Abstract

Excerpted From: Tomar Pierson-Brown, It's Not Irony, It's Interest Convergence: A CRT Perspective on Racism as Public Health Crisis Statements, 50 Journal of Law, Medicine & Ethics 693 (Winter 2022) (55 Footnotes) (Full Document)

Starting in 2014, a range of state and local organizations, from public health associations to County Boards of Commissioners to Governor's offices, began to issue declarations addressing racism as a public health crisis. This trend accelerated dramatically during the COVID pandemic, with the adoption of over 200 such statements across the United States, in 2020 alone. Coinciding with the period of racial reckoning in the U.S. which defined the summer of 2020, the trend of adopting racism as a public health crisis statements (RPHCs) mark an interesting moment in the movement for health justice.

Health Justice is a “jurisprudential and legislative framework” for the eradication of health disparities caused by political subordination. This framework calls for the courts and other governing bodies to consider and account for the health consequences of their actions. It also centers engaging and empowering marginalized populations in the development and implementation of health policy. Advocates may see the trend of RPHCs as a discursive win in the movement for health justice, because naming racism is a crucial first step in dismantling the systems which replicate its harms. This conversation is happening, in multiple instances, in ways that reflect a sophisticated understanding of what racism is and how its harms translate into health consequences. For example, the RPHC adopted by the Westerville, OH city council defines racism as:

... a social system with multiple dimensions including individual racism that is internalized or interpersonal, covert racism which is subtle and often socially acceptable, overt racism which is blatant and often unrepentant, and systemic racism which is institutional or structural and is a system of structuring opportunity and assigning value based on the social interpretation of value, which unfairly disadvantages specific individuals and communities, while unfairly giving advantages to other individuals and communities and saps the strength of the whole society through the waste of human resources ...

RPHCs are public acknowledgements of a political reality that legal, medical, and public health scholars have been pointing to for over 20 years. Racism must be targeted as a public health crisis to create a fair and just opportunity for all individuals to be healthy.

While RPHCs correctly name racism as a root cause driving health harms, most have been issued through declarative statements that do not carry any political weight. In response, critics of RPHCs have described them as “menaningless.” The largely symbolic nature of RPHCs situates the vital discourse on health justice in the gridlock between what it takes to identify a problem and what is required to actually solve it. From this perspective, the trend in RPHC adoption can feel frustratingly ironic. Most RPHCs were released by governmental bodies that possess real political power. These groups could have passed legislation, allocated resources, or imposed consequences in order to disrupt the causal chain between the system of subordination based on the construct of racial identities (racism) and access to the social determinants of health (the resources necessary to realize health justice); but they didn't. Their decision, to adopt an RPHC rather than public policy that seeks racial equity, suggests that these bodies may have been more interested in appearing aligned with the aims of health justice than in actually realizing it.

When viewed from a critical race theory (CRT) perspective, the irony of only making a symbolic statement that racism is a public health crisis when there was the capacity to take consequential action, is better understood as interest convergence. Interest convergence hypothesizes that anti-subordination efforts will fail unless they are sufficiently aligned with the interests of dominant power. It suggests that the inability of these limited alignments to realize the end-goals of marginalized groups, reflects a passive intent to maintain the status quo.

This comment argues that the trend in adopting RPHCs carries signs of interest convergence, and asserts that the alliance between government and the movement for health justice reflected in this phenomenon falls short of the substantive anti-racist action needed to realize health justice. Part II provides a deeper definition of interest convergence and identifies the hallmarks of this dynamic. Part III explains that consistent with these characteristics, RPHCs present distinct normative and positive approaches, are attractive for reasons independent of the aims of health justice, and rarely represent the distribution of power. Approaching the trend from this perspective is instructive. Part IV concludes with a discussion of what the movement for health justice can take from the evidence of interest convergence in the adoption of RPHCs. Health justice advocates must utilize CRT and be strategic in determining whether to leverage, or be wary of, the power dynamics which shape political change.

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In many cases, RPHCs present distinct normative and positive approaches, and rarely discuss the need for or the intention to redistribute power. Because there are also attractive reasons for making these statements that differ from the aims of health justice, there is a basis to conclude that interest convergence played a role in this trend. For a window of time, the interests of health justice advocates and certain governmental leaders converged like a Venn diagram; enough overlap for racism to be acknowledged as a public health crisis, but not so much alignment as to institute sustained and substantive anti-racist action.

Finding evidence of interest convergence in the RPHC trend is in no way meant to belittle the efforts of those whose dedicated activism resulted in a local government or public agency's acknowledgement of the health crisis spawned by racism. It is likely that, in a number of cases, those who adopted RPHCs did so in good faith. They were created by leaders who, on some level, recognized that the health consequences of racism pose a problem and who wanted to do something to address it. The outstanding frustration is that if the desire truly was to bring about a new reality, why--in so many cases--wasn't the full range of legislative or executive authority applied to effect that outcome? Why didn't the strategy involve conveying authority or increased resources to people of color? Why not act before the tempest of racial unrest?

Given the evidence that interest convergence has played a role in the trend of adopting RPHCs, there are several lessons that the movement for health justice must take from this moment:

First, interest convergence is a real and consequential political dynamic. Its existence may either be leveraged to advance health justice, or it may be undermining, creating the illusion of anti-racist action while shutting down avenues for sustainable change. The health justice framework must embrace tools that support advocates' capacity to assess for the presence of interest convergence, in order to determine when to harness this dynamic to reach strategic ends, and when to avoid the diluted messaging that can occur when interests only temporarily align.

Second, the health justice framework must be explicit and intentional about which outcomes will count as wins. As activists, we can get so used to the struggle that any public discussion of health and injustice can feel like progress or forward momentum. This does not serve the movement. Resolutions pass easily because they pacify; they seldom disrupt. There is a risk of regression politics if the passage of resolutions is relied upon to suggest racism has (already) been addressed. The politics of incrementalism too often becomes the politics of concession, especially when it comes to matters of racial inequity. Actions in service to health justice must be systems-informed; incorporating mechanisms for accountability, opportunities for iteration, and centering those most adversely effected by racism.

Finally, CRT must be affirmatively embraced as a tool of the health justice framework. Just as the application of Bell's thesis to the passage of RPHCs compels a deeper examination of political incentive and resistance, the tenets of critical race theory offer additional entry points for evaluating and catalyzing progress toward equity. Further scholarship and praxis that draws upon the work of CRT scholars is needed to expand the health justice framework as a call to action; not just for those with legislative and judicial power, but for those seeking to redistribute that power.

The theory of interest convergence lays bare that even passionately sought social justice visions, like those at the heart of the health justice movement, are not universal motivators. Interest convergence may not be the only reason RPHCs were adopted, but as demonstrated in this commentary, it can certainly be counted among the reasons why they were.