The statistics are startling to most of us, but, unfortunately, probably not all that surprising to people working in public health. According to the Centers for Disease Control and Prevention (CDC) Black people are 1.4 times as likely to contract COVID-19 than their white counterparts, 3.7 times as likely to be hospitalized and 2.8 times as likely to die from the disease.
Last week, the first installment of ACE’s Black History Month Dialogue Series was hosted by Cedric X. Bryant, PhD, FACSM, ACE president and chief science officer. Joining him were Antonio Williams, PhD, associate professor at Indiana University Bloomington, School of Public Health and a member of the ACE Board of Directors, and Rory James, MPH, director of the Office of Student Diversity and Inclusion at Indiana University Bloomington, School of Public Health.
The wide-ranging conversation began by focusing on exactly why those numbers are so elevated for the Black community. According to James, one primary factor involves comorbidities and the burden of disease. Certain chronic conditions wreak havoc in the Black community, including hypertension, diabetes, obesity and asthma, all of which are devastating underlying factors for people who contract COVID-19.
It’s important to also consider social determinants of health, such as access to healthcare providers (as well as to transportation to and from those providers) and insurance coverage, including those who are under-insured. In addition, there is a historical distrust and skepticism of the medical community among blacks (here, James cites the horrific Tuskegee Syphilis Study, which lasted for 40 years before it ended in 1972 but is still fresh in the minds of many Black Americans). Unfortunately, as James points out, this distrust will likely extend to decisions about whether to take the vaccine, which may expand the racial divide evident in those CDC statistics.
Dr. Williams also points out that most minorities live in metropolitan areas where there’s not as much space to be six feet apart and often work in essential jobs in the community and are therefore not as able to isolate and stay safe. “It’s a domino effect,” explains Dr. Williams. “They’re at higher risk because they’re exposed more, but you also have those underlying chronic conditions. These non-communicable diseases that we have in the African-American community… really exacerbate the virus itself and lead to more hospitalizations, and, unfortunately, because of the racial issues we have inside the healthcare system, this could also lead to premature deaths that could have been prevented.”
Impacting Change on the Local Level
Health coaches and exercise professionals are positioned to play key roles in addressing or even reversing some of these inequities. You know the benefits of physical activity and can clearly and effectively communicate those benefits. You also know the constraints and barriers people face, as well as strategies for anticipating and overcoming those barriers. The next step is to find ways to deliver that messaging to communities that need it most.
All of the panelists agree that there is a knowledge gap, and that creates an opportunity for health coaches and exercise professionals to broaden their reach by providing resources and strategies to vulnerable communities.
James has a message for people who work in the fitness industry: “You are a part of public health.” If you are not part of the Black or brown communities, James recommends doing research or completing professional development on how you can do outreach effectively.
“You have to go where the people are,” says James. This may include places of worship or senior centers. It may also mean leveraging the fact that people are growing used to Zoom meetings and virtual gatherings. Perhaps you can take advantage of that to reach people you’ve never reached before.
“I challenge fitness professionals to look at themselves as activists,” says Dr. Williams. You can campaign for increased opportunities for physical activity in local communities and challenge policies that hinder the opportunity to be physically active. According to Dr. Williams, a lot of Black people live in communities that lack green space, may not be walkable, don’t have proper lighting, lack parks and recreation facilities and are food deserts. You can educate policy makers and key stakeholders about why people may be physically inactive or eat less healthfully in certain communities and offer solutions to help address the problem.
Defining Equity, Diversity, and Inclusion
These three terms are often used collectively, but it’s important to think about what each of those terms means on its own.
Mr. James always starts this conversation with inclusion. As he explains, you can have diversity and representation in terms of the numbers coming through the door of your facility, but you don’t have true inclusion unless Black, brown and other under-represented groups feel included in the space.
Inclusion means the creation of “places where people feel accepted, valued, honored and appreciated,” says James. “Welcome me, accept me, and celebrate me in this space”—that is inclusion.
When thinking about diversity, ask yourself, “Are we seeing all of the identities that we can possibly see in this space?” Think beyond race. Consider varying abilities, different faiths, and all the other dimensions and complexities of identity.
Finally, people often confuse equality and equity. Dr. Bryant explains that equality means “providing the same to all. Equity is more nuanced and involves recognizing that we don’t all start at the same place. So, we’ve got to acknowledge that and we’ve got to make adjustments for those imbalances that exist.”
Dr. Williams agrees. “You can’t provide the same services and support to everyone,” he says, “and expect the same results. We all have unique starting points.”
Having More Seats at the Table
Dr. Williams is optimistic about progress he sees in the fitness industry in terms of people and businesses being more mindful of the images and messages they’re using to market their products or services to people of all backgrounds. That said, there is still an underrepresentation of Black people in fitness facilities, and in the leadership of those facilities.
“Giving someone a seat at the table doesn’t mean that you have to pick your things up and leave. Just bring a chair with you,” explains Dr. Williams. “If you have a seat at the table in the fitness industry—whether you’re on the corporate side, you’re an allied health professional or you’re a health coach—bring another chair to the table and let someone else sit at the table, as well.”
James concurs: “Be intentional. Bring others to the table who may not look like you, who may not think like you, so they can have input.”
There is tremendous value in having diversity in leadership, as understanding cultural differences in how people come to physical activity is complex. An understanding of those differences and the potential barriers they create requires a diversity of experiences, both personal and professional. Gaining this understanding by welcoming new voices to the conversation will allow you to reevaluate how you serve your clientele, and how you communicate, inspire and empower them.
You may be nervous about offending someone when having difficult conversations. “You’re never going to offend someone by speaking to their spirit, speaking to their heart, speaking to their soul, and coming to them with a sense of ‘I want to help,’” says Dr. Williams. “No one would ever penalize you for trying to do those things.”
Putting yourself out there requires you to overcome fears of not being accepted because you don’t have all the answers. Outreach into new communities requires cultural intelligence and cultural competency. It also requires creativity, curiosity, bravery and humility.
You have to be able to acknowledge that you may not have the same background or experiences as the people you are hoping to serve. That said, health coaches and exercise professionals are positioned to help people—all people—live their absolute best lives.
Doing so will require focused and intentional efforts, a willingness to be comfortable being uncomfortable and an open mind and an open heart. You likely entered the fitness industry because of a deeply held desire to help people achieve optimal health and wellness. This may be the perfect moment to embrace a personal and professional evolution that allows you to expand your reach and your impact into those communities that need it most.