Engaging Health Equity

For relevant background for this blog post – check out previous posts. 

See conversation (Blog 6) in the playlist above.
0-15 minutes: What is the book? How do I use it?
15-35 minutes: How did the book come to be? What is the story behind the title & illustrations? Next steps.

Resources

• Embrace Race
  EmbraceRace’s Addressing Racism with Children (written by Dr. Kimberly Narain) resource guide (including Louise Derman-Sparks handout about critical consumption)
• Conversation with Dr. Kimberly Narain and Michael Lawrence-Riddell
• Cycle of a Dream Book Reviews
• Interview with Dr. Kimberly Narain (Feminist Magazine)
• We The People – Netflix series for kids (democracy, advocacy, social justice)
• The Sum of Us, Heather McGhee
• 1619 Project – articles/podcasts – NYTimes (traces origin of policy & issues related to structural racism)
• Wee the People – Boston-based social justice project for children ages 4-12
• Undesign The Redline (public exhibitions, actions, conversations about Redlining)
• CASEL (Collaborative for Academic and Social Emotional Learning) – SEL and equity

Zoom Auto-Transcribed Transcript

00:00:04 – 00:01:39

Lindsay Rosenfeld: Hello, this is Lindsay Rosenfeld. Welcome again to my blog Engaging Health Equity on the Harvard Public Health Review. Please check out all the blogs at https://bcphr.org/fellow-lindsay-rosenfeld You can read or listen to each blog there check out the many accompanying resources as well. I’m very pleased to welcome today my colleague and friend, Dr Kimberly Cauley Narain to discuss her important book for kids about structural racism, called the Cycle of a Dream, A Kid’s Introduction to Structural Racism in America, published in 2020 to purchase the book and explore other details, please check out the books website at cycleofadream.com. Motivated by her own battle with chronic disease, Dr Cauley Narain, has devoted her career to ensuring everyone has the opportunity to be healthy. She’s a wife mother internal medicine physician and researcher based at UCLA and the University of southern California focused on improving the health of underserved and under resourced populations. The Cycle of a Dream grew out of her desire to provide our own children with the template to understand how discrimination functions on multiple levels to create advantages for some and disadvantages for others. She hopes that this information will enable them to recognize the way that they and others are privileged and empower them to fight to create a more socially just world so Kim welcome today we’re so happy for you to be here.

00:01:39 – 00:01:47

Kimberly Narain: Thank you so much for having me I’m so honored to have received the invitation and and to have the opportunity to share with you more about this book.

00:01:48 – 00:02:17

Lindsay Rosenfeld: Absolutely, I think folks listening will find a lot to help them think more about or think about health equity and structural racism and how those things are related and how important it is to get kids in on the conversation. So, let’s start by talking about this amazing book for kids and talking about why it matters. So why do you think it’s important to begin a conversation about structural racism with kids at an early age?

00:02:18 – 00:04:15

Kimberly Narain: Yeah unbeknownst to me kids are already thinking about racial hierarchy as early as seven years of age. Kids can match what groups racial or ethnic belong to which stereotypes, with about 70% accuracy so they’re already you know, trying to make sense of what they’re seeing out in the world. You know the other important thing is that’s an age that seven to eight age where they’re really focused on who’s in their in group and who’s in their out group. But you know some positive things about that age is they are really sort of at the top of their capacity for empathy. And they can really you know get in and experience what it’s like to be in somebody else’s shoes and think about that and process that and that you know, actually tends to dissipate the older that kids get so I think it’s really an important opportunity to get in and sort of correct any misconceptions that they may have. Because they are tending to go with the path of least resistance in the absence of informed explanations, so why do I not see a specific racial ethnic group represented in my neighborhood? Why do I not see them in my school, why do I only see certain groups over represented in certain professions like you know the medical profession? And the easiest conclusion is somehow these other groups just aren’t good enough. They just couldn’t cut it, for whatever reason, so I think it’s really a great opportunity to get in and have some of those informed discussions about an issue that they’re already thinking about.

00:04:15 –> 00:04:30

Lindsay Rosenfeld: Absolutely, so can you demystify or clarify for us the term structural racism, a bit more, you know talk about what it is exactly and why it matters generally and then maybe specifically why it matters for health and health equity?

