When Milwaukee County declared racism a public health crisis last year, the news didn’t make a lot of waves.
The decision, signed into law by Milwaukee County Executive Chris Abele in May 2019, was regarded as an overdue and necessary step by local officials, who noted the county’s documented racial disparities in employment, education, incarceration, income, and access to capital.
But while the resolution followed through on an argument public health experts have been making for decades—that to adequately address racial divides in health, governments need to develop holistic approaches to tackling systemic racism—few other local or state governments rushed to follow Milwaukee County’s example. Between January 2019 and February 2020, only four cities and two counties, including Milwaukee, made such declarations.
2020 has been a different story. Between March and July of this year, that number has leapt to 84 cities and towns, with another 42 counties declaring racism a public health crisis. It took two major crises for governments to follow suit: the coronavirus pandemic, which has wreaked havoc on Black, Indigenous and Latinx communities, and the continued problem of police brutality, which has a similarly outsize impact on the exact same communities.
Earlier this month, Sen. Elizabeth Warren (D-Mass.), alongside Congressional Reps. Ayanna Pressley (D-Mass.) and Barbara Lee (D-Calif.) put forward the “Anti-Racism in Public Health Act of 2020,” which would make the Centers for Disease Control both declare systemic racism as a public health crisis and give it the power to track police brutality and come up with policy recommendations for how to combat inequality.
As Sharrelle Barber, a Drexel University assistant professor of epidemiology, explained to the Smithsonian this summer, this approach shifts the way institutions and medical professionals confront health problems like obesity, maternal mortality, and diabetes (all of which have a disproportionate effect on African Americans).
“If we had a structural racism lens going into this pandemic, perhaps we would have done things differently. For example, get testing to communities that we know are going to be more susceptible to the virus,” Barber told the Smithsonian. “We would have done that early on as opposed to waiting, or we would have said, ‘Well, folks need to have personal protective equipment and paid sick leave and hazard pay.’ We would have made that a priority.”
Earlier this month, Saint Louis University’s Institute for Healing Justice and Equity and The Justice Collaborative Institute (which endorsed the Anti-Racism in Public Health Act) published their recommendations for how local, state, and federal officials can effectively address systemic racism using a public health lens. Released on Sep. 3, the report looks at case studies from governments across the country, observing which institutions and systems have put into place meaningful policies that could dismantle institutional racism.
“Declaring racism as a public health crisis is an important first step. Doing so acknowledges that racism exists and that government has a duty to dismantle the system of racism, instead of leaving the burden on individual victims of racism to file lawsuits,” the report states. “Yet a declaration, without more, is not enough.”
This is what the report recommends:
This is the most straightforward piece of the puzzle, but one that the current Department of Health has not yet implemented. It requires, first, defining what institutional racism is—a system that has caused racial inequalities in housing, healthcare, education and law enforcement, and one that results in measurable physical and psychological harm.
“Defining racism as a system not only moves beyond the current limited conceptions of racism in the [social determinants of health] framework and law, it also ensures that solutions crafted to end racism change the system,” the report states.
The second recommendation is arguably the most politically challenging one. The report recommends that the government provide “material, institutional and social supports” that redress the harmful impact past and current policies have had on racial and ethnic minorities. In short: reparations.
Here, the premise is that the federal government, along with local and state governments, have an obligation to use their budgets to address hundreds of years’ worth of government interventions that have limited economic growth for Black communities, wedding race to class so inextricably that Black people remain overrepresented among America’s poor. While many people may think of reparations as a one-time check, a recent bill passed in Asheville, N.C. takes a more holistic approach, with a goal to help create generational wealth for its Black residents by focused reinvestment in Black communities. This includes increasing homeownership, access to affordable housing, and supporting business ownership and career opportunities.
The report also recommends developing and requiring the use of “racial equity tools” to determine whether government laws, policies and practices are reinforcing systemic racism. These could be defined as any process that allows a person or organization to track and evaluate racial disparities, as well as measure the efficacy of any solutions.
One such tool would be a standard, universally applied way of collecting racial data when health crises strike. This is one area where the Centers for Disease Control and Prevention were caught flat-footed in March, as the coronavirus began to spread across the United States. Because the CDC doesn’t have a standard way of tracking racial and ethnic data, it was slow in identifying communities that were vulnerable to the virus. States like Maryland and Michigan, which were already tracking racial data in their health care systems, were able to pinpoint disparities and attempt to tackle them more quickly than other parts of the country.
These tools can also include a specific evaluation method to guide the development of antiracist policies, like the one the Seattle Race and Social Justice Initiative came up with in 2012 (whether the toolkit has been effectively used by Seattle policymakers is, of course, a separate issue).
The fourth recommendation is yet another common-sense approach that is frightfully uncommon: ensuring that racial and ethnic minorities are able to participate in the decision-making process regarding policies that would affect their communities. The report recommends that this component of creating antiracism policies be a required part of any law-making process.
“Laws and policies to address racism as a public health crisis must engage community members, which includes true collaboration with shared decision making, building alliances, and community involvement throughout the entire process, not merely for completing certain tasks,” the report writes. It lists Washtenaw County, Mich. as an example in which local officials have required community engagement and collaboration with social justice organizations as a requisite to crafting antiracist policies.
Another example of this is Rep. Barbara Lee’s recent proposed legislation, the COVID Community Care Act, which would provide funding, via grants, for community-based organizations and nonprofits to conduct testing, tracing and outreach activities in communities that have experienced higher rates of COVID-19. If passed, the bill would require that people hired to educate and engage these communities about the coronavirus would have previous experiences and relationships to the community they’re serving.
The final recommendation is one that both precedes and includes reparations: a healing process, through which historical grievances can be named and reckoned with publicly. This process is necessary, the report states, in order to build trusting community relationships and remember our shared histories, as well as our shared humanity.
One example of this the report lists is Providence, Rhode Island’s truth-telling and reparations process, which outlines “a plan for sharing the state’s role throughout history in the institution of slavery, genocide of Indigenous people, forced assimilation and seizure of land.” Simply put, healing must begin with full recognition of all the wounds that have been inflicted over time—an audit of the crimes perpetrated and perpetuated against marginalized communities, in order to better understand how those actions ripple through to the present day.
Only by naming what systemic racism has done—be it redlining, divestment from public education, or land theft—and the material impact it continues to have on people’s lives, can the path forward be illuminated.