Implementation Considerations for SDOH Programs Serving Racial and Ethnic Minority Populations and Tribal Communities

Addressing social determinants of health (SDOH) among racial and ethnic minority populations and tribal communities may require additional considerations. This section describes unique considerations for these specific rural groups related to SDOH programs.

Preparing Rural Communities to Address SDOH for Racial and Ethnic Minority Populations

Addressing SDOH among rural minority populations may involve training rural program staff and partners — particularly those working in healthcare services — in issues of cultural and structural competence. Cultural competence involves understanding the ways that culture and language can influence health beliefs and outcomes. Structural competence involves understanding how health outcomes are affected by SDOH and preparing to act on the root causes of inequities. This could include learning about influences on health, such as the historical context and current issues that affect local communities, joining cross-sectoral efforts to address SDOH, and integrating an SDOH assessment tool into healthcare interactions.

Addressing racial and ethnic health disparities in rural areas also requires recognizing how racism interacts with SDOH. According to the Institute of Medicine's Unequal Treatment Report, health outcomes among African American patients were found to be worse than those of White patients, even after accounting for income, neighborhood, comorbid illness conditions, and health insurance type. Rural communities engaging in SDOH projects may need to understand the impact of implicit bias, which refers to unconscious assumptions that can influence perspectives of and action toward others. Implicit bias can affect the way that many people, including those who work in education, the criminal justice system, and healthcare, interact with racial and ethnic minority populations.

Understanding the Intersection of Trauma and Inequity

Health inequities can arise from actions and policies that have harmed and continue to disproportionately burden racial and ethnic minority populations. Race-based discrimination, social exclusion, and violence can contribute to traumatic outcomes. This includes historical and intergenerational trauma, concepts that are particularly pertinent to American Indian and Alaska Native communities. This mass trauma can manifest in physical and behavioral symptoms, which affect the health and well-being of future generations. Research shows that African American and Hispanic/Latino populations are also disproportionately exposed to traumatic events. For example, African American and Hispanic/Latino children are more likely to experience adverse childhood experiences than White or Asian children.

Rural communities can take action to build trauma-informed programs, organizations, and communities. Key principles of trauma-informed practices include:

• Promoting the safety of community members
• Creating trust and promoting transparency between affected populations and program staff
• Facilitating interactions and mutual support among peers and trauma survivors
• Recognizing power dynamics and establishing a commitment to collaboration and respect
• Prioritizing the active involvement of affected populations in their healing and recovery through shared decision-making
• Acknowledging the intersection between trauma, racism, and discrimination, and responding to cultural needs and perspectives of affected populations

Promoting Participation and Leadership

One of the root causes of racial health inequities is structural barriers that limit participation in policymaking and decision-making. Addressing these inequities will require involving affected community members in SDOH programs and promoting their ability to shape program design, goals, priorities, strategies, communications, and interpretation of findings.

When working with tribal communities, rural program planners should understand the importance of securing buy-in from the tribe and involve members in every step of the planning and implementation process. Rural programs have reported the need to work with and engage multiple generations within a tribal community, including youth, parents, and elders.

Resources to Learn More

Bodies Don't Just Tell Stories, They Tell Histories: Embodiment of Historical Trauma among American Indians and Alaska Natives
Document
Describes the way that historical traumatic events continue to influence health inequities among American Indian/Alaska Native communities.
Author(s): Walters, K.L., Mohammed, S.A., Evans-Campbell, T., Beltrán, R.E., Chae, D.H., & Duran, B.
Citation: Du Bois Review: Social Science Research on Race, 8(1), 179-189
Date: 4/2011

Social Determinants of Health among African Americans in a Rural Community in the Deep South: An Ecological Exploration
Document
Discusses SDOH that affect a sample of African Americans living in rural southeastern Georgia. Discusses factors that affect health at several levels of society, from the individual to the structural (for example, race relations and poverty).
Author(s): Scott, A.J. & Wilson, R.F.
Citation: Rural and Remote Health, 11(1), 1634
Date: 2/2011

Why Place and Race Matter: Impacting Health Through a Focus on Race and Place
Document
Describes the influence of neighborhood environmental factors, such as the physical environment and economic opportunities, on the health of people. Discusses how people of color are disproportionately affected by factors that lead to negative health outcomes. Includes examples from rural communities, including rural portions of Shasta County, CA.
Author(s): Bell, J. & Lee, M.M.
Organization(s): The California Endowment and PolicyLink
Date: 2011