We lead explicitly — though not exclusively — with race because racial inequities persist in every system across the country, without exception. We can’t find one example of a system where there are no racial disparities in outcomes: Health, Education, Criminal Justice, Employment, and so on. Baked into the creation and ongoing policies of our government, media, and other institutions — unless otherwise countered — racism operates at individual, institutional, and structural levels and is therefore present in every system we examine.

We also lead with race because when you look within other dimensions of identity — income, gender, sexuality, education, ability, age, citizenship, and geography — there are inequities based on race. Knowing this helps us take a more intersectional approach, while always naming the role that race plays in people’s experiences and outcomes.

Last, we lead with race because inflaming racial tension has been a deliberate political strategy by those seeking to maintain their own power. Through subtle, “dog-whistle” coded references and, more recently again, overt racist statements, wealthy special and corporate interests have successfully divided low-income people of color from low-income Whites, preventing those groups from joining forces to build power. This has been detrimental to the physical, mental, social, and economic health of people of all races, including Whites and must be countered if we are to advance equity.

Advancing health equity requires addressing all areas of marginalization and understanding the interconnected nature of oppression. However, there is benefit to starting with race as we can harness tools, frameworks, and resources to address these inequities. As noted by our GARE colleagues, “As local and regional government deepens its ability to eliminate racial inequity, it will be better equipped to transform systems and institutions impacting other marginalized groups.”

Examples of Health Departments Leading with Race
  • The Boston Public Health Commission (MA) developed an Anti-Racism Advisory Committee, is requiring all staff to participate in racial justice and health equity training, and is creating accountability mechanisms to ensure that their workforce reflects the city’s population.
  • Cuyahoga County (OH) commissioned a report to examine how institutional racism in housing policy 60 years ago shaped neighborhood opportunities and health outcomes along racial lines today. They are also creating an Eliminating Structural Racism Subcommittee in their Community Health Improvement Plan consortium.
  • Public Health Madison & Dane County (WI) worked to build internal and external collective understanding and capacity to address racial equity which has resulted in the creation of an internal health and racial equity team; a strategic plan with explicit equity goals; and application of racial equity analyses to Madison programs, policies, and plans.
  • New York City launched their Race to Justice initiative which is building staff skills to address racism, implementing policies to lessen the impact of structural oppression, and strengthening collaborations with communities across the city.
  • Santa Clara County is developing internal infrastructure to advance racial and health equity by hiring dedicated staff to lead department-wide efforts, developing a training program for its public health workforce, and pilot testing the application of racial equity tools.

View other case studies of health departments working to advance racial and health equity.

Key Resources for Leading with Race

View other helpful resources to advance racial and health equity

Not everything that is faced can be changed.
But nothing can be changed until it is faced.

James Baldwin

Go to Defining Health Equity

Last Updated: June 13, 2023