Start a conversation about health equity.
Waiting for Health Equity is intended as a tool for launching new discussions and challenging our own perspectives and privilege around health equity. As such, we’ve developed a facilitation guide (PDF) for groups wishing to host a conversation. Additionally, throughout Waiting for Health Equity there are “LEARN MORE” icons, which indicate that a character has more to say about an issue than what could fit in these pages. Learn more about the impact transportation, working conditions, food access, and other factors have on a person’s ability to live a healthy life by reading their commentary and reading suggestions below.
LEARN MORE: the impact of transportation on access to health care
+ Perspective
TAMARA: “I never figured I’d be taking the bus my whole life, but here I am. A car is just a luxury my family cannot afford. But it’s not so easy catching the bus. As the day goes on, they get more and more off schedule. It’s not the bus driver’s fault, it’s just another system that doesn’t work how you need it to. Once I got fired from a job because the bus was 25 minutes late! “No excuses,” they said. “Should’ve caught an earlier bus.” It’s not that easy, you know?! And then when I’ve got Damian—that poor child. I don’t want him wheezing his lungs out because we had to run to catch the bus! Not to mention the exhaust–our apartment is right near a highway so we get all that pollution, and then there’s the big plant nearby puffing all that toxic smoke into the air…and we’ve gotta be outside in it to walk a mile and a half–on these streets that often don’t have sidewalks–to the bus stop. I’ve been late to many a doctor’s visit because it just wouldn’t pick us up on time or it moves too slow. Sometimes when that happens, Damian doesn’t get to see the doc because she’s already moved on to her next patient and marked us as a no-show. Then we run out of meds and his asthma flares up, all because of we don’t have reliable transportation. I wish I had the money to get us a car, but honestly, even public transit is getting harder and harder to afford. We certainly aren’t the only folks in our community dealing with this. Transportation is the second largest expense for most families, and for low-income families it’s about 42% of their budget.1 I see all these transportation projects going on in other communities, but not ours. We need more funding for more bus routes and better roads to serve families like mine.”
+ Readings
Data Source:
Additional Readings:
- Evaluating Transportation Equity: Guidance For Incorporating Distributional Impacts in Transportation Planning (PDF) by Victoria Transport Policy Institute
- Moving to Equity: Addressing Inequitable Effects of Transportation Policies on Minorities (PDF) by Center for Community Change & The Civil Rights Project
LEARN MORE: the impact of language & literacy on economic opportunity and health
+ Perspective
ANH: “In Vietnam, I was an engineer and was making good money helping my country build roads and bridges. When the war came, we had to leave everything behind. Not just what we owned, but our lives–who we were. There, I had respect because I had a good job. I was a hard worker. I provided for my family. Who am I here? I’m invisible. I wish I could have used my education and training here–I know Colorado needs better roads and bridges. But, I would have had to start over. Learn English. Go through all the schooling again. Retake exams. Those things cost time and money; we had no money and we needed to start working right away to survive. We worked in a nail salon, and sometimes I drove a taxi. Over time, I did learn how to speak English–it was the only way to not feel completely isolated–but I still can’t read or write it very well. That’s why forms are hard for me. And Americans love forms. Fill out this form to see the doctor. Fill out this form to open a bank account. Fill out this form to vote. It’s very frustrating, because people assume I am uneducated when I can’t do these things. But I am educated. I speak two languages. I am very good at math. It’s not just me, either. Forty-eight percent of immigrant adults that came to the US between 2011 and 2015 have college degrees.1 So now we barely make any money, which means we can’t afford healthy food or good housing, and when we get sick, we can’t afford to go to the doctor. Even if we do go, most clinics and hospitals don’t have someone that speaks Vietnamese. Would you trust a health care system where you couldn’t get someone to tell you what was wrong with you or what care you needed in your own language? I wish interpreter services were provided all the time–I know the law says they’re supposed to be, but it doesn’t happen.”
