By Dr. Sharon Kelly-West –
What does “declaring racism as a public health crisis” mean?
Racism—“the R word”—is not unfamiliar to many, especially those who are African American and “living while Black” in the South. Nationally, we are all witnessing conversations surrounding reckoning on race. As Wendy Williams would say: “How you doin’?”
Having served as a public health nurse for at least 15 years, I knew while in nursing school that public health was my niche. Public Health is population health—which means that public health prioritizes wellness in communities. The World Health Organization (WHO) defines wellness as “a state of physical, mental, and social well-being, not merely the absence of disease.”
WHO gets it. They have perfectly captured the reality that wellness can only be achieved holistically. Some 20 years ago Dr. David Satcher, the 16th Surgeon General of the United States (under Presidents Bill Clinton and George W. Bush), declared that certain communities were not thriving but dying disproportionately from preventable illnesses compared with other communities. This declaration definitely heightened awareness nationally, but was it embraced by all? Not so much. Why is that?
Because persons in positions of power, who had a vast platform, had long allowed and even encouraged the creation of racist policies that excluded minority groups—ultimately driving the practice of normalizing inequity. Their policies were de facto segregation, which quickly became segregation de jure. Acts of terrorism against African Americans, such as lynching, which occurred across the country, most notably in the South, totaled over 4,000 lynchings by 1960. As Calvin Hill, Chief Judge for NC’s 28th Judicial District stated, “Separate but equal was legal, but we all know separate can never be equal.”
This practice of dehumanizing African Americans as less-than-full citizens of the United States long ago invaded the health system, including public health; it has faithfully reproduced the script of devaluing of minority communities—African Americans—generation after generation, CEO after CEO, executive board after executive board, medical practice after medical practice. The best example of such devaluation is the Tuskegee Study of 1932 (Bad Blood: The Tuskegee Syphilis Experiment, by James H Jones). Read The Immortal Life of Henrietta Lacks, by Rebecca Skloot, and Medical Apartheid by Dr. Harriet Washington. The hard work and the dedication of late-19th- and 20th-century leaders in public health brought attention to inequities in the distribution of resources mostly affecting communities of color. As a result of that attention, public health has been targeted for budget reductions, program eliminations, and staffing reductions over many years. Such attacks thwart the purpose and value of public health work, yet force public health workers to remain silent and be “grateful” for even the most minimal disbursement of funds they receive.
If public health were treated as the force that keeps us all well, if the voice of public health experts were respected as the voice of how populations experience health and illness, how social, economic and political systems contribute to the shaping of contemporary structures of wellness, I firmly believe we would not be experiencing the longstanding health and healthcare disparities we are witnessing today.
If public health were adequately funded for research, funded to implement programs within the communities most affected in a way that would yield much-needed information triggering excess morbidity (disease) and mortality (death), we could study live data rather than just death data. That is population health.
A lot of mandated education is needed to overcome racism in the form of implicit (or unconscious) bias that runs deep in our society. It starts with reviewing existing policies identifying those practices that exclude communities of color from benefitting. It is important to invite those cultural experts from your staff representing the ethnic/racial minority group who can readily identify bias within the policies. If you have no leadership staff representing ethnic/racial groups—red flag! Hire some. This is how cultural congruence is best utilized.
Next, does the staff of your hospital, clinic, medical practice mirror the representation of that group in your community? Does the leadership (decision makers) represent ethnic and racial minorities? If not, start asking questions.
Change must be intentional. “What we learn from history is that we don’t learn from history.” Let’s change that. It will take each of us to advocate for each other. It will take courage to stand up and speak out. It is not easy, but it is worth it.
Institutional/Systemic racism shows up as acts of doing also as acts of undoing. We must be aware and acknowledge the circumstances into which people are born and under which they must live. Recognize that not all of us were born into this world benefitting from unearned privileges that are based solely on one’s skin color.
There are blatant injustices still being reproduced over centuries. We have reached crisis mode in our country. Racism is making us sick. The time is now for each of us to choose to no longer be complicit in accepting the script of inequity based on racist ideology. Instead, now is the time to advocate for Justice—for all!