On June 9th, 2020, the City of Charleston created the Special Commission on Equity, Inclusion, and Racial Conciliation "focused on the creation of measurable outcomes, promotion of greater accountability, and coordination of community wide efforts to achieve racial equity in our community."
In August, 2021, the SCEIRC released its recommendations. The complete, official document can be found here. In the interest of public consumption, we have translated the hard-to-read tables embedded in the report into bullet-pointed lists.
Each of the following areas of SCEIRC focus are outlined in separate posts:
- Criminal Justice Reform
- Economic Empowerment
- Health Disparities and Environmental Justice
- History and Culture
- Housing and Mobility
- Internal Review
- Youth and Education
This post is dedicated to Health Disparities and Environmental Justice and contains the stated Long-term goals, Objectives, Strategies, and Actions from the report.
The report contains the following additional details for each Action: Performance Measures, Evaluation Tools, Lead Staff, Oversight, and Due Date. Those have been omitted here for brevity.
LONG-TERM GOAL: Improve the life expectancy of minority and/or underserved communities by implementing policies and programs that consider the social determinants of health giving all citizens the opportunity to reach and enjoy optimal health.
OBJECTIVE: Support interventions at the individual and population level to impact a variety of social conditions form the incidence of chronic illnesses to overall life expectancy.
- Strategy: Align health access strategies with the health improvement plans available in the 2019-2023 Tri-County Health Improvement Plan (TCHIP) and updated as appropriate.
- Mandate a Health and Equity in All Policies approach for City government, City-sponsored programs, non-profits and community members that integrates and articulates health considerations into policymaking across sectors to improve the health of all communities and people.
- Encourage healthy eating and physical activity by incorporating obesity-prevention tactics (sidewalks, healthy vending, healthy snacks, green spaces, senior activity areas, low-price farmer markets, etc.) in city expansion and event planning efforts.
- Implement the Office of Minority Health’s (OMH) 15 National Standards for Culturally and Linguistically Appropriate Services (CLAS) at the City of Charleston and promote its use as a road map for improving equity among organizations serving citizens in the physical, mental and socioeconomic health ecosystem, including, but not limited to, hospital systems, healthcare providers, healthcare insurers, schools, police, and community-based organizations.
- Strategy: Encourage collaboration and strategic partnerships to improve healthcare systems and networks for the underserved.
- Identify and promote SMART city-endorsed health disparity initiatives like Research Allies for Reaching Community Health Equity (ARCHE).
- Explore synergy with The South Carolina Department of Health and Human Services’ Managed Care Withholds and Incentives Initiative, a major driver behind the prioritization and funding of quality improvement projects at Managed Care Organizations in South Carolina.
- Collaborate with One80 Place to better understand the healthcare needs of the homeless and develop innovative solutions.
- Strategy: Improve access to mental health training and resources for professionals and residents.
- Promote the use of local resources like SC Hopes, an anonymous support line with experienced mental health and addiction counselors.
- Mandate mental health introductory training for all City personnel to increase awareness, reduce stigma and reinforce de-escalation tactics.
LONG-TERM GOAL: Increase the number of high quality, subsidized healthcare providers on the Charleston peninsula.
OBJECTIVE: Recruit more subsidized healthcare providers and/or services to the City of Charleston, to include SC DHEC.
- Strategy: Improve access to healthcare for low-income residents.
- Offer public transportation waivers for medical and social support appointments that extends outside of the Charleston peninsula.
- Encourage non-traditional hours for healthcare providers/services within the City of Charleston.
- Promote the use of telehealth when and where available.
LONG-TERM GOAL: Sponsor free, consistent and sustainable COVID testing and vaccination.
OBJECTIVE: Intentionally and strategically build infrastructures and networks that consider the most vulnerable first for COVID testing and vaccination.
- Strategy: Increase opportunities for COVID testing, vaccination and education.
- Host simultaneous testing and vaccination locations with varying hours and testing options (rapid, standard).
- Offer free disinfectant cleaning products and toiletries for families and individuals in need.
LONG-TERM GOAL: Prioritize flood mitigation strategies that address racial equity and environmental justice.
OBJECTIVE: Acknowledge and resolve inequitable environmental disparity between historically and predominantly Black neighborhoods on the peninsula and new, high-income developments.
- Strategy: Invest in more opportunities to address flooding in low-income areas
- Create open spaces in underserved communities that can double function as water storage.
- Continue to invest in drainage projects in low-income areas and provide routine updates to residents.
- Increase marketing and promotion of existing environmental initiatives like Adopt-a-Drain and Charleston Rainproof programs.