+ Readings
Data Source:
- Untapped Talent: The Costs of Brain Waste among Highly Skilled Immigrants in the United States by Migration Policy Institute
Additional Readings:
- New Grant Focuses on Improving Health, Health Literacy of Immigrants by Missouri Public Radio
- How Long Does it Take to Learn a Second Language? (PDF) by the Spring Institute
- Cultural and Language Barriers / Access to Health Care by Asian American Health Initiative
LEARN MORE: the impact of insurance on health
+ Perspective
ANH: “I’ve had no insurance for most of my life. I had it for a short while when I arrived in Colorado, but then they took it away and said we had to get it ourselves. It’s too expensive to buy though, so we never did. It has to be affordable. I know more than four in five uninsured Coloradans said insurance costs too much, so we’re not alone.1 Sometimes I’d get a job that would provide it, and I would have it for a short time, but never long. So when you do have it, that’s when you go see the doctor to get your medicine and get help for your back that hurts or the bump you found on your skin or whatever. When you don’t have insurance, health care is too expensive, so you do without. A few years ago my wife was having stomach pain, but she had no insurance so just took whatever she could get at the pharmacy to help with the pain. She was tired all the time and losing weight. When the new health care law passed, it expanded Medicaid and someone came to our apartment to help us enroll. When we got our Medicaid cards, my wife was finally able to go see a doctor, and they found out she has cervical cancer. If she had had it checked sooner, it wouldn’t have spread so much, but we also wouldn’t have been able to afford any treatment. I don’t like handouts–I’d rather work for what I have–but this Medicaid is saving my wife’s life. The doctors say she’s going to be okay. And it’s helping me get healthier, too. I still don’t like having to go to doctor’s appointments, but it’s definitely better when you have insurance than when you don’t.”
+ Readings
Data Source:
- Who Remains Uninsured in Colorado – and Why? (PDF) by the Colorado Health Institute
Additional Readings:
- America’s Uninsured Crisis: Consequences for Health and Health Care (PDF) by the Institute of Medicine
- High-Quality, Affordable Health Care for All: Good for Families, Communities, and the Economy by PolicyLink
LEARN MORE: the employment and health issues facing Coloradans because of their disabilities
+ Perspective
JAKE: “The physical disability is hard, but the brain injury is harder. With my leg, I had to learn to walk all over again on an artificial leg, and I still got a lotta pain in my hip. I’m slow getting around and people look at me and feel sorry for me–which I hate. But my head–that’s an invisible disability. I have PTSD from the explosion, and it hits me at really bad times. I’ll hear a door slam, or fireworks on a holiday, and I’m back there. I live it all over again. The gunfire, the smell of the IED–that’s an Improvised Explosive Device, or a kind of bomb–the smoke. And I can’t move. I’m just…frozen. And my head–it just goes blank. I’m on meds to help, but that means I can’t drive, so I’m totally reliant on other people to get me where I need to go. It doesn’t work well for grocery shopping, going to the doctor’s office, and especially for holding a job. Sure, companies are supposed to make “reasonable accommodations” for my disability, but I’d have to get hired first, and I can’t even get past the interview. It’s so frustrating that I’m always seen as unable to do the work ‘cause of my leg or that I’m seen as either too dangerous or too damaged because of my PTSD. It’s not like having a disability is uncommon–one in five US adults has one!1 But there was this study that showed that having a disability decreased your chance of even being considered for the job by 26%.2 If that isn’t unfair, I don’t know what is. Even though my military career was cut short, I learned a lot of skills that could be useful to an employer, if only they were willing to work with me. It’d be great to see more companies willing to take a chance on hiring someone with a disability. Just being able to work would help me feel better about myself. I’d stop just sitting around all day with nothing to do, and maybe live a little healthier. It would also help me afford all the medical care I need, which is not cheap.”
+ Readings
Data Source:
- Persons with Disabilities as an Unrecognized Health Disparity Population by Center for Disease Control and Prevention
- Study Finds People With a Disability Are More Likely to Face Employment Discrimination by Mic.com
Additional Readings:
- Veterans Battle for Jobs on the Home Front by The New York Times
- What Can You Do? by The Campaign for Disability Employment
LEARN MORE: the impact of food access on health
+ Perspective
ANH: “Back in Vietnam, it was vegetables, rice, and fish, vegetables, rice, and fish. Every meal. It was good for me, and I was healthy. Strong. Now I get my food from the corner store in my neighborhood, because it’s the only place close to my home. They don’t have fresh food there. It’s all this packaged, processed, junk food and fast food. So much sugar. I know eating fresh, healthy food is important to my health, but there’s no grocery store anywhere in my community. My neighborhood is called a “food desert”–there are almost 760,000 Coloradans living in communities like mine.1 Even if there was somewhere to buy fresh meat and vegetables, though, I’m not sure I could afford to buy it–they are usually much more expensive. Instead, I am forced to eat things I know are not good for me, and now I have these health issues–chronic diseases the doctor calls them–that make me feel weak and old. Those of us that live in these food deserts have lots of these health issues. Almost 30% are obese.1 Maybe we could have a community garden or sell fruit and vegetables in corner stores. I just know we need to get more fresh food into my community or our health will only get worse. Food is such an important part of my culture, and I hate that it’s being stripped away.”
