutions as things start looking a little more chaotic.”
‘A Critical Mass to Shift the Tides’
In a later interview, Britten talked about the need to reach a critical mass if there is to be real movement to improve the health of residents. “There’s a lot of pockets of movement in this community,” she said, conceding that “we’re so disparate and disjointed” with the efforts. These efforts need to be working parallel with each other.
Britten recalls reading somewhere that it only takes about 3.5 percent of a population to overthrow a ruler. “You really don’t need that much of a critical mass to shift the tides. But you do need a percentage of the population to get a policy changed. And so I think that’s where we’re at right now.
“I do firmly believe that we probably have enough people” now to advance racial health equity in the Benton Harbor/St. Joseph area. “It’s just not moving in the right direction. Everybody’s in their own lane doing their own thing well, and there are groups of us that are trying to get equity into what we’re doing. But we’re not leveraging each other enough to have that collective impact.
“I think that takes a little bit of time … trust building.”
Britten said the health department is seeking to get its own house in order for the broader effort of working on racial health inequities and other health problems in the community. This “organizational transformation” includes efforts to build the staff’s capacity regarding trauma and race equity, and communication and emotional intelligence. The staff is also looking inside to spot any of its policies and practices that might unintentionally be perpetuating health inequities.