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When the coronavirus outbreak hit the United States in early 2020, public health officials in Milwaukee were among the first to notice its disturbing racial trend.

In the same week in March that President Trump declared a national emergency in the U.S. as a result of the disease, statistics showed that Black people, who represented a third of Milwaukee鈥檚 population, accounted for nearly three-quarters of its confirmed COVID-19 cases.

Milwaukee was able to identify and track this trend early, and ahead of other jurisdictions in the U.S.鈥� even the federal government鈥攂ecause less than a year earlier, the city and county had declared racism a public health crisis. The designation was a commitment to framing disparities in health outcomes through a racial lens. It also meant that when COVID-19 began spreading across the country, health officials in Milwaukee were already collecting data based on race and ethnicity.

鈥淲hen COVID-19 hit, Milwaukee was ahead of the curve because they already had that framework to begin with,鈥� says Dr. Marshall Fleurant, assistant professor of medicine at Emory University School of Medicine and chair of the Society of General Internal Medicine Health Equity Commission. 鈥淭hey were one of the very first departments to show us the disparity and who鈥檚 dying from COVID-19. That鈥檚 one of the benefits from declaring racism as a public health crisis.鈥�

Now in the wake of the police killing of George Floyd, a growing number of jurisdictions as well as major health organizations are acknowledging that racism is a detriment to public health. 

鈥淲e can see the impact when we look at Breonna Taylor, Ahmaud Arbery, George Floyd and many others,鈥� says Dr. Tracie Collins, dean of The University of New Mexico College of Population Health. 鈥淭he racism really warrants attention, it warrants prevention, diagnosis, and treatment like any other crisis.鈥�

Racism adds additional stress to the lives of people already trying to figure out how to pay their bills or feed their children, Collins says. 鈥淒uring the pandemic, maybe I can鈥檛 stay at home and self-isolate because I鈥檝e got to get to work and therefore I might be exposing myself. When we address [the role of] racism, we鈥檙e addressing a level of stress鈥攖hat can also help these communities.鈥�  

A growing movement

The American Medical Association, the American College of Emergency Physicians and the American Psychological Association have all declared institutional racism an urgent public health issue.  The head of the APA, Arthur C. Evans Jr., PhD, in a report about elevated levels of stress in this country said, 鈥淭he majority of Americans are finally coming to terms with the reality people of color have known all too well for all too long and that research has documented: Racism poses a public health threat and the psychological burden is immense. We have a lot of healing to do as a nation.鈥�

Nearly 70 local jurisdictions have made this designation, most of them doing so as protests and demonstrations over racial inequality erupted across the nation and the globe. Several states, including Michigan and Ohio, are also considering it.

While the meaning of racism as a public health crisis differs from one jurisdiction to another, the designation opens the door for a range of issues, including health inequities, to be examined through the prism of race鈥攆or instance, understanding the impact of food deserts on the prevalence of obesity and other health disparities in Black communities. 

A range of disturbing health trends helped support the declaration in Milwaukee last year, including the high mortality rate for Black residents, whose life expectancy is 14 years shorter than for White people. 

And, as in other cities across the country, COVID-19 continues to devastate Black communities. As of July 22, Black people comprised nearly 33% of all confirmed COVID cases in Milwaukee.

In Boston, the convergence of two crises鈥擟OVID-19鈥檚 disproportionate impact on people of color and the national backlash against Floyd鈥檚 death鈥攑receded Mayor Martin J. Walsh鈥檚 declaration of racism as a public health crisis in June 2020. 

Boston created a COVID-19 Health Inequities Task Force in May after discovering what cities across the country had already learned: Communities of color were more likely to experience severe consequences from the disease. Nationally, if you were Black, you were five times more likely to be hospitalized with the disease than if you were White, according to data from the Centers for Disease Control and Prevention (CDC). On top of that, the non-partisan APM Research Lab pegged the mortality rate among Black people to be approximately 2.3 times higher than for White people.

Floyd鈥檚 death on May 25 underscored how police violence and the resulting stress associated with it impacted the health of Black people as a whole.

While the meaning of racism as a public health crisis differs from one jurisdiction to another, the designation opens the door for a range of issues, including health inequities, to be examined through the prism of race.

Though the pandemic and police violence were two distinct threats, it struck Marty Martinez, chief of health and human services for the city of Boston, that they stem from the same cause. With all the talk about health disparities, 鈥渋t can be easy to forget the role racism plays at the root,鈥� he says.  