+ Readings
Data Source:
- Fresh Ideas for Healthy Food by the Colorado Health Institute
Additional Readings:
- An Equitable Food System: Good for Families, Communities, and the Economy by PolicyLink
- Resources on food security by Unnatural Causes
LEARN MORE: the impact of working conditions on health
+ Perspective
CLAUDIA: “It’s day in and day out for me and my mom working at the meat packing plant. We work so hard and never get ahead. Cutting up the meat, bagging, boxing–and the lines just move so fast. My mom is only 50, but she’s so tired and achy. She’s losing the grip in her hands. And her back is killing her. All the time she’s popping ibuprofen for the pain. I know if I keep up the pace, I’ll end up like her… Probably even sooner, because they speed us up every day. The owners want to increase how much they put out all the time, so we hear, “Faster! Faster!” But we can only go so fast! How can you do good work if you’re going too fast to be careful? A heavy box of frozen meat fell on me the other day and hurt my arm and I’ve seen people get caught in the machinery. The plant gets fined if we report anything, so they’re always saying to keep it quiet, and we do. Even without all the injuries being reported, the data says it’s still one of the most dangerous jobs to have–but we don’t even get sick days. And you can’t say anything–they’ll fire you or call immigration. That’s why they like to hire people like us, without papers. Use us up and then leave us broken from the hard work without any other options. Almost 40% of meatpacking workers were born outside of the US, so we don’t have rights to protect us.1 It’d help a lot if we even all had the right safety equipment for us and the machines, but as long as they pass inspections it stays the same. So we just keep our heads down and keep working.”
+ Readings
Data Source:
- Slaughterhouse Workers by Food is Power
Additional Readings:
- Dangerous Jobs, Cheap Meat: Packing Plants Can Still Be Deadly Places by Rocky Mountain PBS News
- Is the Meatpacking Industry Getting Safer? By United Food and Commercial Workers International Union (UFCW)
LEARN MORE: the impact of immigration status on health
+ Perspective
CLAUDIA: “I used to dream of what life would be like in America. You see things on TV and in movies–it makes you think everything is great here. It’s a country of immigrants, right? And the Land of Opportunity? On those long nights when we were crossing the border, and we weren’t sure if we would make it or if we would be caught and sent back–or worse, robbed and killed–I would lay awake at night and think of how much better my life would be in the US. Maybe that was the problem. I built it up in my mind too much. Because it is nothing like I expected. Don’t get me wrong–it was worth the risk to come here, but life is still very hard for us. I’ve been here since the late 90s, but I still live in the shadows. Trying to go unnoticed and constantly looking over my shoulder. Getting sick or injured is one of my worst fears. The plant has a health insurance plan, but they don’t pay enough of the premium so I can’t afford it. And without papers you can’t get Medicaid and you can’t get those subsidies to buy the Obamacare plans. Some insurance companies will sell you a plan if you don’t have a social security number, but not very many and they’re too expensive anyway. So I’m uninsured, just like many of my relatives, because there’s no options for us. In fact, 40% of immigrants without documents are uninsured.1 When something bad happens, we just wait and hope it gets better by itself or until it’s too bad to ignore. It’s just–my life, our lives–they’ve become this political issue and everyone wants to weigh in on it but nobody ever asks us what we think. I feel like I am an American–Mexico isn’t my home anymore–and I want to contribute and help make our country better, but I can’t when I’m being pushed away all the time. I’ll buy health insurance if it is affordable–I want to! I’ll go get my check-ups to help me stay healthy instead of waiting until I’m sick. I’ll keep working hard and pay taxes. I just want to be given a chance.”
+ Readings
Data Source:
- Health Coverage and Care for Immigrants by Kaiser Family Foundation
Additional Readings:
- Immigrant Inclusion: Good for Families, Communities, and the Economy by PolicyLink
- Migration & Health: Mexican Immigrants in the U.S. by UCLA Center for Health Policy Research
LEARN MORE: the impact of geography on access to health care
+ Perspective
MANUEL: “Farming and ranching is all I know; it’s all my family knows. We have been doing this for generations, and we’re good at it. We live in Colorado’s Arkansas Valley, and we love it there. I don’t like the city–too much noise, too many people, and there’s no sense of community. Out here, I can breathe. But, that don’t mean it’s an easy life. We have less of everything. And it’s especially hard to see a doctor out here. We’ve got the one hospital, but it’s a 40-minute drive for us, and if you need an ambulance, you better hope for good weather and clear roads. I ask God every morning to keep my family and all the workers safe and healthy, but it’s a farm. We’re no strangers to accidents. There used to be two clinics in town that saw patients, but one closed during the recession. Now the one that’s left has a weeks-long waiting list to be seen, so most people I know just don’t go. And forget it if you need to see a specialist. In urban parts of the country, there are almost nine times as many specialists as there are in rural areas. A lot of our community is on Medicaid, but finding a doc who’ll take it is tough because it don’t pay well. And then there’s the stigma of needing a “handout,” too–nobody wants the government in their business, and I don’t blame ‘em. Everybody is already in everybody else’s business as it is. That’s why I come to Denver for my appointments. Easier to get in and nobody knows me, so people can’t talk. But it’s crazy that I have to come this far.”
