Go easy on your predecessors

WARNING: Nerdy Public Health post coming up.

I read this article yesterday about the creation of the KCMO 2022-2027 Community Health Improvement Plan (CHIP). I'm thrilled that the KCMO Health Commission (a volunteer board, full of the best and brightest appointed by the Mayor) has more clearly pointed to Racism as a root cause of health inequities. It's bold, it's real and it's time.

But something didn't sit quite right with me after reading this, and I felt a little unsettled. I have been in the field of Public Health and Policy for over 15 years, and in that time I've seen a rapid evolution of the frameworks for health equity. Every city and county I've had the pleasure of working with over the years is on their own journey towards true integration of structural oppression into their plans to improve health. Some take longer than others, and the realities of public sentiment and political climate mean that many communities have to be highly strategic in how they talk about race and place and health. It's one of the reasons I left the public sector for mySidewalk, because I wanted to meet communities where they were at with stories that might change some minds.

Maybe I'm biased because I served on the CHIP Committee for the previous plan, then later moved to a staff position to support implementation, but I think what this article leaves out is the fact that the 2016-2021 CHIP broke so many barriers and left a very important legacy. It was not focused on health behaviors or individual health outcomes. It was focused on the systems that create opportunities (or restrict them). And believe me, not everyone was on board with this approach. So it takes some finesse--relationship building, negotiation, persuasion--to get buy-in. This CHIP became a model for plans all over the country as the field moved upstream. It was also the first KCMO CHIP to include an interactive data experience to track progress in real-time. Contrary to the article, it continuously called out race and racism.

It was a conscious choice to not be overly prescriptive in how to implement the plan. It was kept high level so that the cross-sector committees could create action plans. We tried something new, and it didn't work well. Our committees were full of superstar experts, grasstops, and grassroots leaders--all with busy day jobs.

What DID end up happening is that departments across the city government started to take ownership of the plan. Because of this CHIP, the city was able to:

• Call out Life Expectancy gaps as a citywide business plan goal for the first time
• Establish a Mayor's initiative around reducing school discipline inequities and disrupt the school-to-prison pipeline
• Strengthen payday lending reforms
• Shift programmatic efforts in the Parks department to the lowest life expectancy zip codes
• Support the establishment of rental inspection regulations to reduce childhood asthma and increase school attendance
• Start collecting amazing data on social isolation and connections, as well as data on generational wealth and mobility

Public Health as a field has been yelling about the health effects of racism--both structural and interpersonal--for a long time. Sometimes it's felt like yelling into the wind. As I have traveled the country meeting with leaders in Public Health, I find that the most effective teams are those that give grace to each other, speak truth to power in love, and pay attention to the importance of strategic communications and a united public front. When we build new plans, we are always innovating and learning from the beautiful failures of the past plan. But, as we do this, it's important to recognize and respect the foundation we are building on. I'm not sure I've done this enough in my own career, and reading this article made me realize my own shortcomings in this department.

I also realize, looking back, that I was pretty high and mighty on our CHIP. I needed a humility check--a reminder that Kansas City was already about a decade behind in the conversation of race and health vs. our counterparts on the coasts. Now with a little time and distance, I see that this pride may have blinded me and kept the weaknesses of the plan in the dark.

So let's agree as a field to use our words wisely when talking about the work of our predecessors. Public Health already has a reputation problem--it doesn't do anyone any good to dismiss the work that got us where we are at. I know I'm guilty of this, and so I promise to do better too.