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REPORT: Reconciling MENA Exclusion With(in) the Build Back Better Agenda

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September 9, 2021 


In the coming weeks, the U.S. Congress will pass an additional budget reconciliation measure — the second in the last six months. In the last 41 years, the United States Congress has sent 26 budget reconciliation bills to the President’s desk to be signed into law. Only 22 have passed. As those numbers suggest, budget reconciliation is a relatively rare occurrence. In fact, reconciliation is an optional and highly formalistic procedure that allows Congress to bypass the 60-vote requirement to pass legislation, provided that the legislation meets several conditions. It effectively allows Congress to change current law in order to bring revenue, spending, and debt-limit levels into conformity with the policies of the annual budget resolution. Therefore, before passing a budget reconciliation measure, Congress must first adopt a budget resolution – the piece of legislation, presented in the form of a “concurrent resolution,” that the House and Senate agreed to in a matter of weeks. 


The budget resolution articulates the topline amounts budgeted to each Congressional Committee, as well as the “reconciliation instructions” by which each Committee will appropriate those aforementioned “toplines.” For instance, the “budget resolution agreement framework” issued from Democratic Party leadership to Senate Democrats instructed the “Agriculture Committee” to apportion “$135 billion” to a set of initiatives including “rural development and rural co-op clean energy investments,” “child nutrition,” and “debt relief,” among other items.  There, the authorized funding will go to various networks of state and local providers who will distribute the funding in the form of various contracts, grants, and cooperative agreements.  


In the time between now and formal passage of the budget reconciliation, committees will use these instructions to draft legislation that accomplishes the goals of the majority party — in this case, the Democratic Party. Senate Majority Leader Chuck Schumer, the Senior Senator from New York, has pinpointed September 15th as the target date for passage of the budget reconciliation measure.  


Between now and then, the National Network for Arab American Communities (NNAAC) is working with its congressional and coalitional partners to articulate and advocate for legislative solutions to the concerns of the communities which the 27 NNAAC member organizations serve across 11 different states. 


This is no small feat. Like many underserved populations, the Arab American and broader MENA community is subject to systemic exclusion from the established pathways for community advancement; our unique health needs, small business concerns, residential segregation in ethnic enclaves, and linguistic and cultural barriers to familial or professional development are underrepresented or outright excluded from consideration in Federal programs designed to address those very conditions. At the same time, the Biden administration has made racial equity a priority in its “Build Back Better” agenda. During the Presidential campaign, they articulated a “plan for partnership” with the Arab American community.  

This budget reconciliation affords Congress the opportunity to partner with the Arab American community as part of its effort to make good on their mandate to “support visionary and transformative investments in the health, well-being, and financial security of America’s workers and families.” NNAAC is excited to support such an ambitious promise. The reconciliation instructions provide for intra-Committee debate on aspects of President Biden’s Build Back Better agenda. For too long, the MENA community has been left out of such policy discussions.. We look forward to working with our partners in Congress and civil society to ensure our country and its people a stable and prosperous future through advancement of the following key initiatives.  

Recognition of the Unique Health Needs of the Arab American and broader MENA Community 


The congressional budget resolution calls for the Senate Committee on Health, Education, Labor, and Pensions (HELP) to allocate $762 billion between a set of initiatives including “health equity.” These include  maternal, behavioral, and racial justice investments. 

The existing data on the Arab American community is limited because the Federal statistical policy directives do not require disaggregated data on individuals from the (Middle East and North Africa) MENA region. Instead, Arab Americans are collapsed into the White reference category. In effect, this marginalizes the unique needs of a population with cultural and linguistic barriers, as well as pre-existing conditions that are inherited from either their descendants or their countries of origin. The lack of a racial/ethnic identifier for the Arab American community has also suppressed groups from trying to articulate the Arab American community as one of the groups for whom racism deleteriously affects health outcomes.  

