Questioning the American Dream: Judith Warren on the Ties Between Economic Mobility and Healthcare
Judith Warren’s career could be described like glitter: Once she touches something, she leaves a bit of shine behind. In 1993, she arrived in Cincinnati to become the C.E.O. of the West End Health Center. She then moved to the Health Foundation of Greater Cincinnati (now Interact for Health) and eventually became the founding C.E.O. of Health Care Access Now. Judith’s work has consistently shed light on health-related problems and fought to solve them for all people. Now retired, she’s still working to bring brightness to underserved communities through her sorority, Delta Sigma Theta, and serving on the board of numerous nonprofits. We spoke with her in July, and I’m in awe of her. Her advocacy for the Black community, especially Black women, offers me hope in our centuries-long fight to dismantle systemic racism which plagues the healthcare industry as much as any other.
Women of Cincy and the Women's Fund of the Greater Cincinnati Foundation are teaming up to bring you six stories spotlighting the economic mobility of Black women in Cincinnati. “Questioning the American Dream: A Look at the Economic Mobility of Black Women in Cincinnati” supports the Women's Fund's “Historical Analysis of Black Women's Labor Trends and Systemic Barriers to Economic Mobility” study.
These are the stories of Black women navigating life in Cincinnati. We believe telling stories changes things; we believe listening changes things. We promised our community we would tell their stories. It's up to you to listen. Visit womenofcincy.org/economic-mobility for the full series.
The following Q&A is based on the interviewee’s firsthand account of their experiences and opinions alone.
Look for editor's notes with additional information in [bold brackets] throughout the article.
Interview by Sandra Okot-Kotber. Photography by Chelsie Walter.
Tell us a little bit about yourself.
I grew up in Hampton, Virginia; lived there until I graduated from high school and then went to school in Nashville at Fisk University. After graduating from Fisk, I went on to grad school at the University of Michigan and got a master’s in public health, and so that kind of started my career. I stayed in the public nonprofit sector for 40 years. I just retired from my service in the community. I am a mom of two wonderful sons, and I have three grandchildren.
You mentioned that Cincinnati was challenging to get acquainted with when you moved here. What were the obstacles?
Well, you know the two questions that you get asked: Did you go to high school? Where’d you go to high school? Like that even matters. If you can't answer those two questions and you didn't come here to work for Procter and Gamble, then you might struggle.
I came here to run a nonprofit community health center that was not in the best neighborhood (because community health centers usually aren't). They serve the uninsured and the under-resourced. It wasn't a prominent position. It took awhile to kind of maneuver, if you will, and make connections with people.
I had to do things to prove that I was capable, that I was professional. I did have a couple of mentors I definitely want to acknowledge: Eddie Sellers, who was one of the founders of the West End Health Center, which is no longer open. I could certainly call on her for advice and to guide me through the West End politics. That's also the neighborhood that Senator William Mallory came from and his son, Mark Mallory, the former mayor. His presence was felt in the community, so I could kind of feel his support from afar.
Then Dolores Lindsay, another trailblazer; she's kind of like the matriarch of community health centers, certainly here, and has been nationally recognized through the Association of Community Health Centers.
How have you seen the West End change over the years?
The West End was one of the most vibrant communities for African Americans, whether it was through the community life, the social entertainment life, Ezzard Charles (the boxer that came from the West End), so you had so much rich history there. Of course the I-75 construction split the West End, so now you have Queensgate and the West End. It's lost its community, whether it’s redlining or the redevelopment of the Hope IV project that was supposed to kind of stabilize and bring life back to the West End… It really didn't. During the time of the construction of the new housing, people had to move and they were relocated – some in Forest Park or the West Side or other communities, and they didn’t come back. [Prior to the construction of I-75 the West End was home to 25,757 residents, 10,295 dwelling units, 137 food stores, 118 bars and restaurants, 86 barber shops and beauty parlors, and more. Nearly 5% of the city’s population called the West End home and 98% of residents were ‘non white.’]
