The LOOP’s “Health Equity Academy” Series

The LOOP’s “Health Equity Academy” series provides frameworks and tools for partners and stakeholders in commercial tobacco control and beyond the field who want to ground their understanding of this issue from the perspectives of California’s priority populations. Such understanding recognizes the importance of lived experience and local knowledge in identifying and understanding root causes of commercial tobacco use, and developing effective strategies for addressing them.

To date, The LOOP has created several educational materials and learning opportunities in this series that promote deeper thinking and stimulate conversations about structural racism and other related topics that will better inform commercial tobacco control work. With The LOOP’s adaptation of the 21-Day Racial Equity Habit Building Challenge that was shared shortly after the murder of George Floyd and subsequent nationwide protests in 2020, we embarked on a deeper exploration of the inequities that contribute to tobacco-related disparities. In 2021, we created an additional “5-day check-up” activity that was built around Heather McGhee’s recent discussions and writings about “zero-sum” thinking explored in her book, “The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together” (2021). McGhee’s work has inspired us to share a broad range of resources (e.g., podcasts, news stories, articles, etc.) that bring the effects of racism into clearer focus.

Through the Health Equity Academy series, we try to shed light on the interconnections between racialized dynamics in specific domains such as housing and commercial tobacco use and availability of tobacco products We hope this exploration helps build frameworks and sensibilities that broaden considerations of root causes that contribute to tobacco-related disparities, offers insights for more effective policy and tobacco control efforts targeting California’s priority populations, and results in strategies driven by specific community experiences and knowledge. Such exploration is especially important as we move collectively towards The Endgame. We do not want any group left behind.

The LOOP’s Health Equity Academy Series

Case Study: Racial Residential Housing Segregation and

Long-Term Impacts on Outcomes for Communities of Color

“U.S. cities are deeply segregated, often with streets or highways separating higher-income predominantly White neighborhoods from lower-income predominantly Black ones. This is not an accident of history, but rather a geographical modern-day manifestation of age-old institutions such as slavery and Jim Crow segregation.” (Sonali Kolhatkar)

In this edition of our Health Equity Academy Series we are exploring some emerging resources and discussions around racial residential housing segregation, structural racism, and implications for commercial tobacco control. In recent years, many public health efforts have focused on building a “syndemic orientation.” Syndemic theory focuses on the adverse interactions between diseases and social conditions, specifically drawing attention to the mechanisms of these interactions. Identification of syndemic interactions allows for a new way of understanding the involved conditions or issues. Syndemic theory calls for us to integrate cultural, social, economic, and political/ideological factors as we think about how to approach community health issues related to commercial tobacco use and associated disparities. Seeing that commercial tobacco use and tobacco-related disparities are part of a larger structural legacy that amplifies risks and health impacts, especially for priority populations, it is important to consider changes in the broader physical, social, economic, legal and policy realms that influence risk/protective factors and prevention.

In January 2020, the California Tobacco Control Program (CTCP), in collaboration with the California Endgame Advisory Council, hosted a statewide strategic meeting focused on ending the use of commercial tobacco in California. CTCP invited Dr. Yerger to open this groundbreaking meeting with a presentation that would establish the need to apply an equity lens to any endgame-related effort. It was during this talk that Dr. Yerger introduced the Social Progress Index (SPI) . The SPI is a comprehensive measure that assesses and quantifies a society’s capacity to meet the basic human needs of its citizens, establish the building blocks that allow those citizens and their communities to enhance and sustain the quality of their lives, and create the conditions needed for all citizens to reach their full potential. Dr. Yerger’s talk compelled CTCP in just a few months to convene a workgroup composed of several members from the CA Endgame Advisory Council, including Dr. Yerger. These Council members volunteered additional time to explore the use of the SPI to identify and engage with potential non-traditional partners, organizations that currently may not focus on commercial tobacco control, but who are established in communities and providing services to the population groups disproportionately burdened by tobacco. The SPI, for example, found that California ranks 49th out of the 50 U.S. States in the issue area of housing (quality, availability, affordability, precarity, etc.). Work that government agencies, community-based organizations or individuals are doing to secure safe and affordable housing for marginalized groups may not include any effort related to commercial tobacco control; however, these same marginalized groups may likely have disproportionately higher rates of smoking and tobacco-related health diseases than what is seen among the general population. In this example, the SPI clearly presents an important opportunity for a potential partnership between those working in housing and those working in commercial tobacco control.

The SPI workgroup also identified other indices, such as the California Healthy Place Index, to be useful. Hence, the workgroup’s name changed to the “Social Equity Workgroup,” which has identified a number of issue areas or California’s priority populations that intersect with and even go beyond commercial tobacco control. These intersections help us in a more targeted way to further identify and engage with potential non-traditional stakeholders.

While these indices might provide clues to the “what” (e.g., housing), they may be limited in helping answer “why” with specificity, especially for diverse priority populations who have unique experiences that might not match what we suppose is happening on the ground or be the same. We need additional information that helps to clarify the issue and narrow the broad focus of “housing” to something grounded in the histories and experiences of impacted communities. Furthermore, it is important to appreciate that potential partners are likely to have different, and thus competing, priorities when compared to those of us working in commercial tobacco control. Therefore, we must be mindful as to how we engage with potential stakeholders without minimizing their priorities or placing additional burdens on them. We must also remember that the workforce, in general, has been adversely affected by the recent COVID-19 pandemic, resulting in many agencies facing limited resources, both funding and personnel.

