Racism is a Public Health Crisis
And has been for over 400 years.
At a vigil for George Floyd in Portland, Oregon, a young black woman stepped up to the microphone. She had tears in her eyes. “When I moved to Portland from the Midwest, one of the first things I noticed was how healthy you are here,” she said. “All your yoga studios and organic food and wellness clinics…” she paused for a long while, trying to get the words out. “But it’s still not for us.”
I see this truth every day. As a home health worker, I drive between patients in a number of zip codes. Even before I arrive at their homes, their neighborhoods foreshadow the medical conditions I will see. The list of diagnoses grows longer as green spaces turn to concrete, fast food restaurants replace grocery stores, and health clinics become blighted buildings.
The conflict raging in the streets right now has been raging for over 400 years. Two million enslaved Africans died of smallpox, measles, and dysentery during the “Middle Passage.” Today, African Americans shoulder the greatest burden of coronavirus. Before the civil war, the state sponsored slavery. Today, it sponsors police brutality and mass incarceration. Injustice is and always has been inscribed in the body. Even if there were no words or concepts to talk about oppression, the body would bear faithful witness.
Black Americans are 50% more likely to have high blood pressure. Epidemiologists typically explain this difference by pointing to unequal access to healthcare, healthy food, green spaces, and economic opportunity. A lesser known body of research suggests that the experience of race itself contributes to high blood pressure. In a racist society, the stress of merely walking down the street, sitting at the bus stop, or waiting in a checkout line does measurable violence to the heart.
(The fact that all this medical research exists is, on the one hand, promising: the literal heartbreak of a country is being understood. On the other, it is sad to think how many healthcare workers and policy makers didn’t understand it before it was translated into the elitist language of science).
In our United States, black lives are and have been shortened lives. Whether cut short by state-sponsored violence, white supremacist terrorism, chronic illness or coronavirus, one etiological factor underlies them all: institutionalized racism.
“When we no longer observe these racial variations in disease occurrence and outcome, our society will have at last vanquished racism,” write Mary Bassett, MD and Jasmine Graves, MPH in the American Journal of Public Health.
When a person’s zip code is no longer a determinant of health, we will have vanquished racism.
When the woman who spoke at the vigil has equal access to spaces of health and wellness, we will have vanquished racism.
Justice, like injustice, is inscribed in the body.