You can drive up and down Linn Street and see those little retail spaces that were supposed to be businesses. Other than the usual cellphone shops, I don't know what else is there. It used to have the Arts Consortium, a gallery of creative and performing arts for the community – that’s gone. The West End Y.M.C.A. – which is now the Carl Lindner Y.M.C.A. – still at least has a presence there. Some of the churches going up Linn Street [are still there]. I know one just sold their property to F.C. Cincinnati. The public schools there hadn’t been upgraded in a long time.
We can't depend on the federal government to fix it, so it's like one person, one neighborhood, one community, one family at a time recognizing: What can I change in my behavior?
When you don't have the infrastructure of churches, education, and good housing, and you have people who can't get jobs at a livable wage to be able to maintain the housing that they want, it's always those under-resourced, low-income communities that get redesigned and urbanized and gentrified. The mere fact that F.C. Cincinnati would choose that location to disrupt the community again when they could've gone to Oakley, where there's more than enough space for a stadium… What's gonna be the benefit to the people that live there? Not enough. You see the economic and the racial gentrification of the community.
There’s all this talk about TIF money and tax abatements and so forth. Do you think that people tie in equitable development to healthcare, or is it not on their radar?
[Tax Increment Financing Districts (TIFs) are 300-acre areas where increases in property tax revenues sparked by new development are set aside for public improvements. Cincinnati is home to 20 of these districts.] No, it’s not. I was kind of like the voice in the wilderness, the lone voice in the room serving on the steering committee, and they would want to focus on education and income and work. I said, “If people aren't healthy, they can't go to work. If children aren’t healthy, then the parents don’t go to work or they go to work sick.”
At one time we were providing statistics that talked about the cost of healthcare for the uninsured. People who are insured bear that cost because it rolls into the cost of your premium. The hospital is going to pass it off to the people who are insured, and the insurance companies are going to pass it off to the customer in your premium. That was the whole purpose for the Affordable Care Act. We’re almost back to square one again.
And for women… The health status of women is so critical to families, whether it’s physical or mental health. Depression is very prevalent now. Underdiagnosed, but very prevalent. The cultural attitude African American women have about mental health and even disclosing depression, and then seeking treatment and care… Being able to find culturally competent providers in the city [is a problem]. We struggle in Cincinnati with keeping positions of color. I've lost two O.B./G.Y.N. docs in this city that were African American. I don't even know if we have any more. [According to a new study, Black babies are more than 3x likely to die than white babies – but when cared for by Black doctors, the mortality rate was cut in half. Black Americans make up 15% of the U.S. population but just 5% of physicians.]
When you're underpaid and you're working in jobs that don't provide insurance coverage or the insurance is not affordable, the emergency room becomes the primary care office. One, it’s open 24/7, and if it's a choice of going to work and getting paid versus not going to work and losing your job… That's a constant struggle for women. [According to the Harvard Business Review, “Those with lower incomes suffer from more chronic illnesses and have higher overall medical utilization and cost. Low wage workers with unaddressed medical problems might be less able to concentrate fully on their work, possibly leading to decreased opportunities for promotion and reduced productivity for employers."]
We're working with one of the initiatives through the Child Poverty Collaborative, Project LIFT, on this through providing financial assistance for families, households, and individuals under 200% of the federal poverty level. Just listening to the kind of careers or jobs that women have now – like home health aides are very popular – because they either didn't graduate from high school, have a G.E.D. and didn't go to college, or couldn’t afford to go to college or whatever…
Now, in the pandemic that we're in, they can't find enough work to take care of their household, so then you find ways to make money, doing hair or whatever you can do to put food on the table. Some of the bills you just string out until you get the disconnect, and then you have to call around all day to find somebody to help you pay part or all of it. When you have to live with that kind of stress every day, that's just overwhelming, and you have children to feed.
There's still those challenges out here. I think the gap is just getting wider economically for women. They already put us on $0.70 on the dollar that we get paid – C-suite or not: All the way down the ladder, it's still inequity there. [The racial wage gap is widening for Black Women. In 2019, Black women in Ohio made 66 cents for every dollar earned by white men.]
