Reflections on Racism and Public Health
Updated: Sep 12, 2021
By: Dr. Jovonni Spinner, MPH, CHES
Do you ever wonder why people of color (POC), particularly those who are black, brown, and indigenous have higher rates of just about every chronic disease, have worse health outcomes, and die prematurely?
In one word- RACISM.
Racism is a root cause of the health inequities experienced by POC in America. It’s an ugly word and no one ever wants to be the first to utter it. But, let’s be real, it is a systematic, long-standing problem in our country. Simply put, race is a social construct designed to separate groups and perpetuates racism. Listen to Dr. Camara Jones TEDx talk on “Allegories on Race and Racism” where she provides an excellent framework to understand racism.
People of color’s health is not thriving due to laws and policies that inherently disadvantage POC from making progress, taking away opportunities to make better health decisions.
Racism starts young. It can be covert or overt- ranging from subtle microaggressions to racial slurs, stereotyping, or profiling. For example, black children are seen as older and less innocent than their white counterparts, leading them to be perceived as malicious or disruptive, less likely to be protected by the police, and receive more punishment. Physicians of color may have difficulty getting hired, which limits patients' ability to receive culturally competent care. And, POC experience a phenom called “anticipatory trauma” referring to the stress of anticipating being subject to gun violence and the traumatic after-effects. All of these scenarios are examples of the everyday struggles of POC which lead to increased stress levels having to “cope” with living in a world that is unequal and has a history of institutional racism that ultimately impacts our health outcomes.
Diseases do not discriminate, the public health system does! More importantly, the system was designed during racist times, and even now some people leading these systems may be racist, biased, or do not gain from making the system equitable. Institutional racism fuels our health system in America. So, even if euphoria set in and we could live in a world free of racist people, the systems built by them still live on, continuing the cycle of discriminatory practices. Furthermore, racism is a driving force behind social determinants of health, which are non-medical factors that contribute to health outcomes like housing, education, access to quality health care, and insurance, just to name a few. For decades, historical laws and policies like redlining, segregating schools, and predatory lending practices have prevented POC from achieving home ownership and building wealth, which created unequal neighborhoods and cycles of poverty. Thus leading to reduced decision-making power, neighborhoods with limited life-sustaining amenities, and often having to choose between health and basic needs like housing.
Beyond the structural and systematic issues that racism has caused we cannot forget the human and biological toll. The racial divide among health outcomes is NOT NORMAL. Experiencing racism on a constant basis leads to increased stress levels, depression, higher rates of maternal mortality, premature death, complications from chronic diseases, and a myriad of other health problems. For example, research on maternal health found that regardless of economic status, African American women are 2-3 times more likely to die from childbirth compared to other groups and many of these deaths are preventable. Additionally, many POC suffer disproportionately from diseases and conditions like hypertension, obesity, and diabetes that lead to disability and premature death. The trauma of racism has placed an unequal demand on the minds, bodies, and spirits of POC. The bottom line is that in an equitable world, we should all get sick and die at equal rates, but we don’t.
Curing the health inequities stemming from our broken society fueled by racism is not going to happen overnight. As public health professionals, we must be brave to engage in dialogue that will affect change. If you and colleagues are not doing so already, start the conversation and keep it going. We have to bring these issues to the forefront of the discussion so we can be a part of the solution and not the problem.
Here are 3 steps you can take to help advance the needle forward:
Name it: We need to call racism out for what it is. If you see it, call it out. It’s scary, but it needs to be done.
Educate yourself: Understand what racism is and how it impacts healthcare. If you are an ally, find ways to use your power and privilege to help the cause to build better programs, increase access to services that improve health outcomes, and ensure healthcare policies meet the needs of our diverse society. Here is a list of four books you can read to be a better ally and a list of things you can do to support positive change.
Check yourself: Do you have implicit biases that need to be checked? The answer is yes, because we all do. But we need to identify those biases and educate ourselves on ways to minimize them so they are not a barrier to achieving our goals of eliminating health disparities.
As a black woman living in America, racism is nothing new to me. However, I am not willing to accept that this is the best America has to offer. It is my goal as a public health professional to help address the health needs of racial and ethnic minorities. I use my voice to make sure the needs of our communities are acknowledged and addressed in a culturally sensitive manner; and I hope you also use your voice to elevate change.