Nevertheless, ethnicity and race are important determinants of health in Arab American infants.1 Arab American mothers have higher odds than non-Hispanic white mothers of initiating breastfeeding, giving birth to small-for-gestational-age infants, and having gestational diabetes.2Other recent research identifies disparities between Arabs in the United States and non-Arab White Americans in terms of poverty, language access, and insurance coverage.3  

Moreover, the MENA diaspora in America has experienced persistent and systemic stigma and discrimination, particularly due to the racist backlash at home from American geopolitical and military campaigns abroad. For example, the Arab-Israeli War of 1967, the War on Terror, and the Arab Spring, to name a few, accomplished a sort of second-order effect by creating a surplus population of Arab émigrés fleeing from violence or state breakdown. When they arrive from the Middle East and North Africa, they come to America as a racialized and under-resourced population.4 The most recent issue of the ACCESS Health Journal published studies which identified “a growing body of research” indicating that Arab Americans, particularly refugees, “are subject to a host of stressors, including discrimination, lack of social support, and economic hardship that could detrimentally influence their mental health” but which are under-emphasized without “the introduction of an Arab-origin or MENA identifier in nationally representative epidemiologic surveys.”5  

NNAAC is calling for the Senate HELP Committee to pass legislation that addresses maternal health disparities and authorizes funding for the inclusion of MENA within the Research Interest Areas of the National Institute of Minority Health and Health Disparities (NIMHHD). 

Addressing Social Determinants of Health within Arab American and broader MENA Community 


The $762 billion allocated to the Senate HELP Committee also includes a line item for “pandemic preparedness.” 

Policies and programs designed to bolster our pandemic preparedness will fall under the jurisdiction of the U.S. Department of Health and Human Services (HHS). Given the budget reconciliation rules and restrictions, this funding can only amend existing HHS policies and programs. On September 9th, NNAAC sent the HHS Secretary a letter which articulates the specific limitations to our existing pandemic preparedness infrastructure for the MENA community.  

NNAAC is calling for HELP to authorize funding for the following:   

  • A study of underserved or excluded community groups whose incorporation within the HHS’ data strategy would bolster the pandemic preparedness and response effort, pursuant to the Foundations for Evidence-Based Policymaking Act.  

  • Inclusion of the “Middle Eastern and North African” (MENA) community among the list of groups eligible for the REACH (Racial and Ethnic Approaches to Community Health) grant program within the Center for Disease Control and Prevention (CDC).  

  • Inclusion of a data collection category for the MENA community within the National Health and Nutrition Examination Survey (NHANES), the National Survey on Drug Use and Health (NSDUH), and the Immunization Information Systems within the CDC; and the Behavioral Risk Factor Surveillance System (BRFSS) within the Centers for Medicare & Medicaid Services (CMS). 

  • Usage of the Public Readiness and Emergency Preparedness (PREP) Act to recognize MENA healthcare workers who, due to differing licensure requirements, are barred from practicing in the United States.  


Recognizing and Addressing the Small Business Concerns of the MENA Community 


The congressional budget resolution calls for the Senate Committee on Small Business and Entrepreneurship to allocate $35 billion between a set of initiatives comprising “small business access to credit, investment, and markets.” These initiatives afford a significant opportunity to further develop the proximate factors of small business growth in the Arab American and broader MENA community.  


A 2012 study of the Arab American small business and entrepreneurial community in Detroit, MI found that Arab American entrepreneurship contributed a significant amount to the economic stability of Detroit after the Great Recession.6 It also identified success factors that are broadly replicable across the country, such as the necessity of community business assistance through social service organizations that close the gap between Arab American entrepreneurs and the linguistic or cultural barriers to small business ownership. Also crucial were capital investment funds, which facilitate the transfer of low or no interest rate startup or relief capital, as well as organizations that provide business training, opportunity searching, and instrumental support for start-up businesses. 


Consideration of different group characteristics is a necessary precondition for the development of opportunity structures through which small businesses flourish in underserved communities. Without disaggregated data, we are unable to estimate the impact of small business downturns to local economies that rely upon small business concerns of the Arab American and broader MENA community. We are also unable to direct sufficient resources to local economies which may rely upon small business ownership from the Arab American and broader MENA community.  


With these considerations in mind, NNAAC is calling for the Senate Small Business and Entrepreneurship Committee to include in the budget reconciliation any legislation which would support the formation of small businesses, through coverage of the associated technical assistance, seed capital, and start-up costs. NNAAC is also calling on the Small Business Administration to include individuals from the Middle Eastern and North African (MENA) community in its interpretation of “socially or economically disadvantaged individual.” 


