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Posts tagged as “racial disparity”

Health report card: Durham gains ground, big gaps remain

A new State of the County Health Report is out and the message is clear. Durham is making progress on some major health priorities. But more work is needed.

Racial and ethnic disparities remain a systemic problem, this year’s Partnership for a Healthy Durham report stresses. “Racism is a public health crisis,” it reads, echoing recent statements by local elected officials. 

For one, Black babies here are more likely to die during their first year of life than white babies. From 2014 to 2018, Black infants died at three and a half times the rate that white infants died in Durham County. In addition, life expectancy among Black county residents was 5.3 years shorter than among white residents during 2016 to 2018, according to the report.

While the 2019-focused report doesn’t address the new coronavirus, recent data makes clear that Black and Latinx people living in Durham County are hardest hit by the pandemic. Where people work, construction projects, nursing homes and jails included, explains some of the risk. 

“Racial equity is being embedded in all the activities that we’re involved with,” said Angel Romero Ruiz, coordinator for a local community health program and co-chair of the Partnership for a Healthy Durham.

Three years ago, residents of Durham County ranked their top five health-related priorities, including affordable housing, access to healthcare and health insurance; poverty, mental health,  and links between obesity, diabetes and food access. 

The partnership, a group of 200 active members and dozens of organizations, this year predominantly addresses three of those priorities. Here’s a summary of the latest major findings: 

Expand affordable housing

Source: State of the County Health Report

Between 2010 and 2019, the median sale price for homes in Durham rose by more than 50%, the report notes. Median gross rent rose 27% from 2010 to 2018, from $798 to $1013.

“Durham is gentrifying, so housing that used to be affordable is starting to be unaffordable,” said Romero Ruiz. 

A large proportion of Black and Latinx residents are renters. Only 29% of Black residents and 33% of Latinx residents own their homes, compared to 64% of white, 49% of Native American and 44% of Asian households, according to the report. 

This disparity leaves Black and Latinx renters especially vulnerable to rising house prices. Consequently, Black and Latinx households have less to spend less on food, healthcare and other necessities.

“Housing and health is totally related. You know, depending on what neighborhood you live in, you’re probably more likely to have better or worse outcomes,” said Romero Ruiz.

Progress in 2019

Durham County voters approved a $95 million housing bond last fall. Paired with $65 million in federal and local funding, the bond money will help redevelop public housing properties in downtown Durham over the next five years. The money will also help finance permanent housing for people who are homeless, fund down payments for first-time home buyers with low incomes and assist people in danger of being evicted.

Durham City Council approved Expanded Housing Choices, an ordinance that permits higher density building in neighborhoods near downtown.

Durham County created a coordinated entry program for people who are homeless in October 2019. Anyone who needs shelter must first report to Durham County Department of Social Services for a coordinated entry and diversion intake. This creates one point of entry for shelter and housing resources.

Challenges

Durham was reminded that health and housing are connected in a big way this year. Nearly 900 people living in McDougald Terrace were evacuated from their homes after carbon monoxide leaks were detected in some apartments. Inspectors found stoves, furnaces and water heaters leaking hazardous gas at the public housing complex.

Conditions at McDougald are also a reminder of the long-lasting impact of racial segregation and economic discrimination. McDougald was built in 1954 for Black tenants in what has traditionally been a Black neighborhood at a time when Durham was still racially segregated.

Local officials have big plans to upgrade many public housing properties here, but not McDougald. That’s because it’s located outside the city’s growing downtown, officials say, where investors are less likely to risk their money.

There are multiple ways that long-ago racial discrimination affects the health of Durham residents today, said Jannah Bierens, a health equity consultant and co-chair of the Partnership for a Healthy Durham.

“Just because laws change, that doesn’t mean that people change or that the practices change. So it takes an internalized transformation as well,” she said.

Increase access to care

The proportion of uninsured residents in Durham has decreased from 15% in 2015 to 12.2% in 2018. But among that 12.2%, who remains without coverage? Most are Latinx residents, who cite immigration status as the most common barrier to receiving health insurance.

In 2018, 40% of Latinx residents were uninsured along with 11% of Black residents, according to the report. Durham has a small Native American population, totalling 726 at the last count; 19% of these residents are uninsured. In comparison, the percentage of white and Asian residents uninsured was 6% and 7% respectively. 

