Normalizing Atonement: Implications for Public Health Policy, Practice, Education, and Training

February 28, 2023 | Christopher J. King

A Black man leans against a desk in his office and smiles broadly at the cameraAs we reflect on the past few years, the task before us is clear. COVID-19 illuminated numerous vulnerabilities. Stark mortality disparities by race and place amplified the relationship between poor socioeconomic conditions and health outcomes. Healthcare and public health institutions experienced difficulty partnering with communities of color to implement culturally nuanced and community-driven mitigation initiatives. And mistrust in the institutions of medicine and research presented a threat to public health.

Disparities, Inequities, and Race

Before the phrase “social determinants of health” was socialized in current health sector lexicon, in 1906, American sociologist and historian, W.E. Burghardt DuBois, asserted that disparities in infant mortality, life expectancy, and infectious diseases cannot be attributed to race but caused by unjust social, environmental, and political conditions. These trends occur when inequities exist—meaning one population has more access to resources and opportunities than the other.

Therefore, as we work to close the chasm on racial differences in health outcomes and improve health for all, it is important to pause and take inventory of more than 400 years of policies, practices, and events that created an unlevel playing ground for people of color—whether intentional or unintentional. The Black-white wealth gap is a powerful outcome indicator.

Atonement and Reframing

In his letter from a Birmingham jail in 1963, Dr. Martin Luther King, Jr., emphatically stated, “injustice must be rooted out by strong, persistent, and determined action.” To undo the effects of centuries of intergenerational damage, all sectors of society must reflect on their histories, interrogate the status quo, and chip away at vestiges that sustain inequitable conditions. This process can be facilitated by retroactive analyses, which helps unearth contemporary injustices—whether real or symbolic.

For example, by reflecting on history, institutions throughout the nation have demonstrated atonement through courageous action. They have issued formal public apologies, renamed buildings, and removed physical icons that cause pain and do not reflect appreciation for diversity and the nation’s founding values. And in many cases, these iconic figures have been replaced by new representations of hidden figures who have sacrificed for a more perfect union—for all.

These acts are essential for racial healing, building trust, and fostering environments where communities are empowered and operate in partnership with medical and public health institutions.

Atonement and reframing interventions are also needed at micro levels, including audits of common language and traditional programmatic practices. Examples include—but are not limited to—discontinuing ivory tower, saviorism, and paternalistic approaches. Instead, more efforts are needed to operationalize power shifting. For example, instead of creating an intervention “for a community,” we “co-create interventions with the community.” Instead of “adopting” a nonprofit, we “partner” with a nonprofit. Demonstrating humility and curiosity in learning from the communities we serve calls for new competencies.

As the proverb goes, history is often written by the victors. The interpretations of that history, which exclude the voices of the powerless and most vulnerable, have shaped the narratives and biases that exist in the structures and systems that govern society today. These conditions perpetually benefit the privileged, upholding a caste system of haves and have nots. Inevitably, health disparities follow suit.

In our shared vision for a nation where all people can thrive with unalienable rights, such as life, liberty and the pursuit of happiness, reckoning with our history and normalizing atonement in policy, practice, education, and training may be one of the most transformational population health interventions of our time.

Note from the Author

All professional sectors and academic disciplines can contribute to a healthier nation by conducting retroactive analyses of the evolution of their own histories, and use lessons learned to formulate novel approaches for atonement in policy, practice, education, and training.

About the Author

Christopher J. King, PhD, FACHE is the inaugural Dean of the Georgetown University School of Health, and Associate Professor of Health Management and Policy.  As a Fellow of the American College of Healthcare Executives, Christopher is nationally recognized for his peer-reviewed scholarship and achievements at the intersection of racial justice, public health, and healthcare.