00:04:31 –> 00: 06:53

Kimberly Narain: Right, so when I’m saying structural racism I’m really thinking about the laws policies and practices that really predict access to advantages and disadvantages along racial lines so I’m thinking specifically about access to control of Labor. I’m thinking about access to material resources so who gets into what neighborhoods who has access to high quality schools I’m also thinking about symbolic social good like who has access to democracy, who has access to justice, and I think it’s really important to focus on. Structural racism, as opposed to some of the things that are more commonly focused on like interpersonal racism because it’s the most difficult to detect but yet it’s the most impactful in terms of who has opportunities to really advance and achieve the American dream and it’s also you know structural racism that really lays the foundation, you know for interpersonal racism to thrive. So I think by addressing that, that really sort of the way that you get at these differences in these circumstances across the board and why it matters specifically for health is because the structural racism really defined sort of the socio economic context that you see a lot of racial ethnic minorities and particularly. Black individuals and studies have shown that more than 50% of health outcomes are you know determined by socio economic status as opposed to something like what I’ve spent a lot of my time doing healthcare, anywhere from 10 to you know 20%. The bang for your buck is thinking about these broader contextual factors. In terms of improving you know health outcomes and you know it’s really incumbent on us to bring this issue to light, because it’s something that’s there bubbling under the surface powerful. But because it can operate without any individual action at this point is the thing that’s hardest to change.

00:06:53 –> 00:08:12

Lindsay Rosenfeld: Certainly, and as we’ve talked about before in other conversations right that that like 60 plus percent that’s on social and other factors. You know the fact that health policy is transportation policy health policy is education policy health policy is neighborhood policy and on and on and on and the ways in which that kind of racism is baked into institutions and into processes right and equity being a process, as well as an outcome. Right, and so this is part of thinking about not just, equitable outcomes that we’re hearing so much more about which all of us in health and public health focus on. I’m really happy to hear more of the public conversation, but also about that whole process, right and the ways that structural racism creates the differential access to opportunity in there for health outcomes and really that idea right the social determinants of health, that social factors impact health and if we have different opportunity to those social factors and those social influences and those opportunities and experiences, that that’s really going to also follow along on our health outcomes and other outcomes.

00:08:12 –> 00:08:13

Kimberly Narain: I could not agree with you more.

00:08:14 –> 00:09:00

Lindsay Rosenfeld: And that’s one of the reasons that this book is so exciting to me, is because it’s really giving us the opportunity to talk about this with kids and also to make sure that we as adults, parents, educators, you know other professionals that may interact with kids or just with our own kids, the neighborhood kids or the grandkids or the nieces and nephews or whatever it may be, right. And so it would be great to talk a little bit about some advice that you might give people about how they can become better informed about structural racism and how they can in turn help kids whether it’s in one of those roles: community member, parent, educator, clergy, become more familiar with how structural racism operates, and what kids can do about it, what we all can do about it.

00:09:00 –> 00:012:43

Kimberly Narain: And the nice thing about the time that we’re in is there’s just been this proliferation of resources that are extremely accessible; it’s information that I didn’t have access to you until I was deep into my training that’s at the fingertips now for some individuals, so a couple of resources that I’ll give that I really think are useful and accessible, one is the 1619 projectsso that was put out through Nicole Hannah Jones in conjunction with the New York Times, and that six short podcast, 4 minutes to an hour so you can do it  on your drive and it really sort of traces the origin of a lot of these policies and links them to a lot of the circumstances that we see currently. She’s got a section on democracy, she’s got a podcast specifically dealing with health care so she really just takes these topics and makes them really accessible. Another book that I will recommend is a Heather McGee’s The Sum of Us, What Racism Costs All of Us and How We Can Prosper Together. I think this is really a nice resource, because not only does it sort of recount some of the same laws policies and practices, she does a little bit of a different framing in that she looks at the ways in which these laws, policies, and practices really compromise the quality of life for all Americans. So why is it that we don’t have investments in the safety net, why don’t we have a more equitable distribution of income, why can’t we sort of develop a public health consciousness and she sort of ties, all this back to these racist ideas and really shows what she refers to as the solidarity dividend, so for what is the gain for us, kind of dispensing with these false ideas of racial hierarchy and really pursuing a road that’s more equitable and just for us all. Another, is a handout that comes from Louise Sterling Sparks where she actually really lays out how to recognize bias, promoting storylines. So how do you recognize others, how do you recognize tokenism, and I think her framework is a great way to sort of critique your media that you’re exposing your kids to, so to ensure that they’re not passively ingesting some of these racist concepts, but the other reason I think they found it helpful is because you can teach your child to be a more critical consumer, so not only moving those sort of storylines away from them, but you know exposing them to these various storylines, allowing them to critique it so they build up that critical analytical muscle and they see these things they won’t absorb, passive things about themselves or anybody else.

