Chicago AHEC at Health & Medicine is pleased to share this issue brief series on Criminalization of People of Color as a Barrier to Diversifying the Health Workforce. Please read our introduction to the series below and our issue briefs. We will continue to update this page as briefs are released.

• Issue Brief One: Disproportionate Minority Contact (DMC)
• Brief Two: Arrests & Detainment
• Brief Three: Sentencing & Incarceration

Introduction
Chicago Area Health Education Center (AHEC) is launching a series that examines a critical barrier to contemporary workforce development efforts. Our Issue Brief series, Criminalization of People of Color as a Barrier to Diversifying the Health Workforce, emerges from our current work as a federally funded workforce development program serving underrepresented people and underserved communities in the Chicago area. Over-policing and the criminalization of people of color are not consistently addressed in healthcare workforce development and policy initiatives. Typical health workforce strategies entail predicting workforce needs, developing pipelines/pathways, and implementing “Grow-Your-Own” workforce strategies. Workforce organizations often utilize these strategies in an attempt to think creatively about diversifying the health workforce and addressing local workforce needs. This series is written to facilitate dialogue across sectors in order to foster more equitable workforce programming, policy, and advocacy efforts in education, labor, health, and in the legal system. We strongly believe that a broader discussion of these issues will help us to better address barriers to diversifying the health workforce and also redress social injustices and inequities.

Who We Are
The AHEC Program is administered at the federal level by the Health Resources and Services Administration, Bureau of Health Workforce. Originally developed by Congress in 1971 to recruit, train, and retain a health professions workforce committed to underserved populations, AHEC has been reauthorized several times including as part of the Affordable Care Act in 2010. AHEC’s mission is to enhance access to quality health care, particularly primary and preventive care, by improving the supply and distribution of healthcare professionals via strategic partnerships with academic programs, communities, and professional organizations.

In 2011, Health & Medicine Policy Research Group became the host site for the Chicago AHEC. Chicago AHEC at Health & Medicine works to recruit, support, and maintain a diverse health workforce. Chicago AHEC is uniquely situated as an AHEC in an independent “action-oriented policy center” promoting health equity and challenging health inequities using the social determinants of health framework. AHEC and Health & Medicine share language that focuses on underserved populations, inequities, disparities, and community as well as being “honest brokers” bringing together diverse stakeholders with interests in common goals regarding health generally and the healthcare workforce specifically.

Because Chicago AHEC at Health & Medicine is part of a larger federal program, it is required by statute to meet its stated mission. An innovations and “responding to community needs” component of the statutory requirement allows Chicago AHEC to do traditional AHEC work while incorporating our more expansive Health & Medicine vision and values. Chicago AHEC creates and implements innovative strategies that recruit, train, and retain a diverse health workforce from early exposure to late education. We prepare and support individuals from underserved communities for a health career trajectory with opportunities for lifelong learning, stackable credentials, and jobs earning a living and thriving wage, while helping them to navigate the barriers associated with pursuing a health career. This work is directly tied to the long-term maintenance of a diverse healthcare workforce in underserved and underrepresented communities. Chicago AHEC works with other Health & Medicine colleagues and partners on workforce concerns and is deliberate about expanding to new workforce specific coalitions and partners.

How We Got Here
Late in 2013, Chicago AHEC staff exhibited at a local community college event to provide information to students about the Center’s programs. An interested student inquired about our health careers pathways work. Once we shared that it was related to health careers, the young man started to leave saying that he had “a background” and therefore this opportunity would be closed to him. We agreed to check into this and get back to him with information. Our Chicago AHEC team returned to Health & Medicine and discussed the issue, knowing that our Health & Medicine colleagues would understand this as a health equity concern  within its health workforce policy efforts. Through these conversations, Chicago AHEC and Health & Medicine learned that we needed more information about existing policy and protocols.

Internally, we began to work with our colleagues who work in the Court-Involved Youth Project (CIY) and Safety Net  and Public Health Equity Initiatives. Our CIY colleagues connected us to community partners including Cabrini Green Legal Aid (CGLA), First Defense Legal Aid, and Illinois Juvenile Justice Commission (IJJC) who were working on related issues. We also learned about the Health Care Worker Waiver and the expungement process. As part of state level meetings over the previous few years,  that focused on health reform implementation and challenges, the Chicago AHEC director co-chaired a subcommittee on health career pathways issues. Through this process she learned that general workforce development agencies and advocates, particularly those working to link low income and job seekers living in poverty to employment opportunities, were responsive to the challenge of criminal records as a employment barrier for populations that they served in their workforce development efforts. Since then, Chicago AHEC has been able to work more closely with workforce organizations like the Chicago Jobs Council and the Safer Foundation to ensure that employment issues that are central to health careers are represented within workforce coalitions.

The knowledge learned  from these activities inspired the Chicago AHEC team to propose a forum in October of 2015 that would bring together local groups who rarely collaborate to discuss the barrier of criminal records to the workforce. That forum, part of Health & Medicine’s Chicago Forum for Justice in Health Policy series was entitled Locked Out of Opportunity: Diversifying the Health Workforce. Chicago AHEC convened panelists from CGLA, Heartland Alliance, Safer Foundation, IJJC, and a health professional with the experience of navigating their career with a criminal record. Cook County Board President Toni Preckwinkle addressed forum attendees on the County’s perspective on related issues. These earlier experiences as well as new challenges that emerge continue to inform our thinking and writing on the criminalization of people of color as a barrier to diversifying the health workforce.

Where We Are Going
For the past six years Chicago AHEC has been partnering with federally qualified health centers (FQHCs), local health centers, community-based organizations, workforce agencies, high school and community college students, and individuals from underrepresented and underserved communities. While we have made strides, the criminalization of people of color, particularly those who live in poverty, continues to impact our work as a significant barrier to recruiting, maintaining, and supporting a diverse health workforce in Illinois.

Identifying and confronting barriers to health care workforce diversity and developing policy recommendations to address them will ensure the health workforce is more representative of the diverse communities it serves, an indicator that has been linked to patient satisfaction and improved health outcomes. This work will also increase the employability of underrepresented groups, strengthen communities, and confront inequity. By failing to address the structural issues that inhibit diversity in the health workforce, workforce organizations are missing an opportunity to examine critical issues impacting people of color, people living with disabilities, poor people, gender and sexual minorities, and people living in rural communities.

Through a series of forthcoming issue briefs–the first of which is linked below–Chicago AHEC at Health & Medicine will examine the role that the criminalization of people of color plays on an individual’s life course and ultimately diversity in the health workforce. Throughout the series we will be highlighting current legislative strides that work towards these efforts in the state of Illinois. If we seek to recruit, train, and retain a diverse health workforce in the City of Chicago and beyond, we must constantly question the interpersonal, institutional, and structural barriers impeding their health career trajectory and actively work to address these barriers. Chicago AHEC will use each brief in the series to unpack the multitude of ways in which the “Criminalization Pipeline” disrupts a “Health Career Trajectory” for people of color, acting as one of the main inhibitors of a diverse workforce in our city and our nation (see Figure 1 below).

Figure 1:  Chicago AHEC Model of Criminalization as a Barrier to Health Careers