United Way of Dane County’s Health Community Solutions Team: Now Is the Time for Change
Gabe Doyle (l) is director of health at United Way of Dane County and Carola Peterson Gaines, longtime community health advocate and member of United Way’s Health Community Solutions Team
By Jonathan Gramling
Who knows when the health racial disparities for African Americans living in Dane County began? Perhaps it was when the first African Americans resided in Madison in the 1800s. And the greater community didn’t notice or didn’t care because the African American community was so small even though it was painfully clear to African Americans. And some of that statistical significance is even lost today.
“Madison, Wisconsin routinely gets high marks for the best place to be born, best place to go to school, best place to grow, best place to be employed and even best place to retire in 2020,” said Gabe Doyle, United Way of Dane County’s director of health. “That’s amazing to me. We beat out Key Largo, Florida, I think. The best place to retire during a pandemic is Madison, Wisconsin. I don’t think the people who ranked it, Money Magazine, understood how winters work. So essentially from cradle to retirement, this is the best community to be born, raise a family and retire in.”
But those numbers disguise the fact that there are two Madisons. Just as Madison’s public schools were called some of the best in the nation due to the high number of National Merit Scholar semi-finalists, while African American students were experiencing a serious achievement gap, African Americans suffer severe health disparities that are disguised by the overall Madison and Dane County health numbers. Madison wasn’t that great if you were a person of color.
Carola Peterson Gaines, a longtime health educator and advocate at Unity Health and member of the Health Community Solutions Team, has seen the disparities upfront and personal for four decades of being in Dane County’s health system.
“I’ve been working for 27 years with Medicaid families, the most marginalized and vulnerable families in our community, 100 percent of federal poverty level,” Gaines said. “That’s core. And then on top of that, you put the issue of racism because of how you look and understand and finally recognize and know that racism within every system affects our health. And if we don’t address those things, we’ll continue this path of thinking Dane County, to a larger extent, is this great place to live, but not for all people.”
United Way’s Health Community Solutions Team began to look at these issues as part of periodic strategic planning effort that each team conducts.
“It was Health’s turn to go do a deep dive, look at all of the research and the literature, get a good understanding of what our community — meaning Dane County broadly speaking in all corners — is trying to say are the priorities and needs as well as the strengths of this community,” Doyle said. “When we went out and set off on that course, similar to every other organization, the pandemic hit and it made it a challenge to truly get out and talk with community members. We have a great team of Community Solution Team members and volunteers who have really strong networks themselves, have a good finger on the pulse of our communities and really understand what the needs of our community are. We also have no shortage of data sets to look over. And we really leaned on the most recent community health needs assessment, which is comprised of all of our major health systems and insurance plans and really does a good job getting out in the community and capturing the community voice. We also lean on the county health rankings report, which is put together by the University of Wisconsin’s Institute of Population Health.”
What the deep-dive revealed or reminded the community of the severe health disparities.
“Our Black, Indigenous, Latinx, Southeastern Asian and other marginalized and oppressed communities aren’t seeing the same type of health outcomes that the rest of the Dane County community is seeing,” Doyle emphasized. “And that is where our Community Solutions Team really dug in. We said, ‘We cannot continue to put Band-Aids on problems or even illuminate things that are working well for the majority if we are going to continue to see these disparities present and consistently showing up across the board. And so we really wanted to create a pathway to improve the conditions, the social and economic environment. And so we are really looking at the systemic and structural change, but also applied at the individual and family level. And so what we really set a course to do is pretty simple, but pretty bold and audacious. And it’s going to take generations to make a difference. We want to reduce or eliminate the racial health disparities that have been persistent and consistent in Dane County.”
It has been declared that racism is a public health problem. And along those lines, the Health CST is taking a broader look at health determinants.
“For generations, Black and Brown, Southeastern Asian, and Indigenous people have had traumas based on their experiences of just existing,” Doyle said. “And that was something that our CST and United Way of Dane County is very interested in supporting. And so our Goal Number Two is very simple. We want to increase the trauma supports around resiliency and trauma for our Black and Brown, Indigenous, Latinx, Southeast Asian and other marginalized and oppressed communities so that the healing can begin. It’s one thing to have all of the resources, but if you are still experiencing symptoms of trauma, it can still be difficult to navigate everyday life.”
While the trauma aspect may be right in front of people, it still remained “hidden” because of how people were raised and educated. Gaines is now “woke.”
“I didn’t learn this in school,” Gaines said. “I didn’t learn any of this in grade school or high school. I may have had about two paragraphs about slavery. I don’t think I even learned about Juneteenth until I got to Madison to be honest with you. And I will say that once I took the healthy families class through Urban Triage, that cohort, I learned a whole lot regarding the dehumanization of women, regarding the actual piece of slavery and the post traumatic slave syndrome that we as Black people still have, that we are still dealing with. That cohort of four months of classes every Tuesday and Thursday really enlightened me along with books we read. And the same thing, The Miseducation of the Negro, they wrote way back when and it is still happening now. We’re still dealing with these same things. It hasn’t changed.”
And so the approach is not just to look narrowly at the illness or condition itself because it may be merely a symptom of a much broader health problem. Doyle used the issue of Black Maternal & Child Health as an example.
“I’ve had the privilege and honor of working alongside Lisa Peyton-Caire on the work of the Dane County Health Council,” Doyle said. “Lisa once said in a meeting — it is something that really sat with me — that it is not the low-income Black babies who are coming out low birth-weight. It is the middle class and upper class Black women who are dealing with hyper-stress from their environments by being the only Black woman in the space, by having micro and macro aggression constantly in their faces, by being somehow not on the same paying field even though you have a Ph.D. as your counterpart. And constantly feeling that they might be fired because they are challenging systems that have oppressed communities for years and years and generations of years. And so we need to stop having these stereotypes that this is a poor Black women’s issue. This is a societal issue. This is a racism issue.”
Gaines echoed and reinforced Doyle’s comments.
“People do think this is just a poor Black issue,” Gaines emphasized. “We know that is not true because Serena Williams, the tennis player, isn’t poor and the doctors weren’t listening to her. I just talked to one of my little babies whom I am mentoring, a master’s student who works for a big corporation and her husband is working on a Ph.D. and just had a baby. She said the system she was in and did her prenatal visits, they had to school them and tell them how they were being treated and had to call them out on it. And the one person they encountered, they said they never wanted to see that person again. This fight has to be through systems to make these changes. They knew what their income level was. They knew that they weren’t Medicaid recipients. If you can imagine that you are being treated that way looking at your skin being Black, someone who feels that they have no power because they are on Medicaid and feel that they are being treated poorly and bad because they are on Medicaid, it is just a vicious cycle that needs to be changed. You have to call out racism. You have to call out the racial oppression system, the health care system that has built been built on white supremacy period.”
To change systems means digging in for the long haul as a community-wide movement begins.
Next issue: Breaking down the silos