Public health leader Natalie S. Burke will present the keynote speech at NeighborWorks America's upcoming symposium, "Co-creating an Equitable Future at the Intersection of Health, Housing and Community Development." Burke, president and CEO of CommonHealth ACTION, works to help 
organizations understand the root causes of health inequities and how solving those inequities can improve outcomes.
NeighborWorks asked her a few questions to learn more about her and her strategies.
Why is health a field where equity is especially important?
Absent equity, people experience an unfair burden of illness, disease and early death. Those burdens are preventable, avoidable and unjust. When we choose to pursue equity, we are deciding how we will be in relationship with one another and how we can create fair opportunities for all people to achieve their best possible health. If we work together, if we value people equally and treat them equitably, we can achieve that.
How do you see health as interconnected with housing?
Your health is not an accident, it's a production of society. It's about 10 to 20% genetic, 30 to 40% based on personal behavioral choices. Do you eat right? Diet? Exercise? Engage in risky behavior? Wear a seat belt? Wear a condom? Wash your hands?
But the other 40 to 50% of health and production of that health is based on the systems and institutions that create the context in which we live our lives and make decisions. We know in public health that housing is a critical component of that. And the reason for that is that when inequities in housing exist, opportunities for health are limited and sometimes nonexistent. We find that when people live in unsafe housing, sub-standard, unstable housing, they experience exposure to lead, poor air quality, toxins and overcrowding that often lead to chronic disease and unsafe conditions that perpetuate injuries. By stabilizing individuals and families into safe and quality housing, we stabilize whole communities. In that process, the production of health has an advantage. Health becomes possible and at times, it becomes the probable outcome.
Do you remember when you first felt you had the power to do something about addressing inequities?
Having done extensive work in the Mississippi Delta, in New Orleans, post-Katrina, in Albuquerque, New Mexico and the Port Towns in Maryland and in over 100 other communities, I had the opportunity to work with community-based coalitions as they created and led change to improve health outcomes. CommonHealth ACTION helped them to develop the capacity to change policies, practices and systems, and cultures that support health equity. Seeing a sector plan adopted that radically changed the built environment; the emergence of youth leadership in communities; and the inclusion of community partners in local and state decision-making processes – those were the moments when I knew my work and the organization's work was making an impact.
Define "constructive discomfort."
In my work, my focus is on something called perspective transformation, an adult learning theory by Jack Mezirow. In essence what it says is: When you know, think and believe something different, you will decide, behave and act differently. For that to happen, we must experience some form of discomfort. Discomfort often precedes great change. So constructive discomfort is asking the hard questions, provoking different thoughts, helping people find new solutions to old problems. The key is to do that in ways that make them feel uncomfortable but not paralyzed by their fears of the unknown or change. My job, whether serving as facilitator, leader or keynote speaker, is to orchestrate that discomfort. I work to unsettle old thoughts and ideas. This creates new opportunities and perspective transformation that are necessary to make health and equity possible.
What do you do and why do you do it?
I went into public health because of my own lived experience. When I was 19, my grandparents, who I grew up with in a multi-generational household, seemed to become old overnight – at least to my mind. They had tremendous difficulty navigating healthcare systems when they moved to Georgia from New York. I wanted to understand why by exploring policies and practices that create conditions in which it is impossible for some people to be healthy. I don't believe that's how we should live in relationship to one another. I believe we should give people every opportunity to make choices and have everything they need to be healthy.
CommonHealth ACTION is a manifestation of my hopes and dreams on how to make health — good health — accessible to all people regardless of socio-economic status, racial or sexual orientation, gender, age or mental ability. We should all have fair opportunities to be healthy. I first engaged in this work because I wanted to make the world a better place for my grandparents. In that, I explored public health, learning that health really is a production of society, and I could be a part of producing better outcomes.
What was your first job and what did it teach you about equity?
As soon as I turned 14, I wanted a job and got one at Dougherty's Pharmacy in Laurel, Maryland. It was an old-school pharmacy that had been there for a very long time. I worked the soda fountain and the cash register. In terms of what it taught me about equity, I don't know that Mr. Dougherty knew this, but he created the conditions where I had the opportunity to be successful. He arranged the hours I would work, the pay I would receive and expectations for me on the job and did it in a way that was tailored to fit my needs, skills and abilities as a 14 year old. That's what equity is about, creating the conditions for people to get to their best possible outcome. I used to make, I remember, it was $46.73 a week. It was a huge deal.
Would you finish this sentence? To have a healthy society, we first have to … value people. Not in spite of who they are but because of who they are. When we can do that and see value in one another, I think the rest of it begins to fall into place. The dynamics of racism sexism, classicism, ageism, ableism and xenophobia all start to fall away because we see value in one another as full human beings. That is the first big step. After that, public policy will fall in line. The way we allocate resources will reflect that mindset. When you can value someone as much as you value yourself or as much as you value the person you love most in world, it doesn't get much better. That's when I believe our decisions and behavior and actions change. In an abstract way, I'm talking about love.
What does power mean to you in health equity work?
When you look at people living in poverty, their health outcomes are worse. Those health outcomes are worse for many reasons, the biggest being that they live in a state of chronic stress. That's triggered by two things: One is trauma and the other is a persistent feeling of powerlessness. When you live in poverty, your ability to define your own reality is limited or nonexistent. So power is a critical component to health equity existing or ever becoming a reality. The experience of power, access to power, how power is used or misused all factors into whether or not good health outcomes become possible for all people. So power is that ability to define reality for yourself and others. When we can make power accessible to every single person, every single household, we have a much better chance to extend life expectancy — and better yet, healthy life expectancy — across populations, across populations, communities and across people.
One more thing we should know?
Language is really important to me. I think there's power in how we talk about health equity and how we talk about equity in general. My hope is part of what I can share with people is not only a way to think about it, but a way to talk about it.
The symposium will be held Feb. 28 from 8:30 a.m. to 4 p.m. during the NeighborWorks Training Institute in San Francisco. Registration is open until Jan. 29.
01/10/2024
