See Change: Overcoming Anti-Black Racism in Health Systems

Abstract

Anti-Black racism embedded in contemporary health systems harms Black and Indigenous People of Color (BIPoC) in concert with various diseases. Seemingly unrelated at first, the COVID-19 pandemic is a recent example that reveals how the combined manifestations of anti-Black racism in disease governance, course, and burden exacerbate the historic and still present subjugation of Black people. Thus, such conditions highlight a biosocial network that intricately propagates and consolidates systems of oppression since the birth of the United States of America. In this article, we show how anti-Black racism in conjunction with past and ongoing epidemics exemplify intertwined conditions embodying and perpetuating racial inequities in the North American country. Through schematic visualizations and techniques of progressive disclosure, we situate disease governance, course, and burden as action spaces within a design model that alternates views of organizational strategies, operations, offerings, and people's experiences, supporting an action-oriented discussion in each of these spaces. We utilize insights from this analysis to recommend that public health moves forward, considering more holistic, solution-oriented questions that embrace systemic complexity and people-centered perspectives when seeking to improve health outcomes for all.

Keywords: COVID-19; anti-Black racism; design; health systems; inequity; pandemics.

Figure 1

Health-related organizations became the primary agents governing diseases, influencing their courses through medical offerings that respond to specific medical issues and condition how individuals experience their burden. In this diagram, health-related organizations are represented by a triangle divided by strategies (why), operations (how), and offerings (what). The exchange of value is represented by the arrows and related labels. Individuals (who) are represented by a human figure.

Figure 2

Primarily designed and led by white individuals, health organizations create strategies and operations that respond to why and how they envision value being created to combat diseases.

Figure 3

Health organizations create systems of offerings based on the information available to them. Because they lack proper documentation on diseases endured by Black populations, they transfer racial bias into medical offerings that shape the experiences and health outcomes of Black populations.

Figure 4

The diagram above illustrates how critical aspirations of Black individuals, including those related to their freedom, safety, and economic security, become conditioned by health systems that carry racist affordances in disease governance and courses.

Figure 5

The diagram above shows critical questions that designers ask to understand people's experiences and related frameworks they use to organize information gathered during research. For example, POEMS, an acronym for people, objects, environments, messages, and services that compose systems of offerings, and User Terrains, that helps organizations understand their users in the context of their aspirations, rather than solely socio-economic and demographic standards.