Vernellia R. Randall and Glen Safford
Vernellia R. Randall and Glen Safford, Public Health Preparedness and the Law in Communities of Color, 31 Journal of Law, Medicine & Ethics 45 (Winter, 2003).
Vernellia R. Randall
Public health preparedness must use a comprehensive approach that includes both communities and public health systems. There are three basic questions that should be asked when evaluating public health preparedness in communities of color: 1) Is the community basically healthy?; 2) Does the community have access to necessary information, resources and services?; and 3) Are the information, resources and services available and provided to the community in a nondiscriminatory manner?
Racial-based health disparities is a well documented fact for many communities of color. Individuals from these communities tend to have more morbidity and higher mortality. This health disparity is race based and not just a function of social class. Similarly, access to basic goods and health care is racialized and class based. For instance, 50% of non-white women have financial difficulty in obtaining food and more blacks than whites are in temporary and emergency shelters. Similarly access to health care resources is also impacted by race. For instance, more blacks than whites are without adequate health insurance. Most hospital and physicians offices are outside minority communities. In fact, since the 1960's as many as 70% of hospital closures are in minority communities. Finally, access to first responders is affected by race. While access is generally inequitable, it is further handicapped by lack of trust between first responders. This lack of trust is often caused by instances of racial profiling.
The bottom line is that institutional racism in basic goods, in health care, and in first responders impacts the ability of communities of color to be adequately prepared for a public health emergency. Institutional racism is a system of procedures, practices, and patterns that perpetuate and maintain the power, and influence the well-being of one group over another. A comprehensive public health law approach to preparedness would eliminate health disparities, increase health care utilization, ensure quality health care, enhance data collection in minority communities, eliminate discrimination, and increase first response effectiveness.
Tribal sovereignty is based on the concept of nationhood. The Indian Self-Determination Act recognized that American Indian people needed to develop leadership skills crucial to the realization of self-governance, and a voice in the planning and implementation of programs.
Tribal health care systems are operated by tribes, under contract with federal and state governments and private entities. Staff must answer to tribal councils and health boards as well as the Great Lakes Boards. The level of collaboration varies, but most tribal health care systems report communicable diseases and collaborate during outbreak investigations and prophylaxis. Tribal health care systems also receive and use free vaccines from the state and other programs.
The Great Lakes Inter-Tribal Counsel's (GLITC) mission is to expand self-determination efforts, with deep respect for tribal sovereignty and reservation community values. There are three levels and functions to the system: provide technical assistance and support; provide input, ideas, and model procedures; and provide assistance with policy and planning approval with tribes. GLITC does not do anything the tribes want to *46 reserve for themselves. True community public health is provided through a mixture of professional and consumer perspectives, with bottom-up strategic planning, with an emphasis on prevention and education, and using a broad definition of health care.
Many lessons have been learned through working with tribal communities. For example, it is important to stress tribal sovereignty. To work together, strong and innovative systems, model approaches, and strong technical capabilities are essential. In addition, it is critical to develop informed, trusting relationships, and broaden mutually beneficial alliances. Most importantly, when working with tribal communities, partners need to have open attitudes, and learn from each other.