To increase access to care and address racial and ethnic disparities, Partnership for a Healthy Durham has outlined two main goals for 2018-2021: increase knowledge about healthcare resources, such as Lincoln Community Health Center, and increase access to culturally appropriate care. That includes patient care teams trained in racial equity. 

Progress in 2019

The partnership recently received a grant from Duke University to place more bilingual community health workers with organizations such as Project Access of Durham County and El Centro Hispano, according to Romero Ruiz. These health workers help both insured and uninsured members of the Latinx community navigate the resources available to them, said Romero Ruiz. 

For the first time since 2015, the partnership updated its Medical Care Options in Durham brochure, which provides uninsured or underinsured residents a long list of resources, including the Lincoln Community Health Center’s new satellite clinics. The new brochure also includes updated information on how to apply for Medicaid.

Alliance Health, a behavioral health organization, continued to focus on evidence-based care in 2019 for Durham County residents who are uninsured or insured by Medicaid, according to the report. Its staff has expanded efforts to respond to severe mental illness, substance use disorders and long-term needs, according to the report. 

Challenges

Employment and access to care through insurance coverage go hand-in-hand. According to the report, residents ranked lack of employer based plans and unemployment as their second and third barriers to health insurance. The report partially blames workforce discrimination for inequities in access to care.

Linking obesity, diabetes and food access

Source: State of the County Health Report

In 2018, 70.4% of adults in Durham and several nearby countries were overweight or obese, according to the report. Additionally, one in 10 people skipped a meal or cut the size of a meal because they didn’t have enough money to buy food. 

Limited access to healthy food, contributes to obesity, among other health problems like heart disease, diabetes and chronic kidney disease. Additionally, income, employment, race, ethnicity and disability may be factors in residents’ ability to get healthy food options, according to the report. 

Black and Latinx residents are disproportionately affected here too. According to the report, 14.9% of Black residents skipped or cut a meal sometimes or frequently in the past year, compared to 12.6% of Latinx residents and 6.6% of white residents. 

Bierens said that Black and Latinx residents don’t always have access to healthy food. 

“Black and brown neighborhoods are heavily saturated with fast food restaurants and alcohol and tobacco. Those things are also coping mechanisms, so there’s so many interrelated layers,” she said.

Progress in 2019

The City of Durham, Sustainable Duke, Feed My Sheep of Durham, TROSA, Duke Pratt School of Engineering, Sarah Duke Gardens, Duke Farm, Inter-faith Food Shuttle and Healthy Duke created the Bull City Community Garden, a new addition to the local food scene.

The partnership also collaborated with Durham Public Schools to expand more nutritional choices in school meals. It created a document discussing health and nutrition for parents. And it improved Durham’s Healthy Mile Trails,

Challenges

The link between obesity, diabetes and food access is not as simple as many think, according to Bierens. Stress and lack of sleep are commonly overlooked factors that induce higher cortisol levels and a rise in body fat, said Bierens.

Teaching people to eat healthy diets without discussing effects from stress and lack of sleep is not enough, Bierens said.

It’s vital to understand the racial dimension of these community health problems, she said. For that reason, the partnership has a Racial Equity Task Force, whose members will include Durham residents grappling with these problems.

Looking forward

One priority from the 2017 survey was reducing poverty. According to the 2019 report, poverty is decreasing in Durham. But this positive news comes with a caveat.

While the percentage of Durham residents living in poverty decreased from 20% in 2010 to 15.8% in 2018, the actual number of people in this category has increased by 64% since 2000. In 2018, 46,805 people had incomes below the poverty level compared to 28,557 in 2000, according to the report. 

The decrease in the percentage of people living in poverty is likely explained by an increase in the the number of higher-income households moving to Durham.

The partnership, like so many institutions locally and nationally, will focus more than ever on the racial and ethnic dimensions to health disparities in Durham. “We just started adding the ‘why’ and talking about inequities,” Bierens said.

At top: People angry over dangerous conditions at McDougald Terrace public housing protested outside City Council chambers last winter. Access to affordable housing is one of five issues that Durham residents have rated as priority needs. Photo by Bella Hutchins

Correction: This article was modified to correct Jannah Bierens’s work title. 

