• Dr. Ryan Hassan MD MPH

Why is Racism a Public Health Issue?

In the wake of the recent highly publicized murders of George Floyd, Ahmaud Arbery, and Breonna Taylor, and the ensuing protests nationwide demanding not only justice, but also drastic reforms of the police and the entire criminal legal system, many counties and cities have begun considering and passing declarations that racism is a public health issue. I am grateful for these measures, and I hope that they will lead to substantial conversations and policy changes that will finally begin to make a significant impact on this issue. But what does it mean that racism is a public health issue?

Systemic racism is at the root of almost every health disparity we see in the United States. It is a significant driver of unnecessary disease and early death, and chronic psychological trauma that impairs people's ability to live a full, healthy life. These latest murders are not unique, or even significantly different from prior murders of Black Americans by police. This is not a new issue, nor is it the only consequence of American Racism. I agree with the notion that the best voices to explain racism against Black people in the US are Black voices, and I strongly encourage anyone reading this to do so. I will attempt to explain the most basic science and facts of racism in our legal system and our healthcare system as I understand them through the lenses of medicine and public health, but to truly understand what American Racism is and how it shapes all of our lives, I recommend the work of Ibram X Kendi, including the book Stamped from the Beginning; the writings and lectures of Rachel Cargle; and the writings and lectures of Nadine Burke Harris, whose pivotal work on Adverse Childhood Experiences has been fundamental to Oregon Pediatrics' ongoing project to better address ACES and Toxic Stress in our clinics, and is inextricably linked to racism.

Racism in the Criminal Legal System

It would take an entire book to fully explore the topic of racism in the American criminal legal system alone, and many such books have been written, including Paul Butler's Chokehold: Policing Black Men, so instead I will provide a cursory summary of some of the statistics that stand out most to me.

Black Americans are at higher risk for being arrested, assaulted by police, murdered, convicted for crimes, incarcerated, and sentenced to death than white Americans with the same criminal backgrounds, education, and socioeconomic status. Police officers kill an average of 1000 Americans every year, including about 300 Black Americans every year, a quarter of whom are unarmed when they are killed. Black Americans are nearly three times as likely to be murdered by police than white Americans.

New York's Stop and Frisk policy provides a powerful illustration of just how overt racism in policing can be. New York City is 42% white and 24% Black, but in 2019 59% of New Yorkers who were stopped and frisked by the NYPD were Black, as opposed to just 9% who were white. 69% of people stopped were completely innocent. This is actually a significant improvement from prior years, when nearly 90% of people stopped were completely innocent. Even though Stop and Frisk is a New York City policy, it is an unwritten part of policing across the entire country, as every Black American is acutely aware.

Perhaps the most illustrative example of systemic racism in the criminal legal system recently is the stark contrast between the reactions to the protests of recent months. When white "re-open" protesters brandished assault rifles and openly threatened violence while storming the Michigan State Capitol, police stood calmly by in face masks and endured being spit on and yelled at, and the president called them "good people", and urged the governor to listen to them and make a deal with them, despite the fact that their demands were based on patently fictitious conspiracy theories about the COVID19 pandemic that have already caused significant harm to thousands by exacerbating the spread of the disease in the US. When thousands of unarmed, predominantly Black Americans took to the streets of Minneapolis to protest the murder of George Floyd, police showed up in riot gear with tear gas and began firing rubber bullets indiscriminately into the crowd, injuring children, and the president called them "THUGS" and threatened to have them shot. Although many have attempted to justify this discrepancy by propagating bogus stories that the protesters were the ones instigating violence rather than the police, in almost all cases the opposite was true. This comparison has been drawn several times, but I feel it bears constant repeating. It is a clear display of the pervasive white privilege and anti-Black prejudice and violence that Black Americans must face on a daily basis.

It is not hard to imagine how being immersed in a country riddled with violence against Black people can be traumatizing for people within the Black community, and recent evidence has shown that police killings of unarmed Black men have been harmful to the mental health of Black Americans in the general population.

Racism in Healthcare

Unfortunately, the American medical system is not free from the scourge of systemic racism either. Though many healthcare professionals may like to imagine that shameful practices like the American eugenics movement or the Tuskegee syphilis experiment of the early 20th century are relics of a bygone era, widespread disparities in health outcomes based on race attest to our ongoing legacy of systemic racism. Black Americans are more likely to suffer chronic diseases, and have a shorter average life expectancy than white Americans. Black women are four times more likely to die from pregnancy-related causes than white women. Black Americans are significantly less likely to receive adequate pain treatment, and as recently as 2016 surveys have found that 40% of medical trainees believed myths like, "Black people's skin is thicker than white people's".

The COVID19 pandemic has brought these health disparities to the forefront of public attention by drastically magnifying the scope of the problem. Black Americans are dying at a significantly higher rate than white Americans due to COVID19, which makes those white "re-open" protests all the more horrifying.

Why is America Racist?

Overt racism in the US is still terrifyingly common, as the Charlottesville protests in 2017 made glaringly clear. But the police officers shooting Black people aren't Nazis. The doctors and nurses failing to provide the same standard of care to their Black patients that they do to their white patients aren't white supremacists. The reason it's still so hard for millions of Americans to accept that racism is a systemic, pervasive problem in this country is that they mistakenly believe that human behavior is simply a matter of choice. This could not be further from the truth. Human behavior is influenced by not just a person's genetics, education, beliefs, and upbringing, but also by their personal interactions, the organizations they are connected to, the community they live in, and the public policies that govern their lives. This is called the Ecological Model of Behavior, and it is how public health professionals are able to look at a problem and find out the ways to fix it. If we raise cigarette taxes, fewer people smoke, which means that fewer people get lung cancer and chronic lung disease and medical care costs decrease. If we make it illegal to drive without a seatbelt, fewer people die in car crashes. If we pass safe gun storage laws, fewer children get injured and killed each year. As Ibram Kendi puts it in his book, How to Be an Antiracist, "racial inequity is a problem of bad policy, not bad people". As of this writing, only 88 Black Americans have been shot to death by police this year. That means that anywhere between 100 to 200 more Black Americans will be killed before New Year's Day. Several of those shootings will be highly publicized, and in each case there will be people loudly arguing about whether or not that particular murder was justified, and what the victim or police officer should have done differently. But the murders will happen, all the same, and the victims will be Black. If we want to change these outcomes, we must change our policies.




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