The Women’s Fund report cites an estimate that the gender pay gap and the racial pay gap combined is going to cost the United States G.D.P. one and a half trillion dollars over the next 10 years. When you talk about Black women considering the racial pay gap and the gender pay gap, there’s obviously a huge issue here. What do you think are some of the ways to start chipping away at that to try to even the playing field?
Which part of that elephant do you bite first? The acknowledgement by white men that they are part of the problem, and they can fix the problem and still keep their six-figure salary plus bonus… I think acknowledgement of that is an issue, and the acknowledgement that same work deserves same pay.
I mean, we’ve been saying it for decades. How much more work do we put into something just because we know we have to? You’re Black and you are a woman, so be twice as smart, three times as smart, and sometimes you’re expected to take more up, just because.
I've also been doing some work with the Leadership Council for Nonprofits because again, some of that goes back to boards: Who's on the board? “We just can't find anybody qualified to serve on the board” – but yet you have legacy seats from people on boards that know nothing about the business.
COVID-19 has obviously been horrific. How do you think the way our country approaches public health and healthcare might change?
I think that actually now public health will finally get the space, the discipline, and the recognition that it deserves – because it's been basic public health since day one: You do contact tracing, and then you test people, you treat, you prevent, you isolate. But it's been so politicized. You see how the voices of the public health experts keep getting silenced or their messages keep getting twisted.
If we would be more data-driven and get away from the lens of racism… Maybe this is the time where, through all these discussions and realizations that are happening now, public health will get interjected. We've been talking about racial and ethnic disparities in health for 20 years!
We clearly have gone backwards from where we started with the Affordable Care Act to really try to bring about some equity. The message of health equity was going loud and strong and very clear, but the forces that prevent or slow us down from making progress are the pharmaceutical companies and the health insurance companies. It's all about the money.
Prevention – which is all public health – has been on the back seat. Well, you've got like 50, 60 years of time that you’ve wasted coming to this point – now what you gonna do? Because now you got national debt – although they don’t seem to have any problem printing money these days for stimulus checks – but then when you start talking about healthcare: “Oh, well, we don't know if we can fund this.” You spend more time looking at things we can defund than things that are fundable.
All policy is local; all healthcare is really local. As we see right now, we can't depend on the federal government to fix it, so it's like one person, one neighborhood, one community, one family at a time recognizing: What can I change in my behavior? Seventy-five percent of what ails us in this country is personal.
So when you hear the talks preparing for declaring racism a public health crisis, you don’t just take that; you want to hear the action plan.
I can declare that it's “bad weather day.” What are you gonna do about it? Besides, we don't need a task force; we don't need a commission. Just do a lit review on everything that's been done about racism as a public health crisis. It’s now about social justice.
I caught the news last night, and one of the organizers of the protests here said it's not just about police violence: It’s social, educational, environmental, housing – all of that rolls up. You have to put the policies in place, but otherwise it's just like all these short-term initiatives that are lip service. Even with Project LIFT, I go into the meetings and I wanna know, “Now that you've heard these sad stories of these women who are trying to get their rent paid, what's the policy that you're gonna do about that? Who's gonna monitor that?” Landlords are not held accountable for the condition of their properties; they don't even live in the city and don't care. You want to keep a list of the bad cops and you got a list of the bad landlords. Stop allowing them to get a permit or whatever they do to chop up a house, and put three apartments in it, and have one of the tenants pay the utility bill for the whole house. You’ve got to always have enforcement or oversight if you’re going to do policy work. Make it accountable.
Who is the most influential woman in your life?
I don't know how many times you've heard this answer, but my mom, my grandmoms, and my godmothers. As you get older – you will find this out, ladies – people will say you sound like and have mannerisms like your mom. My sons tell me that all the time now: “You sound just like Grandma.”
Continue exploring “Questioning the American Dream: A Look at the Economic Mobility of Black Women in Cincinnati” at womenofcincy.org/economic-mobility.