- Provide educational resources about elevating homes in low- income areas, and consider creating a funding mechanism to assist low-income homeowners with elevation
- Strategy: Consider how environmental design can be used to support resident safety and crime prevention.
- Lighting - Remove heavy growth from existing lighting and poles. Employ a resident to report burned out lights.Lighting should be uniformly spread to reduce contrast between shadows and illuminated areas. More fixtures with lower wattage rather than fewer fixtures with higher wattage help reduce deep shadows and avoid excessive glare.
- Vegetation -Create landscapes that allow unobstructed views of the surrounding area. Add murals, gardens, and landscaping to create a sense of ownership. 3’-7’ window of visibility – trim trees up to 7’ and shrubs down to 3’All shrubs should be kept trimmed 6” below a window line
LONG-TERM GOAL: Address climate change and systemic inequities simultaneously
OBJECTIVE: Acknowledge and take equitable action to mitigate harmful pollution that contributes to climate change.
- Strategy: Implement the new equitable Climate Action Plan
- Advocate for pollution-control measures with major commercial polluters, such as shorepower at a new cruise terminal.
- Highlight climate change as a public health emergency in regular communication with residents to raise awareness.
The report contains the following introduction before listing the recommendations:
Health outcomes and environmental justice are closely linked to shared social and economic advantages that impact access to resources that are needed to achieve and sustain equity. When equity is not actualized, the community and its people are faced with chronic disparities with their health and throughout the environment that span across many dimensions, including race/ethnicity, socioeconomic status, age, location, gender, disability status, and sexual orientation. Moreover, disparities in health and the environment not only affect the groups facing disparities; but also limit overall gains in quality of care and health for the broader population and result in unnecessary costs. Addressing these disparities is increasingly important as the population becomes more diverse. It is projected that people of color will account for over half (52%) of the population in 2050 (Kaiser Family Foundation, 2021).
The purpose of the Health Disparities and Environmental Justice (HDEJ) Subcommittee was to (1) explore issues related to health and environmental equity; (2) determine which issues are most salient in the City of Charleston; (3) identify key priorities that would produce the greatest impact; and (4) present these priorities to the larger commission for evaluation and facilitation.
The subcommittee centered its equity work with consideration of the social determinants of health. Social determinants of health are the social and environmental conditions in which we live, work, play, worship and age.
It includes education, economic stability, food access, neighborhood and physical environmental attributes, interpersonal relationships and of course, healthcare access and quality. Grounding our thoughts and recommendations in this concept allows for interventions to be placed at the individual and population level to impact a variety of social conditions that contribute to the incidence of chronic illnesses to overall life expectancy. Thus, the emphasis is placed on creating conditions that allow people to be healthy while creating environments that support health throughout life. Understanding the interconnections of our region, health access strategies should align with the health improvement plans available in the 2019-2023 Tri-County Health Improvement Plan (TCHIP).
As evidenced by the tri-county’s 2016 and 2019 Community Health Needs Assessment, access to quality health care remains a persistent priority for the community. In the 2019 assessment, 21% of respondents in Charleston County cited work schedules, lack of health coverage and lack of income as barriers that prevent routine doctor appointments. These social factors coupled with the near 11% uninsured rate in Charleston County validates why it is important to consider all social determinants of health to fundamentally impact healthcare access and equity in the City.
There is only one subsidized healthcare option for residents on the Charleston peninsula, Fetter Healthcare Network. The federally qualified health center was established in 1975 and continues to be a valuable resource for the community. However, this limits the options that uninsured and low-income residents have if seeking preventive care and ancillary medical services. It also reinforces the notion that options and value-based shopping are privileges in healthcare, not a right.
When we have the chance to explore the City’s environmental disparities, we learn that the issues are pervasive, persistent and seemingly perpetual. Since 1938, the established, predominately Black, West Charleston neighborhoods have been struggling with severe environmental issues.
The City has used the banks of the community as a landfill for over 80 years. Not only did this increase the intensity and impact of the routine tidal flooding, it also resulted in a lingering, repulsive odor. The City of Charleston also built two incinerators between 1900-1956 with staunch opposition from the Black communities that would be most affected. The incinerators created a screen of smog over the Eastside and posed serious health concerns for nearby residents.
COVID-19 has shown a light on the glaring health, social and environmental disparities that exist throughout the world, some of which you will read about in relation to the City of Charleston. This is the opportunity to intentionally and strategically build policies, partnerships, infrastructures, and networks that consider the most vulnerable first.
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