+ Readings
Data Source:
- About Rural Health Care by National Rural Health Association
Additional Readings:
- Resources on rural health in Colorado by Rural Health Information Hub
- Texas Strives To Lure Mental Health Providers To Rural Counties by NPR
- Colorado State Rural Health Plan by Colorado Rural Health Center
LEARN MORE: the impact of cultural responsiveness in health care
+ Perspective
MANUEL: “I’m a third generation Coloradan, but it doesn’t feel like it. Growing up, I saw my older family members and many close friends get deported. It hurts seeing my family and my community torn apart and always moving from farm to farm, going wherever we can find work. You feel like you don’t have any stability when you’re always packing up and headed to the next harvest, chasing your next paycheck. But we Latinos, we’re resilient. We’re proud. Our culture is so rich that even when everything else is so hard, we still have that. But it’s also our culture to bottle things up inside. When I started a family, I finally felt whole. Family is so important to our culture. It gave my life a whole new meaning. So when my son unexpectedly died a few years back, the pain and grief overwhelmed me. I couldn’t talk about it. Even with my wife. I turned to alcohol because it’s all I knew and it dulled the pain. Bottle after bottle, night after night. I lost a good job and many friends as my addiction got worse and worse. It wasn’t until my wife threatened to leave me that I knew I needed to get help, but that was easier said than done. I had to hide it, because in my community mental illness and substance abuse are something we hide; if you don’t talk about it, you can pretend it doesn’t exist. I had to find a clinic that could see me late in the evening, because I couldn’t miss work in the fields. The first doctor I talked to just didn’t get me. He kept insisting I should have my family help me with my recovery, but they didn’t even know I was there. That’s probably why half of people of color that go see a counselor never go back for a second visit.1 There are so few behavioral health providers to choose from, and hardly any from my culture, that I might never find one that really gets me, so I’ve had to make do with what’s available. They’re not bad doctors, I just never feel totally comfortable talking to them, which makes recovery that much harder for me. But I can’t keep going without some kind of help, so I’ll take what I can get. I already lost my son; I can’t lose my wife, too.”
+ Readings
Data Source:
- Improving Cultural Competence by Substance Abuse and Mental Health Services Administration
Additional Readings:
- Becoming a Culturally Competent Health Care Organization by Health Research & Educational Trust
- Cultural Competence and Health Care Disparities: Key Perspectives and Trends in Health Affairs
LEARN MORE: the health issues facing Coloradans because of their sexual orientation
+ Perspective
LAURA: “I get so nervous going to the doctor. Even for a check-up. It has been a lifetime of stress and worry for me. I feel so vulnerable even just filling out the health history form. Sometimes there’s a question about my sexual orientation, which at least means I have a box to check; other times there is no question and it feels like I have to keep it a secret. I know “Don’t Ask, Don’t Tell,” the law that forced gay members of the military to keep their true selves a secret because it was illegal to be gay and serve, has been repealed, but we still feel its presence in a lot of ways. I don’t have strong relationships with my family because they never really accepted me as a lesbian. I’ve never felt like I could show affection to my partner in public or be open about my relationship with her. It’s all weighed very heavily on me and I’ve struggled with depression because of it. I was a heavy smoker, too, for many years. I’ve avoided participating in some normal parts of life–like regular doctor visits–because of how much these places weren’t designed for people like me. In fact, 28% of LGBTQ Coloradans report that their sexual orientation has kept them from seeking health care services.1 Since one in five of us has been refused health care services for being LGBTQ, you can’t really blame us, can you? Change happens slowly, I know–it’s not overnight. My younger LGBTQ friends are more comfortable with their identities and in their relationships but they still face discrimination in their workplaces and their kids are teased in school. That’s why I’ve always kept who I really am hidden from most people. I think a great first step would be to help us step out of the shadows more: collect data on our experiences and show the world that we–LGBTQ people–are a big community and we deserve the opportunity to live healthy and productive lives, just like everyone else.”
