Health Sciences Must Acknowledge Racism as a Public Health Crisis
According to the Atlantic’s COVID Tracking Project, Black Americans are dying at rate two and a half times higher than white Americans. And a recent poll found that Black Americans are nearly three times as likely to personally know someone who has died from COVID-19 than white Americans.
These are among the countless statistics that highlight COVID-19’s disproportionate impact on Black Americans and communities of color.
A sign of how insidious this problem is, these COVID-19 disparities are themselves connected to other systemic racial inequities. Marginalized groups encounter difficulties fully accessing the health care system, which contributes to higher incidences of obesity, diabetes, hypertension and other conditions that make people more vulnerable to severe illness from the coronavirus. These inequities extend into the many factors that shape people’s lives—from the jobs they hold and the places they live, to the air they breathe, the water they drink, the food they can buy, and the levels of stress they suffer because of their income, their personal safety, and the racism they may experience on a daily basis.
The coronavirus pandemic has brought broader awareness of these social determinants of health—the foundation of public health. This recognition has the potential to transformationally change our future and the way we think about health care delivery and prevention in this country.
As a physician and a biostatistician and the deans of the University of Michigan Medical School and School of Public Health, we recognize the systemic racism that has contributed to these vast health disparities, not just with COVID-19 but with countless other health conditions. Racial health disparities are not going to be eradicated by a single physician, health system or public health researcher. Because the root of these problems is systemic, it requires all of us coming together.
Our colleagues across the health sciences must acknowledge that racism is a public health crisis. Instead of overinvesting downstream in the treatment of the disproportionate effects of COVID-19 and other diseases on people of color, we must have the forethought and discipline to invest in an underfunded public health infrastructure. We need public health expertise now more than ever to create systematic, long-term change. This starts with investing in prevention and education to improve population health, which will ultimately decrease health care costs.
A robust field of research, for example, is discovering how racism causes stress and negatively impacts the mental and physical health of people of color. Arline Geronimus, a professor at the University of Michigan School of Public Health, coined the term “weathering” to refer to the accelerated aging experienced by Black Americans due to persistent stress caused by racism. This helps explain the higher death rate among Black Americans from COVID-19, cardiovascular disease and even childbirth.
The long overdue recognition of these vast and systemic forces increasingly guides our approach to tackling COVID-19 and other forms of injury and disease. In addition to the scientific and medical research crucial to understanding and developing treatments for biological disorders, we must examine how political, social and economic inequalities influence well-being.
The community health center, doctor’s office, ER and operating room are just points in a broad continuum of care. Individual health is often a function of public health; not just the choices made by each individual but the profound forces and systems that shape their lives.
That’s why academic medical centers must partner with public health experts and others to unravel the myriad forces that generate and spread disease and address them immediately.
Crisis is often a catalyst to change that society may have recognized as necessary but failed to advance with sufficient urgency. While our healthcare system has long been aware of and worked to respond to systemic racism, COVID-19 has underscored how much work remains to achieve health equity.
Racism is a public health crisis we must first acknowledge, then fight, and win, even after the battle against COVID-19 is over.
F. DuBois Bowman, PhD, is Dean of the University of Michigan School of Public Health. Marschall S. Runge, MD, PhD, is Executive Vice President for Medical Affairs and Dean of the Medical School for the University of Michigan. He serves on the Board of Directors for Eli Lilly and Company.