The barbershop: A space for honest conversation about bias in Durham schools

When Jermaine Porter wanted to better understand the experience of boys of color in Durham Public Schools, he asked them.

Not in just any setting, but in barbershop chairs. “In our community, in barbershops you just talk about anything you want,” he said. 

Porter is the boys of color initiative coordinator for Durham Public Schools, a job focused on building support systems for students who don’t always feel bolstered at school.

With Daniel Bullock, executive director for equity affairs, Porter invited administrators, male students and parents to speak their minds at three public events this year. At each, panel members sat in black leather barbershop chairs while answering questions.

Listening to students’ honest words wasn’t always easy. “I walk around with a target on my back,” Donte Alexander, now a high school junior, said at a session in April.

Yet even that tough news was helpful. “We gave students the floor and listened to them, listened to their perspective, listened to the advice they gave for how to improve outcomes for boys of color,” Bullock said. 

What Porter and others learned helped shape training on implicit bias for principals and assistant principals this year. It also spawned a leadership program for middle and high school students.  

Jermaine Porter, boys of color initiative coordinator for Durham Public Schools, stands in front of students Ronald Hernandez Solarzano and Donte Alexander. Photo by Truitt Avery O’Neal for Durham Public Schools Office of Public Affairs

Getting started 

Porter and Bullock launched Barbershop Talk Series: Building Systems to Support Boys of Color in February. The first session featured school administrators. In April five high school students took the stage. In October, parents spoke.

This was one response to the 2018–2023 Durham Public Schools strategic plan, which includes a call for more programming to help address disparities experienced by students of color. In 2016–2017, for instance, the suspension rate for all students was 8.44%. However, 17.18% of black males were suspended and 6.14% of Hispanic males, according to the district.

At first, Porter and his team were unsure how many people would attend an optional Tuesday night talk. But when they opened the doors for the first session at the Holton Career and Resource Center, over 200 people filled the audience.  

For the second event, principals nominated students from various schools. Porter ensured that boys with varying degrees of academic success joined the panel to better understand a range of experiences.

As a former basketball coach, teacher and school administrator, Porter said he’s concluded that relationships are at the heart of a student’s success. 

“If a student is sleeping on the floor with no electricity, they do not care what x equals. But you wouldn’t know that if you had not built the relationship with the student,” he said. 

Students speak 

Michael Graham, a senior last spring, said misjudgment from teachers was something he struggled with throughout his years attending Durham schools. He was once escorted out of class because a teacher falsely assumed he had drugs on him, he said.  

“The teacher only thought that about me because of my skin color or how because of the way I chose to act or because the vernacular that I choose to use,” he said. 

David Madzivanyika, also a senior, said he’d endured flawed flash judgment too. “Why should a teacher be surprised when a boy of color is doing well in their class when we are in the class every day, and we are learning the same material?” asked Madzivanyika, who enrolled at Harvard University this fall.

Daniel Bullock, executive director for equity affairs, (standing) and Durham Public Schools superintendent Pascal Mubenga (seated) with students and Porter after the April event. Photo by Truitt Avery O’Neal for Durham Public Schools Office of Public Affairs

Negative assumptions about academic promise are too common, Graham said. “In a public school system where it can be predominantly white, you can’t just be smart. Even if you were smarter than those who aren’t your skin color, ‘Oh he’s cheating’,” Graham said. 

But some teachers do build bonds, the young men said. Alexander recalled the first time a teacher connected with him in seventh grade. He did it by drawing analogies between classwork and something they had in common – playing Madden NFL on a PlayStation. 

When Bullock and Porter developed training on implicit bias for principals and assistant principals this summer, they included videos from the Barbershop Talk events.  

The series also sparked a new program called We Are Kings. Middle and high school participants have access to additional academic resources like field trips, guest speakers and college tours. Bullock and Porter are brainstorming how to expand opportunities for more students. 

They may host another series too, though which format they’ll select is not yet clear. 

We have the potential for even more people to be involved, and attend and to expand the conversation,” Bullock said.

At top: Students Michael Graham, Ronald Hernandez Solarzano, David Madzivanyik and Donte Alexander (left to right) at the Barbershop Talk Series event in April. Photo by Truitt Avery O’Neal for Durham Public Schools Office of Public Affairs