We talked with Robin Pfohman, Community Resilience + Equity Program Manager at Public Health – Seattle & King County, about her work with vulnerable populations affected by disasters to better understand how public health professionals can address health recovery needs after major disasters like hurricanes. During this interview, we used the phrase groups impacted by inequity, a phrase Robin and her team coined to more accurately reflect the systemic and structural issues that contribute to some populations being more vulnerable than others before, during and after an emergency.
This conversation has been lightly edited for length and clarity.
When we started our program back in 2006, it was after Hurricane Katrina. We were having survivors from Hurricane Katrina come here, and we really didn’t have great systems in place. There was some acknowledgement by several health staff that that if we had the same type of emergency event here, we would have had the same really horrible disproportionate outcomes on communities that happened there. So, we were really focused on mitigating disproportionate impacts on a number of communities.
[We realized there are] groups are facing inequities every single day because of institutionalized bias and racism in policies and systems, [which] shows up in health outcomes. When I present to groups, I often share a map that shows the significant disparities that exist in health outcomes for the poorer, and most diverse parts of Seattle compared to the white, wealthier part of the City. This same map exists in nearly every city in the country and not in just health outcomes but in education, criminal justice, and income. It wasn’t an accident that our communities look likes this.
When did you begin seeing this trend toward prioritizing the experience and unique needs of groups impacted by inequity and what do you believe drove the movement in this direction?
Initially, the program focused on training community and faith-based organizations on their agency emergency planning to make sure they were prepared to withstand an emergency and to continue to provide services. We also worked to establish a communication network that includes after-hours contact information for community organizations. At this time, the program’s scope was narrow. We weren’t thinking of it broadly, not in a way that acknowledged the systems issues that contributed to the poor outcomes for people of color as a result of Hurricane Katrina. It should have been exceedingly obvious. The communities that did poorly were the same groups that always did poorly – the same groups that do poorly on nearly every map measuring health outcomes in this country. The communities that have been intentionally marginalized by policies such as red-lining, segregating schools and bias in hiring practices.
We can’t achieve resilience if we have segments of our communities struggling to survive on a daily basis – let alone after an emergency. To have a truly resilient community, it will require that we confront the history of institutionalized racism in our country, in our cities and in our neighborhoods. We must hire more people of color to do this work and integrate lived experience into our planning.
When we started this vulnerable population action team, it was pretty narrow in scope. We weren’t thinking of it broadly, not in a way that was really about why the people didn’t do so well in the Hurricane Katrina. Of course, the situation was to have that outcome because communities have been neglected. Communities had been marginalized; people were already really suffering from health inequity and inequality for centuries. As we look to mitigate those disproportionate impacts, it really is for me about addressing racism, institutionalized racism, and inequity in our systems and hiring more people of color to do this work. What I’ve been trying to do is build systems to leverage the health expertise that already exist in communities to address inequities everyday within their community.
One thing that really changed a lot of my work and was a big teacher to me was a big wind here and ice storm [in 2006] where we lost power for an extensive period of time during a really cold weather event. We had hundreds of people showing up in emergency rooms with carbon monoxide poisoning and 8 residents died. It turned out that many refugee and immigrant communities – new to our area -were bringing charcoal grills inside to keep warm and to cook as they would have done in their home countries, not realizing our housing is very different. Also, several deaths were caused by the placement of a generator in an attached garage. This experience, along with some missteps in our outreach efforts during H1N1, led to a project focused on developing sustainable emergency communication systems with the Somali community in King County.
One aspect of the project that made a significant difference is that I contracted with a Somali man who had a Master’s in Public Health from University of Washington. After conducting interviews with community leaders and learning about the many priorities and concerns within the community, when it came time to identify a mechanism for emergency communication, meeting quarterly about health priorities of the community became the avenue for sustainability. The first meeting of the Somali Health Board (SHB) was in July 2012. Since then, the SHB became a non profit organization, helped Public Health respond to measles and mumps, and kept the Somali community safe during snowstorms. In addition, the SHB sits at policy making tables related to healthcare transformation and mental health.
In 2017, we helped establish 8 additional community health boards and brought them together to form the Community Health Board Coalition. Public Health staff of color participate in several of the individual health boards as well as the Coalition. As a white woman working on equity, I’ve learned (sometimes the hard way) that I need to step back and let people of color lead the way.
What first steps do you believe public health professionals and emergency responders should take to begin integrating this focus on groups impacted by inequities in their disaster-related health recovery efforts?
It’s really about building trusted relationships and partnerships – which means acknowledging the wisdom of communities and sharing power. We’ve been most successful when we’ve initiated partnerships that combined emergency communication with the health priorities of communities. We didn’t go into a community with a narrow focus that prioritized our agenda. Developing sustainable communication systems required building relationships that are trusted over time aren’t centered solely on emergencies. Health inequity is a daily emergency in so many communities. It required needing to leverage health experts within a community to come together to address everyday health disparities with support and membership from other health system partners- including Public Health-Seattle & King County.
