Health Officer Britten Says Candid Talk about Race Can Spark Empathy and Action to Fix Health Inequities

BENTON HARBOR, Mich. – Most adults in the U.S. probably know about “The Talk” black parents have with their teenage sons. This is the protective advice designed to keep these young men physically safe during encounters with white police.

Should white parents have their own version of “The Talk”?

Nicki Britten thinks so, though the approach would necessarily be far different. Britten is health officer/director for the Berrien County (Michigan) Health Department and a key member of a team in its first year of a three-year effort called Community Grand Rounds: Healing the Trauma of Racism. Largely through a series of expert speakers, CGR seeks to enlighten the staff of the local hospital system, Spectrum Health Lakeland, and the wider community about how structural racism is one of the causes of far poorer health and earlier death for blacks in Benton Harbor and Benton Township than for white people across the river in St. Joseph. CGR is a collaborative effort of the Todman Family Foundation and Spectrum Health Lakeland. Community Grand Rounds

The CGR team is also intent on seeking suggested solutions from residents of the Benton Harbor/St. Joseph area, mainly through conversations over many months under the title “From Courageous Conversation to Community Action.” These “Courageous Conversations” will be small gatherings, mostly in homes. They’ll follow a protocol but try for candid—not necessarily ‘safe’—discussions,” said Lynn Todman, executive director for population health for Spectrum Health Lakeland.

“The CGR team dismissed the idea of promising emotional safety, because such a pledge could unnecessarily chill honest conversation.” 

‘How to Be a White Boy’

At a meeting in August 2018 on how to conduct these “Courageous Conversations,” Britten, a white woman in her early 30s, said white people need to be aware of their own privilege and role in racial healing.

Referring to her 7-year-old son, she said, “I’m not talking enough about racism. I’m not telling him how he needs to be a white boy in this world. … We need to be having conversations about what it means to be a white boy in this world and how do you behave, what power comes with that, what responsibility comes with that.“

Britten said white people do have a racial identity, although most don’t realize it and might react defensively to the idea. For white people “the default is it’s just you,” the individual, and not a representative of a racial group.

Britten’s racial self-awareness grew when she took part in a yearlong Health Equity Awakened fellowship in 2017-18 through a leadership institute with 17 other health department officials from around the nation. The institute confronts racial health inequities and is sponsored by Human Impact Partners, an Oakland, California-based nonprofit.

In an interview in her county health department office, Britten said the fellows “got deep into much of the personal evolution stuff that needs to happen to transform roles and then change systems.”

Talking about racism is tricky, especially when black and white people talk together. Britten said individuals are at different points along the spectrum. For some people, talking openly about racism during “Courageous Conversations” will be new territory. Others who have had such conversations will impatiently want to dispense with talk and take corrective action immediately.

Britten said it is important in such discussions to honor differences and relationship-building. It’s also important for each person to say what moved them to take part in the conversation.

Sad, Startling Statistics

As a public health official, Britten has been trained to see the larger patterns of health—and in the St. Joseph/Benton Harbor area, that means seeing the blatant racial inequities.

At a July 2018 Community Grand Rounds presentation, she spoke of the dramatic contrasts between the health of white and black people in the area. She noted African Americans in Berrien County are 27 percent more likely to suffer from severe psychological distress, 24 percent more likely to be obese, and 23 percent more likely to have diabetes compared with whites.

Babies born to African American women in Berrien County are four times more likely to die before their first birthday than babies born to white mothers. She also mentioned the lower academic achievements locally and the higher incarceration rates in the Berrien County jail for people of color.

Careful not to accuse individuals or organizations of intentional racism, Britten told her audience: “But, rather, we should see the confluence of so many data points across all systems and institutions, and see that they’re revealing a predictable pattern of who’s doing OK, and who’s not.”

Britten is in her element talking about data and structures and systems and constantly “going upstream” to find root causes.

Referring to racial health disparities in Berrien County, she asked during the interview, “Why is this so common? Why are there so many patterns (of chronic diseases) to this”? She wants to go “further and further upstream, meanwhile understanding that there are people who have vastly dramatic, different experiences than I do as a white woman”—living in conditions contributing to their poor health.

As people in Berrien County begin to understand how structures and systems contribute to poor health outcomes, she asked: “How do we change this? How are we going to fix it?”

Britten is keen to perceive the dismissive, thinly disguised racist comments white people make about public health problems when the implied target is black people. She gave the following comment as an example: “Well, you know, there’s so many single mothers, and that’s what the problem is.”

She asked, “Well, why are we just OK with this? Why do we have so many single mothers, and what’s going on there, and what has happened that has put somebody in that position, or why is that a bad thing?