There is a growing literature that documents how racial residential housing segregation negatively impacts outcomes (including health, wealth, economic, education, policing, neighborhood safety, trees, liquor store and tobacco outlet densities, etc.) in particular for communities of color and the poor. In October 2021, The Othering & Belonging Institute (UC-Berkeley) unveiled its “Roots of Structural Racism Project,” which includes “the national segregation report. This robust resource contains startling findings about the intensification of racial residential segregation in recent decades; an interactive mapping tool that illustrates the level of segregation in every city, region and neighborhood in the country; a collection of tables which list cities and metropolitan regions by various measures of segregation and political polarization; nine city profiles noteworthy for their levels of segregation or integration; and a literature review featuring dozens of local city histories.” (The report and links to these other components can be found here). The Roots of Structural Racism Project has since released findings identifying the most racially segregated neighborhoods in the greater Bay Area (see article links below in the Readings section). In addition to doing its own analysis of data, The Othering & Belonging Institute is actively compiling local histories of racial residential housing segregation that can help us see impacts as they play out in specific neighborhoods throughout the U.S.

We are excited to explore this resource, as well as others, for insights into the interconnections between racial residential housing segregation at the neighborhood level, the long-term impacts of policies that have perpetuated this type of segregation, the distribution of resources and opportunities in segregated neighborhoods, differential outcomes in wealth accumulation and health outcomes, and where commercial tobacco use fits into this mix. We also hope that this spotlight sparks ideas and conversations about engaging non-traditional community-based organizations, agencies, and other stakeholders that are currently not sitting at the commercial tobacco control tables.

READ:

The Roots of Structural Racism Project (UC-Berkeley’s Othering & Belonging Institute)

*‘Where you live determines everything’: why segregation is growing in the US (The Guardian, 06/28/21)

*Othering & Belonging Institute updates investigation on Bay Area racial segregation (The Daily Californian, 10/19/21)

Where Did All the Black People in Oakland Go? (Darrell Owens, The Discourse Lounge, 09/09/21) Examining the intersection of housing policy and affordability in the East Bay Area, including how development interacts with Black displacement in Oakland.

The History of Gentrification in Berkeley: Part I (Darrell Owens, The Discourse Lounge, 10/25/21) Using Census data from 1940 to 2020 and historical research to tell the history of Black people in Berkeley, California and the origins of zoning, housing and displacement in the city.

Marin segregation worsened in last decade, new UC Berkeley census study finds (Marin Independent Journal, 10/12/21)

Racial residential segregation has gone down in Sacramento, study finds (The Sacramento Bee, 10/14/21)

Extreme Racial Residential Segregation In Oakland Despite Its Diversity (SF Gate, 10/13/21)

Here are the Bay Area’s most segregated, integrated communities (East Bay Times, 10/13/21)

This neighborhood in Marin is the most segregated in the Bay Area (San Francisco Chronicle, 10/07/21)

Sociodemographic inequities in tobacco retailer density: Do neighboring places matter? The researchers concluded that policymakers should prioritize interconnected geographic areas experiencing high racialized and socioeconomic segregation when designing and implementing policies to reduce retail tobacco product availability. Source: Kong, Delamater, Gottfredson, Ribisl, Baggett & Golden (2021).

Heavy trucks are barred from I-580. Is it time to rethink the 70-year-old restriction? Since 1951, an 8.7-mile stretch of road from Grand Avenue to the San Leandro border has been off limits to truckers. First applied to city thoroughfares and later Interstate 580, the ban has funneled truck traffic through Interstate 880, along East Oakland’s industrial and residential flatlands. (Dave DeBolt, The Oaklandside, 12/14/21).

WATCH:

*Video: "The Roots of Structural Racism" Segregation Project Launch Event (6/22/21) (Othering & Belonging Institute, UC-Berkeley)

*Video: White Space, Black Hood: Sheryll Cashin presents her new book on opportunity hoarding and segregation (11/05/21) (Othering & Belonging Institute, UC-Berkeley)

* Local Histories of Segregation, from the Bay Area to Hartford, CT (03/30/22) (Othering & Belonging Institute, UC-Berkeley)

Unnatural Causes: Is Inequality Making Us Sick?

On America’s Residential Caste System—and How to Abolish It

In her new book “White Space, Black Hood,” author Sheryll Cashin makes a compelling case for how segregated U.S. cities are organized as a residential caste system.

LISTEN:

Racist Housing Practices From The 1930s Linked To Hotter Neighborhoods Today (NPR, 01/14/21

“...neighborhoods with higher temperatures were often the same ones subjected to discriminatory, race-based housing practices nearly a century ago… In a study of 108 urban areas nationwide, the formerly redlined neighborhoods of nearly every city studied were hotter than the non-redlined neighborhoods, some by nearly 13 degrees.”

Living Downstream: West Oakland's 'Diesel Death Zone'

Meet the Oakland residents fighting environmental racism in one of the city’s most highly polluted neighborhoods.

Historian Keeanga-Yamahtta Taylor on the Racial Wealth Gap and the Crisis of American Capitalism (KQED, 11/10/21)

"In the United States, it’s very stark that the past is not yet past. Problems that we think of as historical in fact continue to impact our lives on a daily basis."