If we had approached the Somali community with the narrow focus of emergency preparedness, and that it would somehow increase their resilience and establish a communication mechanism that was going to last, [we would have been wrong]. But [the fact] that we were really open to the possibility of not even knowing what it would end up looking like, allowed it to it surpass what we could even have imagined. [In addition to] building those relationships, [you have to find] people to hire from communities who represent [the populations you want to reach]. One of the things we’ve been really focused on is trying to [make sure] our Public Health Reserve Corps [and] our staff within the Public Health Department and King County represent the community and reflect the community that we serve.
What systemic and institutional barriers or challenges may public health professionals and Emergency responders encounter when trying to shift their focus to include these groups?
Well, lack of trust, for sure. I think institutional and systemic racism results in distrust, how could it not? A lot of communities… And I’m just thinking if you’re a responder out there. I mean, there’s not historically been good relationships between government and police and communities of color. Particularly, those impacted by inequity, which are most communities of color. And a lot of the institutionalized white privilege and white supremacy, essentially. I don’t know how many responders are really willing to look at that, but really… I mean, a lot of this work requires that white people acknowledge the intentional systematization of white privilege and commit to undo it. And that requires education, internal reflection and a willingness to let go of privilege.
I’ve been working on this myself, and it’s been hard. I do feel like I do this work not as a white savior but from a desire to be connected to all people. Racism separates us from humanity, from ourselves and from each other. To be honest, the Community Health Board Coalition asked me to stop coming to their meetings because they didn’t need some white girl there. I was kind of approaching it as like my job initially, but I didn’t get it when it kind of transitioned to being something different than that. It wasn’t so obvious to me at that time. I can’t be a part of it in that same way, right? That’s the first time I felt like that racism really hurt me personally. It does create divisions that are really painful. I guess it’s going to take white people, and I think particularly white men, to really kind of own white privilege is diabolical, it’s inhumane and it’s killing people.
From that perspective, yeah, really it’s starting to look at, “Okay, so what are the systemic influences? Why are people of color living in flood zones or areas of the country that might be more vulnerable to hurricanes? Why isn’t information about preparedness and safety reaching these communities? Why can’t communities like this afford to be prepared?” Because they haven’t had access to good jobs or good education for a long time – intentionally.
So I think there’s a lot to it. I think that the emergency situation just magnifies the existing institutionalized and systemic racism and the inequities that exist every day. It becomes more obvious in an emergency….but it’s always there and has always been there.
What’s the most significant thing you’ve learned doing this work around community resilience and equity?
Well, that communities are incredibly resilient. Communities of color that I’ve worked with in particular – they’ve had to be. We used to [say] the Somali community were in that vulnerable population category because they didn’t speak English well, in general. But [we learned] they are an incredibly powerful community who know how to advocate for themselves and others. [I’ve also learned] that idea of FEMA knows best or public health knows best [should be shifted to] communities know best. How do we start listening to them and reinforcing the capacity that already exists, rather than us trying to do it all? Because we can’t. The mainstream way of doing this work doesn’t work.
What resources and tools would you recommend to public health professionals and emergency managers to help them better understand how to include groups impacted by inequity in their health recovery efforts?
[It’s also] about getting out there, getting into the community, building relationships, [and] listening. I think public health is a really good partner to emergency managers. I also think emergency managers should look within their own jurisdictions to human service planners who are already probably engaged. But what I would really emphasize is the hiring of people from the communities, as well, and making sure your office reflects the community you serve. Because you’ll have a lot of resources and tools built into your team by having a varied experience and representation.
What additional progress do you hope to see around, including groups impacted by inequity in the next few years?
I guess the progress I would like to make first is, emergency management where they’re recognizing that there’s a reason that disproportionate outcomes happen in their community and that they need to be paying attention to institutionalized racism and systemic racism, and work to change it.
About Robin Pfohman
Robin Pfohman has worked to address health disparities caused by emergencies for the over ten years. As the manager of the Community Resilience + Equity Program at Public Health- Seattle & King County, Robin collaborates with internal and external stakeholders, identifies systems issues and builds programming to address disproportionate impacts in emergency response and recovery planning.
Robin is particularly interested in strengthening everyday systems so that our community will be more resilient in disasters and in the face of climate change. She frequently speaks on issues related to equity in emergency and climate change planning at conferences and convenings in public health and resilience circles. Prior to joining the Preparedness Section, Robin served as a program manager in the Community Health Services Division of Public Health.
Robin has over 20 years of experience in public health, working on such issues as school based health; Medicaid managed care, and community engagement/partnership development. Robin has committed her career to system integration and alignment on behalf of undeserved communities. Robin received her MPA from the University of Oregon and completed her undergraduate degree at the University of San Francisco.
For more information on King County’s Community Resilience + Equity program, visit here.
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