“There’s just all these things where we’ve cast somebody off because they’re in a situation that we blame them for, instead of recognizing their humanity and having empathy with them for where they’re at.”

How Her World Expanded

Britten grew up in Battle Creek, Mich., got her undergraduate degree from Western Michigan University in Kalamazoo and her master’s in public health at Yale University in New Haven, Conn. Each move brought her in contact with a greater diversity of people.

In Battle Creek she encountered few people of color. “They were the token black people. We didn’t talk about race in our home, because we’re white people, we don’t have to talk about race, we don’t think about it. I don’t feel that I was raised in a racist environment at all, but it was definitely ignorant of other world views in a lot of ways.”

Nevertheless, her parents instilled in their children this idea: “There’s a whole big world out there, and you can’t just think of it only through this small lens.”

Britten’s mind was further widened by exposure through her Greek grandmother to a “little enclave of Macedonians and Serbians and Russians” in the Battle Creek area. They gathered for Sunday morning worship at what she said was branded as an Eastern Orthodox church but was actually part of the Russian patriarchy.

She knew this social circle viewed the world differently and expressed its uniqueness in traditions and ways “very meaningful to us.” One such tradition was an exorcism at the beginning of a baptism when the godparents literally spat over the child.

“That’s a totally weird cultural thing to do, but it’s very meaningful for that group of people,” Britten said.

‘Slap You Awake’

Britten is a great believer in person-to-person empathy. When two people are seemingly quite different, empathy can act as a powerful uniting force leading to change.

She recalls being powerfully moved by a comment a black female colleague made. It came when the health department was putting on health equity and social justice workshops around the time of the killing in 2012 of 17-year-old Trayvon Martin in Florida. The black woman said she was already talking to her 3-year-old son “about what it means to be a black man.”

It was a shock to Britten. Her first child was just a baby then. Raising a baby seemed hard enough without having the extra worries of her black colleague. Britten said of her own son: “If he’s out running in the neighborhood, a neighbor is not going to call the cops on him.

“I think sometimes it does take a little bit of just that understanding, and hearing the exact story from another person, to help slap you awake and just realize what’s happening.”

A one-on-one interaction can shape a person’s view on an issue. Britten has attended many conferences on the opioid crisis. Police and judges on these panels have said they used to advocate long prison terms for drug abusers. She recalled the kinds of comments she has heard from people whose thinking has been transformed, such as this: “But then my daughter started using, my neighbor’s kid started using, my wife is addicted. And I had this personal experience, and I realize that addicts are people.’”

It took personal experiences for these officials “to change their paradigm.”

Public Health—With a Spiritual Dimension

“In my opinion, as long as there are humans oppressing other humans, nobody’s living into their full humanity,” Britten said. “Even if I feel like I’m OK and I’m getting what I think I need, there is something not coming to fruition in me and in my humanity if there’s this oppression happening, and I’m OK with it, I’m desensitized to it, I don’t notice it, I’m participating in it. That makes it so I can’t live up to my full potential from my faith, and personally can’t fully have God’s image revealed in me if that’s happening.”

Speaking hypothetically, she said, “I don’t know how to make my all-white circle care as long as we remain an all-white circle, because it gets back to that world view: If you’re only ever being exposed to one world view, one way of life, the other way seems weird, and you start ‘othering’ the people.”

Empathy across racial and other gaps can lead to action to fix problems, because people who empathize want to help change the conditions of people’s lives, Britten said. When people stop seeing people as “the other” and identify empathetically, a “heart engagement” happens, and people see each other as “living, breathing people with worth and value.”

White Women’s Unique Role

During the interview in her office, Britten was asked to comment on the observation that in the Benton Harbor/St. Joseph area women are the ones primarily leading the social justice efforts (including Community Grand Rounds).

She agreed. “And I think white women have such a powerful potential to be leaders in this, because … you go talk to any group of women, no matter what color they are, they’ve all experienced some sort of discrimination, oppression, something for being women. There’s been some sort of sexism that has happened to them,” making it a lot easier for them to understand the problem.

Conversely, there are straight, white, upper-middle-class, Christian males who probably have no experience of being discriminated against, Britten said. “There’s not even a concept of what this is or what this feels like.

“If enough white men actually had a better concept and were better able to understand what other people were going through, I think that would help shift the tides, too. I think white women are uniquely positioned, because you have the white privilege, but then the understanding that comes with some of the gender oppression.

But “if white women are leading the charge, and women of color are not equal players at that table, we’re just propagating the same thing,” Britten cautioned.