In April 2021, Rochelle P. Walensky, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), declared racism “a serious public health threat.” In a statement, Dr. Walensky highlighted the disproportionate impact of the COVID-19 pandemic on people of color in the United States. However, she noted, these disparities are not new. “Instead, the pandemic illuminated inequities that have existed for generations and revealed for all of America a known, but often unaddressed, epidemic impacting public health: racism.”
African American women are three times more likely to die of pregnancy-related causes than white women.
The African American infant mortality rate is twice the rate as white infants.
How Racism Became a Public Health Issue in America
To understand why racism is a public health issue in America, we must look at the structural barriers throughout the history of our country that have impacted racial and ethnic groups differently. This includes policies, practices and norms affecting where a person lives, where they work, where their children go to school and more — known as social determinants of health. “Over generations, these structural inequities have resulted in stark racial and ethnic health disparities that are severe, far-reaching and unacceptable,” Dr. Walensky said.
For example, about 1 in 10 people in the United States don’t have health insurance, and African Americans are more likely than whites to be uninsured, according to the Department of Health and Human Services’ Office of Disease Prevention and Health Promotion. People without insurance may not be able to afford the health care services and medications they need. They are less likely to have a primary care provider, so they may not get preventive care and treatment for chronic illnesses. Or they may live too far away from health care providers who offer these services.
“Because African Americans tend to be poorer than other demographic groups on average, public health insurance programs such as Medicaid are vital to ensure affordable health care and healthier outcomes,” noted the 2019 report from The Century Foundation. Yet many of the states that have not expanded Medicaid are in the South, where African Americans are disproportionately represented, stated the report.
Public Health and Racism: What Can Be Done?
So how do we begin to address the critical issue of public health and racism? It can start with public health organizations around the country actively working to build a more diverse workforce, wrote Helene D. Gayle, MD, MPH, president and CEO of The Chicago Community Trust, on the CDC webpage, Racism and Health. “Our public health institutions cannot effectively combat the race-based health inequities that plague our nation until they address the issues of diversity, inclusion and equity within their own walls.”
Reducing the effects of racism on public health also requires taking steps to address health inequities, according to Georges C. Benjamin, MD, executive director of the American Public Health Association. This includes collecting accurate, publicly available demographic data and data on social determinants of health “so we can understand who is at risk and mitigate that risk.” He added, “We must then develop policy and programs to address what we find,” making sure that such programs are properly conducted and evaluated to measure their impact.
Finally, it is necessary to ensure that the nation has a health system that includes everyone, Dr. Benjamin wrote. “The Affordable Care Act stands as a step forward to achieving this goal. But affordable health insurance is not enough. We also must ensure we have enough culturally competent health care providers and accessible facilities in all communities.”
Confront Systems and Policies of Injustice
To combat health disparities among racial and ethnic groups, advocates say health professionals must explicitly confront injustices and acknowledge that race and racism factor into health care. An example of this is the Greensboro Health Disparities Collaborative, a group formed by community organizers and researchers from the University of North Carolina School of Public Health in an effort to understand and address the lingering effects of segregation. The group conducted studies on patients who had experienced discrimination in a health care setting. Community members helped develop the research questions, conduct interviews and analyze the results.
“This was an important piece of the collaborative,” said Christina Yongue, MPH, coordinator of the Greensboro Cancer Care and Racial Equity study. “We made sure the community had full participation in every step of the research process. This was because of historical distrust among black Greensboro residents for Cone hospital, and because of more general distrust of clinical research going back to Tuskegee.”
Similarly, the Center for Community Resilience (CCR) is committed to improving the health of communities by targeting those who have endured or are facing adverse childhood experiences. Poverty, under resourced schools, household violence and systemic racism are all factors that come into play. Dr. Wendy Ellis, director of CCR and assistant professor in Global Health at George Washington University, has dedicated a decade of work to developing a ‘resilience movement’ in response to systemic equities in health care. She co-authored the organization’s ‘Fostering Equity’ modules in 2020. Available to the public, these modules highlight nearly 400 years of American policy and it’s lingering impact, from social and economic inequities to health disparities.
Diversity, Equity and Inclusion (DE&I)
A focus on diversity, equity and inclusion (DE&I) in an organization “recognizes the qualities, experiences and work styles that make individuals unique (e.g., age, race, religion, disabilities, ethnicity) as well as how organizations can leverage those qualities” in support of their objectives, according to the Society for Human Resource Management (SHRM).
Greater diversity in the public health workforce offers a broader range of expertise and perspectives. It also places “those with experience and personal connection to the lived realities of the communities we are trying to reach at the decision-making tables,” Dr. Gayle wrote on the CDC website.
It’s important to note that equity and equality are not the same. Equality means each individual or group of people is given the same resources or opportunities, while equity recognizes that each person or group has different circumstances and allocates resources as needed to reach an equal outcome. Understanding the difference between health equality and health equity is important in addressing the issue of racism in public health to ensure that resources are distributed appropriately.
Public Health Opportunities
Those who study and work in public health have opportunities to participate in research and solutions focused on addressing structural racism in the United States. Public health degrees can put you on the path to impactful public health careers in government, public, private, academic and non-profit settings, focusing on such areas as public policy, health education and behavioral science, epidemiology or maternal and child health. These are all areas permeated by racism with opportunities for systemic change.
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The George Washington University’s Master of Public Health Online program, MPH@GW, is designed for aspiring public health leaders who are called to advance and safeguard the health and wellness of people across the globe. Students learn from GW faculty, who are active influencers affecting public health on a global scale.