00:12:43 –> 00:14:18

Lindsay Rosenfeld: Indeed, indeed I’m going through my head, so many times that I’ve paused, right. We can pause anything at any time and say, wait a second, what’s going on here? Let’s talk about this. Let’s problematize it. Let’s ask questions. Let’s see what they’re thinking about this thing I’m observing, right. And it’s great to hear about these resources that can really be helpful, folks don’t feel like they have a base, or door to learn more about what would be those kinds of things that I want to see, and then it begins to be a frame, and to be the way you filter and look at things.And another one that I’ve just started with my kids, I have two nine-year-olds, as you know.  There’s a new series on Netflix called “We The People”. And it’s all music and graphic and all these really wonderful visual images and very accessible, but also about democracy, about voting about advocacy, about all of these things. And, and then also, we’re going to post all of these resources, you mentioned on the on the blog site, also Embrace Race has a really nice piece that you’ve worked with to help think through these issues for educators and also parents and community members, so thank you so much. Anything else you want to add about the book and why it matters and why it could be a good tool, or perhaps in some of the settings it could be a good tool.

00:14:18 –> 00:15:20

Kimberly Narain: Yeah I think it’s really something about sort of preserving the empathy that kids innately have and not allowing that to be sort of washed away with what they see through the media, instead of allowing them to tap into that, and what I hope is that children walk away having been exposed to this book understanding that there’s really nothing natural about the status quo of racial relations, really that kind of the state that we find ourselves in today is the consequence of a series of choices that we’ve made as a society and the fact that we can make different choices and we can make a brighter future, not only for them, but for everyone.

00:15:20 –> 00:15:59

Lindsay Rosenfeld: Indeed, indeed we’ve constructed it one way and we can construct it a different way. Not an easy task, but really be talking about the ways in which we can and as you’ve just described, there are many of them. So now, I wanted to turn in sort of this bonus section, shall we say, a little bit more about you and why you decided to write the book and what it’s been like, the process of writing it seeing it out in the world. You have a very busy personal and professional life with lots of commitments in this area of work, you haven’t written a children’s book before, so what spurred your desire to write this book?

00:15:59 –> 00:19:13

Kimberly Narain: Really kind of feeling lost. And not feeling comfortable with everything that was happening, last summer between Ahmaud Arbery, Breonna Taylor, and George Floyd. I just felt like I couldn’t really justify not having these conversations with my seven year old daughter, because there was really no way to get away from it, it was in the media, it was on the streets and I almost felt like it would be negligence, as a parent not to start to try to broach these issues, but really not knowing how to do it, because in my professional life I’m very focused on the way this broader structural context impacts behaviors and health. I knew I did not want to make it a conversation, you know, specifically thinking of the situation with George Floyd where I talked about bad apples, doing bad things. Because I knew it was so much broader than that and I started wondering with this structural way of thinking about things be useful for my daughter’s understanding of that particular event but also provide her a framework for thinking about events or additional instances of injustice that she might encounter in the future and that’s when I really started to do my research, that’s when my research comes into play to figure out, was there any evidence that would suggest that approach, like would this be beneficial for somebody that young. Could they cognitively take advantage of that, that sort of framing and then at the same time, would it not have negative effects right, because this was a way of thinking that I started to get exposed to it, so it was very powerful, for me, but I was at a totally different stage of development. And I was worried about the potential for sapping her agency, damaging her self-esteem, hurting the potential for her to have cross racial friendships. So, it was my desire to see what was known in the field and to my surprise, developmental psychologists have been thinking about this for years. I know in already suggesting that kids be exposed to this more comprehensive understanding of the way different groups interact and what that means for how we see each other, so once I found that and I got comfortable with that, then I was able to say Okay, this is something of value, and this is something that it’s worth committing my time to despite my busy schedule, it’s more important.

00:19:13 –> 00:19:51

Lindsay Rosenfeld: Indeed and I’m so glad you did as a parent, as a public health professional, as a person, you know who lives in this world, and especially the United States. I am so appreciative of this book. And I often think about for you – what was the hardest part of doing it and the most joyful part, because this, this is a big thing to take on to try. It would be hard in a 300 page book, for an adult audience, let alone for kids so what did you find was hardest and what did you find was most joyful?

