Governmental Use of Racial Equity Tools to Address Systemic Racism and the Social Determinants of Health

Report | November 2021

Governmental Use of Racial Equity Tools to Address Systemic Racism and the Social Determinants of Health

Ruqaiijah Yearby, Sidney D. Watson, Charysse Gibson, Crystal N. Lewis, Nicole Strombom, Katherine Stamatakis, & Keon L. Gilbert

Institute for Healing Justice and Equity | Saint Louis University Center for Health Law Studies

About the Study

Support for this research was provided by the Robert Wood Johnson Foundation’s Policies for Action program to evaluate the effects of racial equity tool use on governmental policy change nationwide. This report highlights the following key findings:

  • Racial equity tools can be used to address systemic racism and the Social Determinants of Health.
  • Over 107 jurisdictions around the United States have worked with national organizations, including Government Alliance for Race and Equity and PolicyLink, to use racial equity tools.
  • Jurisdictions using racial equity tools are spread throughout all 4 major regions of the country, with the highest counts in California, Minnesota, and North Carolina.
  • Some of these jurisdictions have also prioritized and enacted laws to address systemic racism and the Social Determinants of Health.
  • Additionally, some jurisdictions have used racial equity tools for strategic planning, yearly training, and everyday operation.

Executive Summary

Asian, Black, Indigenous, and Latino Americans die earlier, have higher infant mortality rates, and suffer more chronic conditions and disability than most white Americans. These health inequities are due in part to systemic racism and the social determinants of health (SDOH). Systemic racism is a complex array of social structures, government policies, institutional practices, and interpersonal interactions used by the dominant racial group to create a hierarchy that disadvantages racial and ethnic minority groups. The SDOH are social factors outside an individual’s control that limit an individual’s ability to attain their full health potential. Systemic racism disadvantages racial and ethnic minority groups in numerous ways, including creating inequities in the SDOH. For example, inequities in COVID-19 infections and deaths have been associated with racial and ethnic minority groups’ lack of equitable access to health care, paid sick leave, and clean water as a result of systemic racism. Systemic racism is hard to dismantle because it is so deeply ingrained in the actions, processes, and policies of governmental entities. To address these challenges, a group of 107 pioneering jurisdictions (cities, towns, villages, governmental agencies, and counties) has been working with national groups, such as the Governmental Alliance on Race and Equity (GARE) and PolicyLink, to address systemic racism and the SDOH. These groups have provided jurisdictions with racial equity tools that can be used to normalize conversations about race, operationalize new behaviors and policies, and organize to achieve racial equity. Until now, no one has cataloged jurisdictions working with racial equity tools created by national organizations. In this report, we begin filling this gap by identifying jurisdictions working specifically with GARE and PolicyLink and discussing how these jurisdictions are addressing systemic racism and the SDOH in their communities.


Racism is a Public Health Crisis
Understanding how racism is a health crisis and ways to respond.

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