Racism and Public Health: An Intro

We tend to think of racism as discriminatory and hateful actions that occur between individuals, but it’s important to understand how racism becomes embedded in the very social structures that are meant to protect us. This can be difficult to understand and there are many factors to consider that are all connected to one another. There are also various other institutions that interact with white supremacy that compound its effects; this is known as intersectionality. In this series, however, we will be specifically deconstructing the impact that racism has on the system of public health.

First, let us consider what influences health.

Of course, understanding human biology is fundamental to advancing medical research and health outcomes. However, it is also important to understand that race, while it’s often mistaken as an objective or natural category, is socially constructed for discriminatory sociopolitical purposes. Specifically, the concept of race was developed in the 18th century as a means to dehumanize Black people and make slavery seem more acceptable.

Understanding that race is a social construct allows us to remove the false biological premise from the discussion and focus solely on societal factors and implications. The conditions in which people are born, grow, live, work, and age are each important social factors that have a major impact on health. These circumstances are known as social determinants. The neighborhood you grow up in, the schools you attend, and the jobs you acquire all influence your health. These types of social determinants are the true root of why we see discrepancies in health outcomes based on race.

Recognizing this is important for understanding why members of the same race tend to have similar social determinants as well as the role that racism plays in health outcomes. De jure segregation is largely to blame for most of these social determinants. This was done through redlining, sundown towns, and was reinforced by white flight. Ultimately, we continue to feel the effects of these practices. These concepts, and more, will be discussed further in future posts.

  • INTERSECTIONALITY: How oppressive institutions can interact and their effects compound. Referenced in the works of Fran Beal, Anna Julia Cooper, Angela Davis, and many more. Coined by Kimberlé Crenshaw.
  • SOCIAL CONSTRUCT: Something that does not exist in objective reality, but rather is created by and for human interaction.
  • SOCIAL DETERMINANTS: the conditions in which people are born, grow, live, work, and age.
  • REDLINING: The discriminatory practice of grading a city and designating minority communities as financial risks for lenders.
  • SUNDOWN TOWNS: A neighborhood that barred entry to minorities once the sun set, being within town lines after dark could be life-threatening.
  • WHITE FLIGHT: Large-scale migration of white folk from diverse urban settings to the surrounding suburbs.

We still feel the effects of the specific action taken on behalf of the government to corral minorities in certain parts of town. This was done through redlining, sundown towns, and was reinforced by white flight.

How do we see the lasting impact of these practices?

The following are just a few of the ways social determinants have been influenced by racism. The neighborhoods in question are often disproportionately filled with waste and pollutant facilities, with restricted access to food, overpoliced, and property-poor. People of color (POC) tend to remain in these same neighborhoods because of trends in generational wealth, employment, and income. Not to mention, our healthcare systems themselves pose a threat to the well-being of POC. This is because of the persistence of pseudoscientific theories of race, practitioner bias and discrimination, and the double-edged sword that is medical research in America.

  • GENERATIONAL WEALTH: The ability to accumulate assets through inheritance.

In Pinellas County, these social determinants lead to some rather alarming statistics. According to the Foundation for a Healthy St. Petersburg, although the county boasts lower age-adjusted rates for asthma hospitalizations and related emergency department visits than Orange County, Hillsborough County, and the general state population, the Black to white ratio of these emergency visits in Pinellas County is 6:1. Approximately 20% of Black Pinellas County residents surveyed stated they had skipped meals in the past twelve months due to financial concerns as opposed to 11.9% of white respondents. Over 23% of Black respondents also claimed they did not have access to mental health services compared to 12.4% of white respondents. As for premature deaths, Black rates in Pinellas County exceed those of whites and Hispanics for all leading causes of death except lung cancer. These rates even surpass the overall state rate for every measure except stroke and prostate cancer. If we look more closely at diabetes we see the largest disparity, 2.6 Black people are dying for every 1 white person. And for age-adjusted HIV/AIDS deaths, Black people are dying at a rate 7.8x higher than their white counterparts in Pinellas County.

As for premature deaths, Black rates in Pinellas County exceed those of whites and Hispanics for all leading causes of death except lung cancer. These rates even surpass the overall state rate for every measure except stroke and prostate cancer.

Foundation for a Healthy St. Petersburg

What can we do to change this?

The first step is acknowledging the powerful link between racism and public health. We can all make a difference just by reading this series, listening to the affected communities, and having these important conversations. On a grander scale, we can do this by passing a resolution to have racism declared a public health crisis at various governmental levels. As detailed here, disproportionate health outcomes have everything to do with the structural differences woven into the fabric of our society. It is our goal to eradicate these inconsistencies which requires recognition of the problem, cooperation, and funding. This is not a radical notion; there are currently 21 proposed resolutions in the Southeastern region alone. North Carolina currently has the most and Virginia has a statewide proposal in the works. Eighteen of these possess language related to organizational policies and practices with commitments to their assessment for equity promotion. Common resolution guarantees include educational activities, training, the creation of justice-oriented organizations and governmental departments, and advocating for policies that improve health outcomes. On April 8th, 2021, CDC director Dr. Rochelle Walensky stated that racism posed a serious public health threat. The agency has committed to both studying the impact of social determinants on health and investing in minority communities. As stated in the CDC’s new “Racism and Health” web portal,

“To build a healthier America for all, we must confront the systems and policies that have resulted in the generational injustice that has given rise to racial and ethnic health inequities.”

Centers for Disease Control, Racism and Health