By Dr. Jeff Duchin, Health Officer
The horrible violence of the past week, with the killing of black men by police officers in Baton Rouge and Minneapolis and of white police officers protecting peaceful demonstrators in Dallas, revolting and deeply offending to all, has left us feeling confused, helpless and frightened. As a public health community dedicated to promoting conditions under which all persons thrive in good health, how can we respond?
First, we need continue to renounce and work to end violence against all persons, adults and children, in all its forms. This includes gun violence and other forms of physical violence as well as sexual violence and emotional and psychological violence.
Equally important, we need to shake off complacency and recognize and confront the structural, or institutional, racism that is entrenched throughout our society.
What is structural racism? A system in which public policies, institutional practices and other norms structure opportunity and assign value based on race, and that unfairly disadvantages some individuals and communities, advantages others, and perpetuates racial group inequity. Structural racism is so deep rooted and long standing in our society that it is largely invisible and unnoticed by the beneficiaries of the status quo – until things boil over, as they did last week.
It is important to note that racism in this context is not something that individuals and institutions consciously choose to practice. The vast majority of us do not identify as or act “overtly” racist and we may even pride ourselves on how fairly we treat and get along with persons of other races on an individual level. Yet collectively, we operate in and tolerate systemic racism as a feature of the social, economic and political systems in which we exist.
The disproportionate number of black men that are killed by police has appropriately put a spotlight on the issue of institutional racism in law enforcement. However, structural racism and injustice against non-white persons are by no means unique to law enforcement.
For example, racism is closely linked to a number of social factors that result in poor health outcomes for non-white persons. We know that the most important determinants of health are the conditions in which we live, such as the quality of our communities, education and housing, and with economic opportunity. Nationally and within King County, persons of color live shorter lives and suffer from a higher burden of life-shortening chronic diseases than do whites. In King County, life expectancy can vary by up to 13 years based on the neighborhood you live in.
An Institute of Medicine of the National Academies of Sciences report concluded that racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as insurance status and income, are controlled. Other research has shown that persons of color are regularly discriminated against in fundamental aspects of daily life, including employment, housing, finance, and education, and that in addition, racism has health-damaging psychological effects.
What can we do as public health professionals? I suggest we follow the guidance that Mary Bassett, current Health Commissioner in New York City, provided in the New England Journal of Medicine last year: we should vigorously study and communicate the ways in which racial inequality, alone and in combination with other forms of social inequality (such as those based on class, gender, or sexual preference), harm health in order to spur discussions about responsibility, accountability and ultimately, policy change.
Within our own work environments, renewed efforts are needed to hire, promote, train, and retain staff of color to fully represent the racial diversity of the populations we serve. We should explicitly discuss how we engage with communities of color to build trust and improve health outcomes. Communities that are more likely to suffer from a range of poor health outcomes, often communities of color, have assets and knowledge; by heeding their beliefs and perspectives and hiring staff from within those communities, we can be more confident that we are promoting the right policies.
In King County, our Equity and Social Justice initiative provides a strong organizational framework for moving forward and highlights the importance of continuing to assert our unwavering commitment to reducing health disparities and promoting equity and justice for all persons.
As individuals, healthcare providers, business leaders, and other community members we must recognize systemic and institutional racism and begin to understand how to address it to achieve true equity and optimal health for all persons. And we all need to start from a position of humility, with all of our actions informed by kindness and respect towards our brothers and sisters of all races.