Recognizing and Addressing the Environmental Injustices Facing the Arab American and broader MENA Community  


The congressional budget resolution calls for the Senate Committee on Environment & Public Works (EPW) to allocate $67 billion across a set of initiatives including “environmental justice investments in clean water affordability and access, healthy ports and climate equity.”  


This budget resolution instructive is part of the Biden administration’s holistic approach to environmental justice. On their first week in office, the Biden administration issued an Executive Order to authorize the Justice40 Initiative. The Justice40 Initiative effectively commits the Federal government to ensure that 40 percent of the benefits to Federal investments on climate and clean energy go to “disadvantaged communities.” The MENA community experiences a combination of factors which the Biden administration identified as part of their definition of “disadvantaged communities,” including “racial and ethnic residential segregation,” “linguistic isolation,” “distressed neighborhoods,” “disproportionate environmental stressor burden and high cumulative impacts,” “limited water and sanitation access and affordability,” “access to healthcare,” and “jobs lost through the energy transition.”  


In 2019, Sara E. Grineski, Timoty W. Collins and Ricardo Rubio, a group of sociologists and demographers, used ACS data to identify Arab ethnic enclaves in U.S. Census tracts. Grineski and others found “significant environmental injustices for Arab American enclaves,” with clear connections to the systemic disadvantage of Arab Americans “as a racialized minority group without minority status.”7 Namely, that MENA individuals across nearly all ethnic enclaves experience disproportionately elevated cancer risks driven by the fact that MENA enclaves in the US have higher hazardous air pollutant scores than the national average.8 Poor housing quality and barriers to quality health care in MENA- dense areas, including Detroit, further the environmental stressor burden felt by the community.9 Communities of color in the US, including Arab Americans and the broader MENA community, are more likely to live in proximity to industrial and chemical facilities, be exposed to lead and other pollutants, and experience extreme weather events that exacerbate environmental degradation.10 A 2011 study of lead poisoning among Arab American and African American children in the Detroit metropolitan area revealed that “immigrant children are at heightened risk of being poisoned by lead.”11 As a result, the community faces poorer health outcomes than non- Hispanic, non-Arab Whites, including high rates of asthma, cardiovascular issues, lung disease, and cancer. 


With these considerations in mind, NNAAC is calling for the Senate EPW Committee to include in the budget reconciliation measure any legislation which would require Federal agencies to recognize and address the environmental determinants of adverse health outcomes and life chances, including through the solicitation of public participation in Executive agencies’ data collection processes and consideration of the cumulative impacts of exposure to hazardous pollutants. NNAAC is also calling for the inclusion of legislation that would amend the Safe Drinking Water Act to increase funding for lead reduction projects. 


Articulating New Modes of Human and National Security 


The congressional budget resolution calls for the Senate Committee on the Judiciary to allocate $107 billion between a set of initiatives including development of a “Community Violence Intervention Initiative.” NNAAC represents communities who have historically experienced adverse relations with local law enforcement authorities. However, we have started to turn a new leaf in our communities. Following up on last summer, we hope to articulate a new dynamic between community groups and law enforcement. As such, NNAAC advocates for passage of legislation that authorizes funding for the Department of Justice to administer a program by which nonprofit community-based organizations can develop evidence- and community-based strategies to interrupt cycles of violence through expansions of economic opportunity or trauma-responsive care. Such legislation would offer a pathway to devising and demonstrating the efficacy of alternatives to extant law enforcement approaches.  


Establishing a Pathway to Citizenship for Qualified Immigrants and TPS Holders 


The congressional budget resolution calls for the Senate Committee on the Judiciary to allocate $107 billion between a set of initiatives including “lawful permanent status for qualified immigrants,” which would stabilize the living conditions for millions of people across this country who establish themselves and their families, oftentimes after fleeing deleterious conditions in their countries of origin and give back to their local communities. NNAAC recommends that Congress establish a pathway to citizenship for TPS holders, Dreamers, farmworkers and essential workers in the reconciliation bill.