Floyd鈥檚 death and the protests afterward forced America to take a hard, honest look at just how entrenched racism is in everyday life鈥攊ncluding public health, Martinez says. 鈥淣ow there was an opportunity where we were not afraid to call out the racism that we see. I think that there鈥檚 power in 鈥� calling something out for what it is. Now we have to do something about it.鈥�

Solutions that stick

Passing a resolution that declares racism a public health crisis is one thing. Finding solutions that bring about systemic change is something else.

One movement that has emerged in the uprising since Floyd鈥檚 death urges cities to #defundpolice, diverting money from law enforcement toward areas such as education, housing, and social programs.

The conversations have raised questions about whether police should even be responding to certain nonviolent calls, such as those involving wellness checks or mental health where situations can quickly escalate. In June 2020, Albuquerque Mayor Tim Keller announced an initiative to have social workers, rather than police officers, respond to some calls, such as those pertaining to addiction and mental health.  

Cities that are just beginning to focus on the systemic causes of health disparities can also look to programs that have worked in the past to address inequities. 

One such program, The Food Trust in Philadelphia, has worked with the Philadelphia Department of Public Health and other partners to bring nutritious, locally grown foods into schools, says Brian Lang, director of The Food Trust鈥檚 National Campaign for Healthy Food Access.

The organization also advocates for food retail development in areas that don鈥檛 have enough supermarkets鈥攐ften in predominantly Black neighborhoods. In 2001, The Food Trust published research showing that people who lived near supermarkets where they could get fresh food were less likely to be diagnosed with obesity or other diet-related health conditions.

鈥淲e published some reports mapping grocery stores and rates of diet-related disease around the city,鈥� says Lang. 鈥淎nd we sort of compared the situation to retail redlining. We said, 鈥榊ou guys are chronically disinvesting in some of Philadelphia鈥檚 Black communities.鈥欌�� 

Their findings caught the attention of state policymakers who worked with the Trust and a local community development bank called the Reinvestment Fund to create a statewide grocery investment program that provided grants and loans to stores, food trucks, and other entities to bring fresh foods to underserved communities. The fund estimates that the program, now in its 16th year, has provided 400,000 Philadelphia residents with access to healthy foods.

Another effort tackling health care disparities targets maternal health. According to the CDC, Black parents are three times more likely to die in childbirth than White parents, a disparity that increases with age. In May 2018, Baltimore Healthy Start, a nonprofit working to reduce perinatal health disparities, partnered with Vitamin Angels, which provides prenatal vitamins to pregnant people in underserved communities, to also offer nutritional information to expecting parents in Baltimore.

Shermika, 39, who asked to have her last name withheld, participated in the program when she became pregnant with her daughter, Stori, in 2019. Prior to the program, she says, she wanted to learn the best ways to keep herself and her baby healthy. Once she started taking the prenatal vitamins and attending Healthy Start meetings, she says, she learned new eating habits 鈥渁nd what was best for me if I want to still be here for my kids.鈥�

Removing the silos

Health advocates believe that to make real progress in reducing health inequities will require communities getting out of their silos. 鈥淲e need police officers at the table. We need the community members. We need Black Lives Matter at the table. We need doctors and nurses, we need public health practitioners. We need people from all backgrounds coming together to say, 鈥榦kay, this is what we should do,鈥欌�� says Collins, dean of the University of New Mexico College of Population Health.

It also means engaging community-based organizations on real and sustainable solutions and interventions, says Fleurant at Emory University School of Medicine. Not only do they know the biggest challenges within these communities, but they also know the people there better and have established trust with them. It鈥檚 particularly critical in the Black community, as a Pew Trust survey found that only 35% of Black Americans have 鈥渁 great deal of confidence鈥� in medical scientists to act in the public鈥檚 best interest compared to 43% of White Americans.

Collins says that as regions move forward in their plans to address how racism impacts the health of Black people, some changes might occur relatively quickly, while others may take time.

鈥淲e could start seeing things immediately with how we鈥檙e training law enforcement and how we鈥檙e responding to emergencies,鈥� she says. 鈥淭hose changes can happen within six months or a year.

鈥淏ut making a change in how we handle housing opportunities and employment鈥攖hat鈥檚 more of a three- to five-year goal, if not longer. So we鈥檙e talking about a decade of having to put forth some really serious effort to make a change.鈥