There are far more symptoms of racism than “fire hoses and police dogs”. They are more deceptive but no less shameful. They are, longitudinally, proof of the harm that racism inflicts on an entire subset of society: our black neighbors.
These symptoms include well-documented, pronounced, and widespread health inequalities: higher rates of chronic disease and premature death among black Americans compared to white Americans. For example, data from the National Center for Health Statistics 2020 reveals that maternal mortality for whites is 19.1 per 100,000 live births, compared to an alarming 55.3 for black Americans. For children with asthma, it’s worse: Black children have an asthma death rate seven times higher than that of white children. How can this happen?
The “social determinants of health” are the factors that create, protect and promote health or, conversely, enable and/or cause disease. Well-known traditional social determinants of health include education, housing, food security, transportation, economic stability and health care. The causes of health inequalities are complex, diverse, dynamic and interrelated. And racism is an insidious web that operates on many levels.
Racism negatively affects each of the social determinants of health by disadvantaging people of color through policies, practices, beliefs, attitudes and behaviors. What, precisely, is racism? And how does this negatively impact the social determinants of health?
Racism, as defined by the Centers for Disease Control and Prevention, “is a system – made up of structures, policies, practices and norms – that assigns value and determines opportunity based on how people look or the color of their skin, resulting in conditions that unfairly benefit some and disadvantage others throughout society.
The Post’s View: The Racial Ignorance of Virginia’s Health Czar
Racism is ideologically rooted in the racial supremacy premise of white supremacy. A Post article reporting Greene’s comments indicated that Greene feared white people would be alienated if the word “racism” was used; it is tantamount to a doctor anxious to alienate his patient when presented with a diagnosis of cancer.
Although black Americans bear its burden (symptoms), the disease of racism is that of our society as a whole, and particularly those in power who deny its reality, actively choose to remain ignorant, or fail to use their power to act to identify, correct and prevent it. Racism exists insidiously on multiple levels, intentionally and unintentionally, consciously and unconsciously.
Historically, racist policies have prevented black people from getting credit. Currently, at a systemic/societal level, reverse redlining practices are creating food deserts in poor predominantly black areas; and Black neighborhoods often have the double burden of nearby industrial and/or road development (with subsequent increased negative environmental exposures) as well as lower property values (with a lower tax base for schools). Racism also exists at the community, interpersonal and intrapersonal levels. And all of these levels affect our black neighbors.
Moreover, there is growing evidence that racism itself – independent of its impact on the traditional social determinants of health – is a determinant of health. This occurs through the cumulative burden of chronic stress and explains why black people with similar socioeconomic status and behaviors to their white counterparts suffer more disease and die earlier.
We all have a lot to learn about the impact of racism on public health, including how to identify, reverse and prevent racism at all levels.
As part of this, we call on Greene to, first and foremost, follow the Hippocratic oath to “do no harm or injustice”; seek out, listen to, and learn from public health experts who have researched and worked in this area, as well as learn from black leaders in Virginia at the state and local levels; and to encourage — even require — that all Virginia Department of Health public health workers become anti-racists through formal training programs. And Greene should lead this endeavor by being the first to undergo such training.