We Need to Name it: Racism is a Public Health Crisis

Our country boils over in tension about the inaction of our leaders to address (among other things) the clear police brutality and racism that has led to the murder of Black Americans, most recently George Floyd and Breonna Taylor.

We were already witnessing the COVID-19 pandemic further expose the fault lines within our health system that disproportionately harm communities of color.  I have continued to search for the best ways to do more—at work and at home—to fight back against the blatant systemic racism that we have all been complicit in allowing to grow. As a recent commentary calls out, we are still waiting for a vaccine that can cure racism – a public health crisis of its own.

As I added to my family’s list of donation groups and considered other new ways to act, I thought about our work at CCF and how we might do more to lift up specific ways racism and white supremacy may be dismantled. While the public health community has more explicitly called out the role of racism in perpetuating health disparities, the language in the broader health world seems to often stop at discussions of “social determinants of health” without fully naming systemic racism as one of the most damaging to communities of color. We must name the problem to understand it. We need to understand it to successfully address it.

Don’t just take my word for it (#1).  Plenty of national health groups have called out racism as a sickness of its own, with plenty of evidence. A few:

  • We are living in a racism pandemic, which is taking a heavy psychological toll on our African American citizens. The health consequences are dire. Racism is associated with a host of psychological consequences, including depression, anxiety and other serious, sometimes debilitating conditions, including post-traumatic stress disorder and substance use disorders. Moreover, the stress caused by racism can contribute to the development of cardiovascular and other physical diseases. (American Psychological Association, May 29, 2020)
  • Racism harms children’s health, starting from before they are born. A growing body of research supports this, and we cannot ignore the impact. (American Academy of Pediatrics President Sally Goza, MD, FAAP, June 1, 2020)
  • The impact of racism has been linked to birth disparities and mental health problems in children and adolescents. The biological mechanism that emerges from chronic stress leads to increased and prolonged levels of exposure to stress hormones and oxidative stress at the cellular level. Prolonged exposure to stress hormones, such as cortisol, leads to inflammatory reactions that predispose individuals to chronic disease. As an example, racial disparities in the infant mortality rate remain, and the complications of low birth weight have been associated with perceived racial discrimination and maternal stress. (AAP policy statement on racism and child health)
  • Racism structures opportunity and assigns value based on how a person looks. The result: conditions that unfairly advantage some and unfairly disadvantage others. Racism hurts the health of our nation by preventing some people the opportunity to attain their highest level of health (American Public Health Association)

Don’t just take my word for it (#2) – I’m white, with all the automatic privilege that comes with it. Now more than ever, we must listen to, learn from, and lift up the voices of people of color in our work to unearth the racist foundation that has contributed to our collective health crisis. A few places to start are listed below. (Please send us your suggestions so we can add to the list.)

When it comes to Medicaid, it can seem challenging on the surface to point to specific policy, as opposed to practice-level, solutions. To be clear, CCF has actively worked to unpack how proposed policies like work requirements would disproportionately harm, for example, Black women, or the ways Medicaid expansion could help uninsured communities of color. And we’ve long examined ways to improve coverage for immigrant families, including Latino families, with close partners like UnidosUS. We will, of course, continue to elevate these data and policy issues where we can.

But what more can we do to promote policies that hit racism head on? How best to concretely address something as politically charged and (seemingly) nuanced as racism in policy? Seems daunting, but if we use the broader lens of systemic, institutionalized racism—not just individual beliefs and culture—we should no doubt be able to call for more accountability. The sheer amount of Medicaid dollars flowing to health systems and managed care organizations compels us to do more to lift up new ways to leverage those payments to improve care and protections for Black Americans and other people of color who have been marginalized for generations.

And now, we listen and continue to learn.

Elisabeth Wright Burak is a Senior Fellow at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.