Enhance Urban Life Through Diversity, Equity and Inclusion

The Big Picture

• America’s cities are increasingly diverse, but diversity without equity and inclusion is problematic.
• City residents from historically excluded groups (HEGs) face critical inequities related to healthcare, environmental living conditions and business ownership. 
• To strengthen our nation’s cities and enhance urban life, policymakers should prioritize inclusivity by removing systemic barriers in how vital resources are provided and allocated to residents.
• Doing so would improve the well-being and quality of life for all city residents, bolster community engagement and drive economic growth.

Summarizing the Issue

Roughly 80% of the U.S. population live in cities, and diversity within U.S. cities is on the rise. Diversity can focus the representation of various identities within a population, such as race, ethnicity, age, disability or gender identity. However, many measures of diversity within cities focus on racial and ethnic representation because members with these identities are among the many HEGs in the U.S.

While greater diversity can be advantageous, many urbanites from HEGs face disparities in critical areas of urban life, including healthcare, environmental living conditions and business ownership. So, increasing diversity within cities without expanding inclusion and equity can be problematic because the quality of life for every resident matters.

Inclusion exists when every resident feels respected, valued, and invited to fully participate in the benefits of urban life. Equity is achieved when every resident is treated fairly and has fair access to resources that give them equal opportunities to thrive. Infusing urban life with greater inclusion and equity would improve the well-being of city residents, bolster community engagement and drive economic growth — all essential elements of strong cities.

Expert Analysis 

Health Equity 

Quality health care is abundant in most cities, but the lack of inclusive experiences create health disparities that impede health equity in medical care, clinical research and public health planning:

• Many people of color experience discrimination during health care visits, and many immigrants find it challenging to find care that is respectful of their culture. Elevating the cultural competency of physicians and enabling patients from HEGs to be served by at least some physicians who reflect their identities would improve their experiences and increase their willingness to seek care. 
• Lack of diversity among clinical trial participants negatively impacts health care access and outcomes. Ultimately, clinical trials are conducted to ensure that new drugs will be safe and effective when approved for usage and/or insurance coverage across a large population of patients. However, people of different races, ethnicities and ages respond differently to drugs and other medical products. So, health equity cannot be realized fully without more diversity among trial participants.
• Clinical researchers must address factors that contribute to lack of sufficient diversity among participants when they recruit from diverse populations. Distrust of the healthcare and medical research community is a major barrier for researchers to overcome with some patients from HEGs. Using more inclusive recruitment processes to foster greater trust could motivate more patients from HEGs to volunteer for participation in clinical trials, leading to more equitable health outcomes.
• Most local health departments within the largest cities do not focus explicitly on racial health equity in their public health plans. Including explicit racial health equity goals would not only acknowledge this need but also likely motivate city health leaders to take proactive measures to solve this complex problem.

Environmental Justice 

Environmental justice exists when everyone has equal protection from environmental threats — but it does not exist for many urbanites from HEGs due, in part, to residential segregation among neighborhoods that persists even within large, diverse cities:

• Urban environmental threats include both natural and built hazards, such as heat islands, that can trigger disparities in physical and mental health risks.
• City residents from HEGs are more likely than other groups to live in heat islands, many of which are located in historically redlined neighborhoods. They suffer disproportionately from greater heat- and air quality-related illnesses and financial costs associated with cooling their often less-energy efficient homes.
• Neutralizing environmental threats could reduce environmentally-caused chronic and life-threatening illnesses, protect those with illnesses that are aggravated by poor environmental conditions, and result in higher quality of life.

Equity for Entrepreneurs and Small Business Owners

Small businesses fortify local economies, but entrepreneurs and small business owners (SBOs) from HEGs face unique barriers to success:

• SBOs who are Black, Hispanic, or Asian are less likely to be fully approved for various types of financing compared to their white counterparts.
• Beyond financing, SBOs from HEGs, especially entrepreneurs, need greater access to local entrepreneurial ecosystems, such as banks, investor communities and universities. Access to these ecosystems would not only support their own success but also benefit local economies by attracting new businesses and a strong workforce.

If critical disparities such as these and others are allowed to persist, every city resident would suffer the consequences of limited economic growth and community engagement, affecting their quality of life. Thus, fostering greater inclusion and equity across health, environment and industry is an essential component of enhancing urban life and building strong cities.

Policy Actions

To foster equity and inclusion across U.S. cities’ diverse populations, policymakers should consider the following to bolster urbanites’ personal, environmental and economic well-being:

Health Equity 

1. Provide consistent, sufficient funding for the federal Community Health Center Fund, which supports health centers that provide care to many medically under-served populations as well as programs aimed at developing culturally competent primary health care workers across facilities through the National Association of Community Health Centers.
2. Increase the budget for the National Institute on Minority Health and Health Disparities, which conducts and supports research inclusive of and disseminated to minority populations to help reduce health disparities.
3. Support collaborative efforts, such as Advancing Inclusive Research, that offer comprehensive strategies for diversifying participant pools for clinical trials.
4. Urge local health departments to revise public health plans to include goals related to racial health equity and offer sufficient funding to achieve these goals.

Environmental Justice

1. Change the name of the “Mayors Climate Protection Agreement” to the “Mayors Environmental Justice Pact” — reflecting the fact that both natural and built environmental threats have disparate impacts on residents — and increase support for policies and programs that align with the goals of mayors who enter the pact.
2. Increase funding for community-based environmental justice efforts, such as Environmental Protection Agency’s (EPA) Community Change Grants and NAACP Center for Environmental and Climate Justice, that empower affected stakeholders to create initiatives most relevant for their communities.
3. Ensure that the EPA’s 2023 Equity Action Plan initiatives are renewed and updated regularly.

Equity for Entrepreneurs and SBOs

1. Sustain the recent, positive trajectory of U.S. Small Business Administration (SBA) loans to SBOs and entrepreneurs from HEGs.
2. Support policies and federal programs, such as the Capital Readiness Program, that assist entrepreneurs and SBOs by providing broad-based information and educational opportunities related to launching and managing a successful business.
3. Advocate for public-private partnerships, such as Forward Cities, that collaborate within local entrepreneurial ecosystems to elevate equity and inclusion.

The Bottom Line

To strengthen our cities and enhance urban life, policymakers should work to provide health equity, environmental justice and equal access to resources for entrepreneurs and SBOs from HEGs. Doing so would enhance urban life for all residents and contribute to the economic growth and success of our cities.

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