RESUMEN
Introduction. The policing of identities through policies that restrict access to IDs issued by U.S. governmental entities disparately affects communities of color; communities who identify as low-income, immigrant, older, and/or transgender; and community members who experience chronic mental illness, housing instability, or incarceration. Yet government-issued IDs are increasingly needed to access health-promoting resources such as housing, banking, social services, and health care, and in interactions with law enforcement. Methods. Since 2012, the Washtenaw ID Project's coalition-building process has involved communities affected by restrictive ID policies, advocates, and institutional stakeholders to enact community and systems change regarding inequities in government-issued IDs. We discuss the coalition-building process that culminated in the implementation of a photo ID issued by Washtenaw County government as a policy change strategy. We also highlight the community-academic research partnership evaluating the effectiveness of the Washtenaw ID in order to ensure equity in Washtenaw ID access and acceptance. Results. In 2015, 77% of Washtenaw ID holders reported having no other locally accepted ID. At follow-up, Washtenaw ID holders reported favorable Washtenaw ID acceptance rates in several domains (e.g., health care, school), but not when accessing banking services and housing. Additionally, community discussions suggested racial inequities in carding and ID acceptance. We discuss next steps for policy improvement to ensure equitable impact of the ID. Conclusions. Without national policy reform instating access to government-issued IDs for all, the social movement to establish local IDs may improve access to health-related resources contingent on having an ID. Careful attention must be paid to community organizing processes, policy implementation, and evaluation to ensure equity.
Asunto(s)
Registros/normas , Poblaciones Vulnerables , Equidad en Salud , Humanos , Michigan , Racismo , Determinantes Sociales de la Salud , Justicia Social , Factores SocioeconómicosRESUMEN
Purpose: Policies that restrict access to U.S. government-issued photo identification (ID) cards adversely affect multiple marginalized communities. This context impedes access to health-promoting resources that increasingly require government-issued IDs and exacerbates health inequities. In 2015, Washtenaw County, Michigan, implemented the Washtenaw ID to improve access to resources contingent upon having an ID. We employed an audit study to examine whether Washtenaw ID users experienced racially biased treatment in carding experiences and acceptance of the Washtenaw ID. Methods: Seven 25- to 32-year-old mystery shoppers (two Latina, three black, and two white women) attempted to purchase a standardized basket of goods, including an age-restricted item in Washtenaw County stores (n=130 shopping experiences). We examined whether experiences of being asked for ID and acceptance of the Washtenaw ID varied by race/ethnicity. Results: Each shopper visited 9-22 stores. Shoppers were asked for ID in 63.1% of shopping experiences. Of these, the Washtenaw ID was accepted 91.5% of the time. Among those who were asked for ID, a higher percentage of Latina (16.0%) shoppers had their Washtenaw IDs rejected than black (6.3%) and white (4.0%) shoppers, although differences were not statistically significant (p=0.27). Latina shoppers had 2.9 times the odds of receiving a comment about their Washtenaw ID relative to white shoppers (OR=2.92, p=0.08), comments that were nonpositive. Conclusion: Local IDs may improve access to resources contingent upon having an ID. However, racialization processes, including anti-immigrant sentiments, may inhibit the mitigating goal of local IDs. Continued attention to the health equity impacts of equity-driven interventions is warranted.