Why Nashville health department's move away from 'health equity' title is a step backward

The Nashville Metro Public Health Department has made a highly regressive decision to replace the bureau director of health equity role with that of a bureau director of people and culture.

There is a difference and here is why this decision is incredibly harmful.

The change indicates a reduction in health equity work that strives to ensure everyone has fair opportunity to access health care. The reduction will largely impact minority groups who compose about 40% of Nashville’s population according to the 2023Census and historically have lower medical care access rates.

Given that Nashville is projected to become a majority minority city by 2040, it is increasingly prudent that minority groups are better supported, but this MPHD decision will lessen the aid they receive.

The new bureau director of people and culture will now be responsible for human resources along with health equity. In the August listing of the 12 typical duties for the new director, only two were health equity-focused. Since then, the listing has been updated to include more health equity-focused duties due to backlash but still reflects a majority of HR-related responsibilities.

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Nashville made a systemic win on health equity that will be undermined

This decision to dissolve the Health Equity Bureau and to displace a health equity focus in the director’s role with mainly HR tasks (a completely disparate field) is concerning, to say the least, and will have detrimental consequences on the state of health in Nashville.

When I contacted the Nashville Board of Health, I was informed that the department does not want to “silo health equity” by having a health equity-focused bureau. They insist that the board and Department of Health still consist of several individuals who care about health equity.

While there are certainly hard-working people who care about health equity within the board and MPHD, it is fundamental to have employees and leaders whose main priority and responsibilities are dedicated to advancing health equity.

Eradicating the Bureau of Health Equity reverts a systemic win for Nashville that we achieved just two years ago and leaves us dependent on unreliable, smaller, variable wins that arise from individuals with other primary obligations.

Health equity is an 'imperative, not just an accessory'

Dr. Jonathan Metzl, director of the Department of Medicine, Health, and Society at Vanderbilt University, notes that this change reflects an “alarming move away from health equity as a frame and also as an objective focus, particularly in the aftermath of the Supreme Court decision (ending Affirmative Action) and what has been happening in southern states.”

He adds that “cities, states, and even universities are concerned that equity-specific offices are political or legal liabilities. And, the Supreme Court decision gives people who didn’t buy into the goals of such offices in the first place an excuse to do away with them.”

Health disparities based on race and socioeconomic factors are real and proven based on data (i.e., American Heart Association report on racial disparities in hypertension), and it’s amiss and unjust to ignore them. Thus, working on health equity is an imperative, not just an accessory that should appear and disappear as beneficial to the entities that hold such offices.

Nashville health department should go back to its old model

Changing the language we use has consequences, and in this case, highly negative ones. Refusing to use the diction “health equity” within the director role indicates a troubling shift.

As Dr. Metzl says, “Decades of progress are being washed away,” and we “need a health strategy and a political strategy” to address these regressive steps.

My hope is that the Nashville MPHD will reverse their decision to replace the bureau director of health equity role with that of a bureau director of people and culture, and keep pushing the needle forward rather than backward as we rally together to make Nashville a more equitable and healthy place.

Suman Mohanty is a Cornelius Vanderbilt Scholar and undergraduate student at Vanderbilt University. She is also a researcher for the Stanford School of Medicine and was one of the youngest presenters at the 2023 American Transplant Congress. Additionally, she is highly invested in public health as Co-President of Vanderbilt Partners in Health among several other health-related organizations.

This article originally appeared on Nashville Tennessean: Health equity post: Nashville changing a job title is a step backward