This profile features Lonias Gilmore, MPH, Director of Health Equity and Social Justice at the Big Cities Health Coalition, a forum for the leaders of 35 of the largest metropolitan health departments in the US to exchange strategies and jointly address issues to promote and protect the health and safety of the more than 61 million people they serve.
In her new role at the Big Cities Health Coalition (BCHC), Lonias Gilmore will oversee initiatives as far-reaching as they are critical to the eventual elimination of racial inequities. Gilmore is expanding and implementing the Coalition’s portfolio of work, including work on health and racial equity and efforts to uplift the role governmental public health must play in addressing structural racism.
Making the responsibilities of this role even more formidable is that almost all participating local health departments have either directly declared racism a public health crisis or sit in a locality, county, or a state that has made an official commitment to address the root causes of health inequities, especially structural racism. Gilmore is working on several initiatives to support them in making good on those commitments.
This is racial justice work, so it’s going to be challenging. But being able to do it and decide on strategy is huge.
As Gilmore collaborates with BCHC’s member health departments to reduce health disparities, some stubborn misconceptions and outdated practices continue to prove challenging:
- Health and racial equity strategies have been both research and practice tested. In fact, for every strategy listed on healthequityguide.org, an online resource organized by categories of equity strategy, there is a local public health department that has used it and seen positive outcomes. Nevertheless, Gilmore has encountered people who believe that communities are turned off by prescribed strategies. Furthermore, it is tempting to think racial equity issues will resolve on their own with time.
This is 2022. I think we’ve proven that racial equity does not happen organically. It would serve us to at least try on proven health and racial equity strategies. They haven’t solved racism, but they’ve had positive impact. It’s okay for us to tell people, ‘This is the North Star. This is the best practice. Somewhere between your current practice and best practice, you can find somewhere to take action.’
- Addressing social determinants of health is essential to advance health equity. But both “social determinants of health” and “health equity” remain mainly theoretical for the many who don’t know how to make the concepts practical.
Many people still don’t recognize that housing and healthy, affordable food are social determinants of health, connected to people’s health and well-being.
- Traditional formula and competitive funding practices are structured so that we continue to fund the exact same people only to get the exact same results. Finance and grantmaking practices become so routine that they take on the force of policy, even where actual policy is much less restrictive.
A human at some point in the past decided to do it that way. That means another human can do an analysis of these practices and make sustainable changes that will lead to attracting more appropriate recipients of funding, resulting in an impact on inequities.
- Racial equity strategies are targeted and have universal positive impact. However, many people interpret this to mean that you’re “taking from” and “giving to.”
Nothing makes people more ‘itchy’ than when you talk about giving to Black people. However, we have case studies and history that tells us that if you focus on lifting the boats with Black people in them, it benefits society at large.
If anyone is up to confronting these obstacles and meeting the challenges of this leadership role, it’s Gilmore, who knew before she even entered the public health field that whatever she did, it needed to have an impact on the gap in life expectancy between Black people and others in the US. Gilmore came to the job at BCHC with the preparation she will need to succeed. As a fellow in the first cohort of the Equity Leaders Action Network (ELAN), she was introduced to consultancies and Communities of Practice, wherein peers work together to resolve real-life dilemmas. Gilmore intends to include these practices in initiatives that support the coalition. The ELAN also gave her the skills to help others check their assumptions – and the permission to correct them.
Checking assumptions is not like a competency you reach and you’re done with it. It’s an ongoing practice.
Gilmore also cites as a formative influence a four-day health equity and social justice workshop early in her public health career in 2011, which helped her put words to things she was feeling and sensing but had never been able to verbalize.
A lot of my personal development has been just realizing I’m not crazy. People in the workplace do change the subject away from race. I realized it’s not just me having an attitude today or that I didn’t have enough coffee or I didn’t sleep well. This doesn’t mean that I’m never wrong, but it does mean that I’m not crazy – I am not imagining these struggles. And I’m also not imagining the things that try to interrupt and threaten our collective progress.
It was huge to learn that I don’t have to use mental energy on wondering if I’m imagining what’s going on. I can use my mental and creative energy to get a conversation back on track, to question my own assumptions, and encourage others to do the same.
Gilmore also derives strength from the perspectives she holds, one being that this is long-term work. While it would be ideal for our society to move toward anti-racism while she is alive, she knows that probably won’t happen, and that she is likely working for her nieces and nephews and, even more likely, for their children.
One other perspective Gilmore maintains is that she probably won’t be any differently regarded than the many civil rights leaders and community organizers who came before her but will remain forever unnamed. And she is okay with that.
If I start worrying about whether people are taking my advice, whether I capture their attention, or whether a group I’ve gathered with full sincerity and intention accomplishes nothing — if I start worrying about every one of those incidents, I won’t be able to do this work.
At the same time, Gilmore has benchmarks and objectives in mind to help measure whether change is happening. She wants to see finance policies change so that we are funding institutions that community members already trust and have a track record but have been either turned off from contracting with the government or never had the opportunity. She also wants to see more targeted, economic interventions—for example, giving pregnant people the opportunity for paid leave to relieve financial stress, which takes stress off their bodies, giving them a better chance of carrying their babies to term.
People might believe that some who are eligible for these opportunities don’t deserve them, but that’s not where my focus is or where I think it should be. I’m aiming for population-level positive change.
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