00:19:51 –> 00:22:36

Kimberly Narain: The hardest part for me was definitely this decision to do it in the first place, like this feeling that I may be shattering some sort of innocence that my daughter had, joy that she had in the world, but I came down on the side of, I would rather her, she’s going to inevitably encounter aspects of structural racism. I would rather her encounter that in a place of support and security and safety, so she would not be shattered when she encountered it in the broader environment. I can say I’ve really been heartened about the responses across racial group to the book. I did not know how that would be perceived, but I would say some of the people that wrote, some of my most supportive reviews have been parents of friends of my daughter across the spectrum, and not only they’ve shared it with parents, and they’ve read it themselves, and said oh how I wish I had something like this, so that has been really, really heartening, because I did not know what to expect or how we will be perceived. I don’t live in a majority minority community, so I did not know if this would be something that would make us ostracized or make us stand out. People have been extremely supportive and hey at the end of the day, if I have helped improve understanding for the kids on my street or their parents, I feel like I’ve done something and it’s all been worth it. What I can say, what I did not necessarily expect and it’s not a response to this book, per se, but a response to this whole type of trying to provide a more comprehensive overview of race relations is the push back at the societal and at the government level. I did not expect certainly children’s education to become ground zero for the next political fight. All of a sudden, I found myself in a context, before I published this book, in light of the executive order banning anything perceived to be like critical race theory, all of a sudden, making contraband material. That was really, really surprising and…

00:22:36 –> 00:22:37

Lindsay Rosenfeld: unexpected.

00:22:37 –> 00:22:39

Kimberly Narain: yeah unexpected; that was extremely surprising.

00:22:47 –> 00:22:58

Lindsay Rosenfeld: And in thinking about getting this out there, how did you decide on the title the illustrations, what you would include, what you wouldn’t include.

00:22:59 –> 00:24:39

Kimberly Narain: So, in terms of the title, one of the things that I was really trying to do with the book is, I did not want this to be separate from what they were learning as second graders. I spent a lot of time looking at second grade curriculum, looking at how civil rights issues were covered. Looking at how slavery was covered, and I remember distinctly coming away from a section talking about Martin Luther King thinking, this makes me feel like this struggle is over. Like this is very much not over, particularly in light of the events that we had talked about, instead of being over, it seemed much more like a series of repeating events that would bring us back to the beginning, which is more descriptive of a cycle so my thought was in order to ever break the cycle, we need to understand, not just that Martin Luther King had a dream, but why it was necessary for him to have a dream and what happened after he gave that dream speech so that’s really kind of what’s at play. On deciding what to include I knew I really want it to be about specific issues, right, because you can’t go into the nuances of everything, that would be a 300 page volume. But nobody would read it.

00:24:39–> 00:24:40

Lindsay Rosenfeld: Right right.

00:24:40 –> 00:28:22

Kimberly Narain: So I knew I really needed to pinpoint, and this is where I say probably my research that came in a little bit, like what does the evidence show has the most sort of important impact on the circumstances that we find ourselves in today, you know so one thing, for example, I’ll say, I get from Dr David Williams, who I know you’re very familiar with, he calls, segregation, the secret sauce of structural racism, so I knew I needed to deal with that pretty extensively, you know, and then in terms of that I thought it was very important for me to not only focus on those high impact things but to draw the line between those things, and how they show up you know in our society today, so how does segregation now manifest itself in the wealth gap, how does it manifest itself in differences in health outcomes, I thought it was very important for me to be very specific about that. In terms of illustrations I was very sensitive to the idea that I needed to be pretty concrete, you are trying to break down these really abstract concepts for kids that don’t necessarily have the cognitive ability, so you think about the front page of the book, it was an education for me how, do I break down structural racism and what you see on the cover is literally structures different structures, one for one group, right next to the other. So I was trying to really pay attention to that. A second thing I was really trying to pay attention to is how do you convey an idea, that is, was hurtful and harmful without inflicting unnecessary trauma on a young age group, right I don’t need to show lynching, how do I convey the idea that something terrible happen without you know inflicting deeper trauma on kids. The other thing that was very important for me to do was to show black people, specifically, with agency, showing them, not as passive victims but as individuals that thought to help shape, the circumstances that we find ourselves in today. The other thing that I thought was particularly important to me, was to show people working together across racial groups for social justice, because that has always been the case, and I think any sort of effort to say otherwise is damaging to our future efforts at trying to create a more socially just environment and I thought it was very important, I will say take in with the fact is, this is really not about just black people but it’s thinking about how do we get out of this mindset of dehumanizing and othering people, so that we basically do not act when we see need and we become indifferent. And this, can be thought about in any other context, how do we think about immigrants, today, how do we think about religious minorities, how do we keep a mindset, where we don’t dehumanize people that we perceive as different.

