As an immigrant, a woman, and the first person in my family to attend college in the U.S, racism and sexism were ever present in my experiences growing up in a small, rural town in Pennsylvania and college days in Philadelphia. While working in local and state government, I was often the only, or one of a few, women of color at tables where policy decisions were being made that would directly impact Black, Indigenous, and People of Color (BIPOC).
Racism has directly impacted the ways that I’ve learned to navigate and survive in a society where in 2022, a person’s skin color continues to impact how that person is treated — from health care services to professional opportunities. Though it’s only one step of many needed, to see cities, counties, states and partners in local, state, and federal government issue declarations that racism is in fact a public health crisis remains important for calling out what many of us already knew – our nation’s BIPOC communities continue to confront racism and we must redouble our efforts to act.
COVID pulled the curtain back from what we in public health and health care have been working to address for decades. In just two years, data show that Black and Latino people in the U.S. experienced a 2.9 and 3-year decline in life expectancy, respectively, in 2020, compared with a 1.2-year decline for white people.
This was all too predictable. Systemic and structural racism have cemented inequities into America’s foundation, and the implications were exacerbated by COVID. BIPOC workers were disproportionately represented in jobs that did not pay living wages, provide health insurance, guarantee paid sick time, or offer the flexibility of working virtually. These frontline workers did not have the resources to stay home and safe as the pandemic raged. Even well-intended public health messages about isolating and quarantining at home were impossible to follow if living situations included multiple families or individuals sharing small, crowded spaces.
Formally declaring racism as a public health crisis is an important first step for elected officials to take to advance racial equity and justice, but resources and strategic action must follow. With this increased attention to racism, along with diverse funding streams that are flowing across different levels of government, philanthropy, and business, there is the real possibility of seizing this moment to accelerate work already underway.
We’ve learned from this work that it’s important to use explicit language that racism is a public health crisis or emergency; focus on meaningful partnerships and collaboration; put accountability measures in place; and dedicate the funding and infrastructure required to facilitate implementation and accountability.
Last year, CDC Director Dr. Rochelle Walensky announced the agency’s recognition of racism as a public health crisis and followed up by creating an agency-wide health equity science and intervention strategy called CORE (Cultivate comprehensive health equity science, Optimize interventions, Reinforce and expand robust partnerships, and Enhance capacity and workforce diversity and inclusion).
CORE is framed around four pillars – science, interventions (including programs, policies, systems change and environmental justice), partnerships and internal organization efforts. This framework catalyzed commitments from across the agency that will help transform how it practices public health and accelerate the progress towards achieving health equity.
Activities include looking at:
- National data systems that assess and monitor racism, health and other drivers of health and health care inequities
- Strategies that establish and sustain anti-racist systems of public health
- Policy levers
- Multi-sectoral partnerships
While it is exciting that the CDC elevated racism as a public health crisis, there are many lessons from the field that will support the agency as it moves toward action.
I, along with Daniel Dawes, executive director of the Satcher Health Leadership Institute at the Morehouse School of Medicine, currently serve as co-chairs of the Health Equity Work Group under the Advisory Committee to the Director. In this role, we’re committed to working with community-based partners, public health practitioners, academic, and public health departments on what we hope will be a transformative journey to support the CDC in its aspirations to be an anti-racist organization.
At Kresge, we recognize the tremendous challenges that communities across the country have experienced during the pandemic and the opportunities that lie ahead as we continue to recover. This context has only re-energized our team as we directly partner with organizations on the ground who are working on a range of initiatives focused on healing, racial justice and health equity. Here are just a few examples:
- Health departments: together with the W.K. Kellogg and the Robert Wood Johnson Foundations we partnered with the Big Cities Health Coalition and Prevention Institute to help move racism declarations to action in large urban health departments. Our goal is to bring a cohort of health departments together to build cross-agency capacity, infrastructure, policies and practices that will enable these jurisdictions to operationalize sustainable actions that address systemic racism.
- Multi-sectoral partnerships: through our participation in a multi-funder collaborative known as the BUILD Health Challenge, we held community conversations that surfaced four critical approaches to centering equity: 1) designing with, not for; 2) building equity capacity; 3) changing deeply rooted policy and practice; and 4) sharing power.
- BIPOC-led organizations: with our Equitable Food Oriented Development (EFOD) partners, we are collaborating to support a justice-first, food-based community development strategies. EFOD leverages food and agricultural development to create economic opportunities, healthy neighborhoods, and actively seeks to build upon community assets, pride and power by and with historically marginalized communities.
Words are important, but action is what matters in addressing the impact of racism on health. Through our collective commitment and efforts, we can improve the health and well-being of communities of color.