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Across the country, more than 80 city and county governments have declared racism a public health emergency. The overwhelming majority have come in the past two months, amid a widespread push to address systemic racism prompted by protests sparked by the police killing of George Floyd in Minneapolis.
The specifics of the declarations vary from place to place, but they share the central vision that racism is the root cause of health disparities between white and Black Americans. The difference in health outcomes is stark. Black people have a lower life expectancy and experience higher rates of death from a long list of diseases, including cancer, heart disease and diabetes. Black mothers are four times more likely to die of pregnancy-related complications. The infant mortality rate for black children is double that of white children.
The coronavirus has shone an especially harsh light on health inequities in the United States. Black people make up a disproportionate number of COVID-19 cases and have a higher death rate than other races.
Why there’s debate
While the health disparities between white and Black Americans are well-documented, there are disagreements over whether declaring racism as a public health emergency is the right way to address them.
Supporters of the idea say inequities in health can only be fixed by addressing their root causes — many of which can be directly tied to racism. Discriminatory housing policies like redlining, for example, have made Black people more likely to live in densely populated areas with less access to health care and increased exposure to harmful pollutants. Advocates say a broad view that considers the impacts of racism on a society-wide level is much more effective than a collection of piecemeal solutions across different areas that don’t share a unifying philosophy.
Scientists have also begun to see evidence that the stress of dealing with everyday racism leads to worse health outcomes that can’t be explained by social or environmental factors like poverty or location. Doctors are also less likely to believe Black women who say they are in pain, which can cause dangerous conditions to go untreated. This shows that racism itself must be confronted if health disparities are going to be fixed, some argue.
Skeptics say declaring racism a public health emergency is nothing but an empty gesture if it isn’t followed up by concrete action. Many of the ordinances passed by cities and counties lack tangible plans for addressing the problem. There are also concerns that trying to tackle the impacts of racism from the top down could interfere with progress being made on the ground in individual sectors like education, housing and police reform.
A number of other cities are considering declaring racism a public health emergency, including Louisville, Kentucky, where the police shooting of Breonna Taylor has led to ongoing protests. Colorado is set to make a similar declaration statewide, according to a top health official. Three Democratic senators introduced a resolution to declare a health emergency nationwide in June, but the bill is not expected to be taken up by the full Senate in the near future.
The declarations are meaningless if not followed by concrete actions
“Acknowledging the damage done by racism is a critical step in improving the lives of all Americans. Yet the declarations will be nothing more than symbolic without effective action.” — Editorial, Minneapolis Star-Tribune
The public health lens helps address harm caused by racism across society
“We’ve been remiss to address them in their individual sectors, in criminal justice, in education, and housing… .So I think looking at it from the health perspective is an astute strategy.” — Racial and social justice researcher Ronnie Dunn to WBUR
Racism is abstract and difficult to measure
“The public health emergency here, racism, is quite amorphous because racism is at the foundation of much of what we do in this society...It’s not like an acute traumatic event like a hurricane or an earthquake that we know has a beginning, middle and end,” — Health equity expert Thomas LaVeist to Marketplace
Racism is the root cause of the many inequities that lead to health problems
“Racism is a public health problem, meaning racism is at the root of the inequities in health that we see, particularly for blacks in this country. So whether it's housing, criminal justice, education, wealth, economic opportunities, healthcare, all of these interlocking systems of racism really are the main fundamental drivers of the racial inequities that we see among black Americans.” — Epidemiologist Dr. Sharrelle Barber to Smithsonian
An official declaration forces lawmakers to remain focused on addressing the problem
“We need our leaders to be morally invested as well as fiscally invested in eliminating this threat to our health and well-being; we must expect and countermand the expected return to complacency. We need systemic solutions when white allies fade into the social media background and grow weary of marching. Black America won’t have the luxury of giving up on the crisis that is racism.” — Renée Branch Canady, Lansing State Journal
Coronavirus shows how systemic racism leads to health disparities
“I think of the coronavirus as a tutorial on racism because it illustrates the multiple pathways by which racism can have consequences for health.” — Public health researcher David Williams to NPR
Ignoring race leads to unequal treatment
“In an effort to engender trust in what they would like to see as a ‘postracial’ society, some U.S. clinicians proclaim that they ‘don’t see color.’ But color must be seen. By looking through a racially impervious lens, clinicians neglect the life experiences and historical inequities that shape patients and disease processes. They may inadvertently feed the robust structural racism that influences access to care, quality of care, and resultant health disparities.” — Editorial, New England Journal of Medicine
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