+ Readings
Data Source:
- Invisible: The State of LGBT Health in Colorado by ONE Colorado
Additional Readings:
- LGBT Inclusion: Good for Families, Communities, and the Economy by PolicyLink
- Understanding the Health Needs of LGBT People by National LGBT Health Education Center
- Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients by Gay & Lesbian Medical Association
LEARN MORE: the impact of race and income on health
+ Perspective
TAMARA: “It doesn’t take a historian to know that black communities like mine have faced discrimination for hundreds of years. It’s hard to talk about race, especially these days, but I’m tired of pretending it’s not the reason families like mine don’t have the same opportunities for good jobs, housing, education, and more. It’s why we live in sight of smokestacks and a freeway that are making by grandbaby sick. My husband, Damian’s grandfather, is nearing what is considered retirement age, but he’ll be working until the day he dies–it’s the only way we can make ends meet. He’s the foreman with a construction crew, and it’s dangerous, demanding work, but after he left the military, it was the only job he could find, and it’s taken him decades to get promotions to where he is today. His boss is younger and has less experience than he does, but he’s white, and sometimes it seems like that’s the best qualification a job applicant could have. You ever hear of the gender pay gap? Well there’s a race one, too. White workers make 22% more than black workers.1 We’re not poor, but we’re far from rich, and we have to make tough choices with our money. Damian’s asthma inhaler and pills are expensive, and our insurance doesn’t cover enough of it to make it affordable. I’ve had to choose between getting his medicine or mine, or between buying his school uniform or a warmer coat for my husband’s days on the jobsite in winter. I saw an article in the paper the other day about how people in my community have shorter life expectancies than in some other Denver communities–by ten or eleven years!2 Some people say that it’s because we have less money that certain neighborhoods have these health issues, but I say it’s just as much about our skin color. I mean, how do you untangle race and poverty? Is it just bad luck that more of our people are poor? Of course having less money is gonna mean you have a hard time being healthy. Good health costs money–fresh food, safe neighborhoods, clean air, and good doctors–all those things are expensive. It’s why my daughter joined the military–so she could make some money to provide a good, healthy life for her son, and I’m so proud of her for it. My family, my community, my culture–we’re strong and resilient, and I know we’ll keep working hard with our heads held high. But why do us black folks have to work so much harder to get ahead?”
+ Readings
Data Source:
- America’s Racial Divide, Charted by The New York Times
- Average life expectancy in Denver can vary a decade depending on neighborhood by the Denver Post
Additional Readings:
- Disparities in Health and Health Care: Five Key Questions and Answers by Kaiser Family Foundation
- Ethnic Disparities in the Burden and Treatment of Asthma by Asthma and Allergy Foundation of America
- Pollution, Poverty and People of Color: Asthma and the Inner City by Scientific American
LEARN MORE: the impact of housing on health
+ Perspective
TAMARA: “The neighborhood that I grew up in was not a safe neighborhood. Gun shots and back alley business. Police always lurking in the background, but it felt like they were more there to protect other communities from us than to protect our community. And then there was the pollution. In the 70’s pretty much every day in the winter in Denver was a bad pollution day, and we didn’t have the luxury of staying inside and out of it. The pollution has gotten better in some parts of the city, but not the neighborhoods we can afford to live in. Between the highways and power plants–they tell me I can’t have a garden because the soil is too toxic! Two generations later and my grandson is still living in a neighborhood that’s bad for his health. No being outside after dark, no backyard to play in, and he has to stay inside some days because the air quality is causing his asthma to flare up. Did you know 40% of all diagnosed asthma among kids is due to exposure to poor housing conditions?1 And now our landlord just told us he’s raising the rent again next year, and we can barely afford it as it is. We’ve had to move before when it got too expensive, and that probably means a longer work commute for my husband and me, and a new school for Damian. It’s not even good quality housing! Our neighbors have some mold in their unit, and then you start thinking–what’s behind these walls? Do we have mold, too? Asbestos? Lead paint? What about our pipes–I know they’re old. Is our water safe? I just worry constantly. The demand for affordable housing is so great, and the supply so small–we’ve got to do something about it. Your home is supposed to be the one place you feel safe when the world is going crazy, but what if your home is what’s making you sick?”
+ Readings
Data Source:
- The Impacts of Affordable Housing on Health: A Research Summary by Center for Housing Policy
Additional Readings:
- Homes for All: Good for Families, Communities, and the Economy by PolicyLink
- Where We Live Matters for Our Health: The Links Between Housing and Health by Robert Wood Johnson Foundation – Commission to Build a Healthier America