Health Equity Champion Profile: Interview with Estelle B. Richman

I grew up in a segregated environment in central Virginia. My father, grandfather, and uncle were all medical doctors who practiced in a segregated environment. It was clear then and in my growing educational years that medicine and insurance were not distributed in an integrated manner. Without insurance, medical options were not available. In many cities, there were only Black hospitals, or “wards” within a white hospital were segregated. As with schools, separate was not equal when it came to health care.

Early on, I knew I wanted to be part of a public system that worked to provide health care at all levels to folks that had little access to a health care safety net. Indeed, in its most basic form, health equity means that all individuals have access to health care. It is not rationed, and need is not denied. In today’s world, advancing health equity means looking at health outcomes across the population and understanding why our minority populations have significantly poorer outcomes. Further understanding the causes of current disparities can lead us to finding ways to incentivize systems to change.

My most constant focus over 48 years of working within public and nonprofit systems has been the integration of services. From my early years of working in the child welfare system to my last position as Senior Advisor to the Secretary of the US Department of Housing and Urban Development, I witnessed how the lives of people most in need of our services rarely have only one area of challenge. Often these individuals struggle with many issues at one time—whether related to housing, food security, physical health, behavioral health, or educational and skills attainment, etc.

Since we as a society often compartmentalize how we fund and deliver care and services, one field frequently does not know of challenges in other areas. Instead, we expect the client to coordinate the services of the professionals. It does not work and has not worked. We as professionals and policymakers must find more effective ways to work together to make the impact of our services more relevant. We must bear the responsibility of coordinating services, not the client. If we understand the social determinants of health, we must realize all players have a value-added role to play in improving outcomes.

It is tough to choose just a few examples because I have had many wonderful connections to families and communities that have worked. Early in my career in Cleveland, I worked as program director for a center that provided educational services for children with severe behavioral problems. In that role, I wanted to ensure that parents were involved in the development of the Individualized Education Program (IEP) for their children. For instance, on one occasion, three of us met with a mom in a parking lot booth who otherwise would not have been able to participate in the IEP process. The mom felt included, which changed her attitude about the school and her child. She talked with other parents, which created a spirit of inclusion for the school and community.

While at the Philadelphia Office of Mental Health, I often asked parent and community groups to write first drafts of proposals or policies. It was helpful to have their perspectives and insights. On several occasions, these documents could be used with minimal editing. There are many examples from the Department of Public Welfare/Department of Human Services, but the most significant were in relation to the Bureau of Autism services.

Prior to the Rendell administration, individuals with autism could access a few funded services within the Office of Mental Retardation but only if they had a Mental Retardation diagnosis. After appointing a leadership group of three stakeholders (a parent, researcher, and practitioner), we organized a conference of parents – constituting 75% of attendees – and community leaders to design and plan an autism system. Parents took charge and designed a system that would support their children from infancy through adulthood. It was thorough and responsive to families. Most of all, it worked. We created and delivered services with funding from waivers that the Bureau submitted to the Federal Government. Today, the Bureau continues to have leadership from families and to update their research, delivery style, and outcomes.

I considered the job at Positive Education Program (PEP) to be my ideal position. I did my school psychologist internship there and then spent the following nine years moving from school psychologist to assistant director. I learned about schools, children, families, juvenile court, children’s mental health, and autism. The experiences at PEP shaped my professional passion around children and families. PEP is a re-education program that adopted the philosophy of Nicholas Hobbs. Dr. Hobbs developed twelve principles of re-education. Two of the principles spoke directly to my passion. The first principle is: “Life is to be lived now, not in the past… .” The twelfth principle is: “Know joy each day; in growing up, a child should know some joy in each day….” We used education to teach behavioral control through positive interactions.

My experiences at PEP led me to all my subsequent professional experiences. I used those lessons over and over again! My brief tenure with the School Reform Commission gave me an opportunity to complete the circle and again try to set the stage for education through positive interactions. I believe to this day that child well-being is best achieved if we can assure that each child experiences some joy every day. The lessons learned at the beginning of my career have served me well.

Research has shown us that the earlier we can identify stressors and challenges, the higher the probability that we can find solutions to relieve them. Children are resilient if we can recognize the issues early on and address them. A focus on all aspects of early childhood including social determinants is critical. The longer we wait to bring supports to the family, the more difficult it will be to resolve the stressors. While we cannot abandon our initiatives for older children and youth, our best long-term results will come from intervening early in life.

We know so much more about the development of the brain of a young child than we used to and are continuing to learn about how they process information and how and why they are unable to process information. Helping young children to understand their world and thrive involves engaging everyone who interacts with children and families: from people working in prenatal care and home visiting to those striving to provide safe childcare and appropriate educational experiences that address all social determinants.

These days, my passion is derived from knowing how far we have come over the decades in which I have be working to promote equity in its various guises and thus feeling assured that we can continue to create environments for families and professionals to learn, grow, and change. I consistently meet young professionals who are eager to change their world, and I am excited to offer support.

I serve on six nonprofit boards and two foundation boards. I continue this degree of commitment because it gives me an opportunity to share my experiences and to nurture upcoming leaders. I am particularly passionate about foundation boards because there we are able to shape policy by funding research and nourishing new ideas and approaches.