00:28:22 –> 00:28:29

Lindsay Rosenfeld: Hearing about some of the ways that you’ve been talking about the book or seen it used, even just giving us a sense of where you’ve been invited to talk about it, or where you’ve been invited to work on something about it, or even where you’ve heard it’s being used. And certainly if you have ideas for other ways, it could be used or other venues you would like to talk about it in we’d love to hear that too.

00:28:48 –> 00:30:21

Kimberly Narain: Right I’m seeing a lot, a lot of use of the book in the home, which has been really, really humbling for me. I’ve actually given a lot of talks in different academic settings and I don’t see this book as the end all be all but it is really a resource for helping groups think more inclusively about the curriculum so that said, I’ve been contacted by a few different school districts. I’ve had the school district out here, actually purchased books and my daughter’s own school district purchased books for their library, so that was really a win for me. I have spoken at religious institutions, thank you, which I thought was amazing because I think anywhere where there’s receptivity to this message and I have capacity that I am open, to to be there because I think there are more people have good will, who are just trying to identify reliable knowledgeable sources in terms of trying to figure out how they approach this information, and the more that I can connect with those people, I think the stronger the impact will be.

00:30:21 –> 00:32:15

Lindsay Rosenfeld: Indeed, and I’ve also felt that it’s also in in seeing you interact with many of these different groups that you describe, also the where. People who especially are newer to it, or may know, but where what what’s their role, how do they insert themselves how do they insert conversations, how do they do it with their family and then expect that more broadly right and that that’s what I love so much about this book for families for kids and for adults is the concrete nature of of the action orientedness of it too right and that concept that this is a cycle, unfortunately, but it’s not the Martin Luther King gave his speech and we’re done, because, as you described, that is, a lot of the conversation right. Barack Obama was elected President and we’re post-racial. How are our folks one coming to that and then how can the conversation and the action, quite frankly, you know be extended on all levels.

So what do you, what do you think is next? What would you like to – I’ll tell you what I am hoping, I hope that you go on a book tour of school districts, where you get to talk to teachers and parents and really share because I think it’s so powerful. Your story and your success and creating this on so many different levels right there’s so many different aspects, I think that you bring to it that’s that’s really powerful and and relatable and you know that’s important for getting especially folks who have not yet been comfortable or don’t know how to broach the subject with others right I think that’s a piece of it too So what do you see as as next?

00:32:15.780 –> 00:32:21.750

Kimberly Narain: Well, I like what you said so sweet that and and the atmosphere for that in the atmosphere, I would love that. Yeah I am just trying to to reach out, you know and see who is receptive a friend of mine who is actually a playwright, and she’s a an assistant professor in the school of nursing at UCLA and she deals a lot with visual sort of art, she was like, Have you ever thought about trying to put this into a play? I was like no, but I would love that. I’m definitely open like I said when I embarked on this journey, I was really thinking about a tool for myself. So, I can’t say I came up with a master plan and how to deploy this for maximum impact, but I really have just been thrilled to see how it’s almost sort of taken a grass roots, and really sort of been disseminated – no publisher which was strategic and a chance, right, to take. Sure, there was no, automatic sort of venue but like I said, I think that to me is even more a testament to the need, the fact that it’s continuing to move and expand, on its own without the massive economic push behind it.

00:33:43 –> 00:35:15

Lindsay Rosenfeld: I couldn’t agree more, I couldn’t agree more, and I love, how you keep talking about it, well, I talked about it like this, and it sounds like this, these aren’t your words but it’s a labor of love. That you did, because you saw the need I’m sure in the wider world too, but really to fill in your own life with your own kids. And when I think, when we think back to so many organizations, that started or even products right like as an early parent, you know when my kids were very young. There were so many things, why does this exist, so why doesn’t this exist, how come there’s not that connection right in and then 10 years later we’ve seen that, because people also noticed that you know, in their own lives or their own interaction so I love that and I love that it’s in this form, because we don’t get to usually see that you on such important topics, to the history of our country and to the possibilities of policy and and better outcomes, for the future as well, so I just so appreciate you taking the time to talk to us today about this, what I call this beautifully important labor of love. And as a parent and someone who’s also devoted my professional life to health equity I’m deeply appreciative of this gift that you’ve given us on so many levels so, thank you so much for your time. I want everyone to check out the resources that we’re going to post on the blog that you’ve mentioned and a few others and and remind folks to check out the website cycleofadream.com, so thank you, Kim.

00:35:15 –> 00:35:18

Kimberly Narain: Thank you it’s been such an honor to chat with you today.