Weighing in on CDC declaring racism a public health threat

It isn’t really news to hear that experiencing racism, both interpersonal and structural, is bad for a person’s health. Any member of a racial or ethnic minority in this country has understood that racism is harmful to their health, in some form, since this mass of land was first called the United States. What is news is the acceptance of the anecdotal with the scientific evidence, and taking measurable steps to track and repair the harm to public health that has come from racism.

“What we know is this: racism is a serious public health threat that directly affects the well-being of millions of Americans,” Rochelle P. Walensky, director of the Centers for Disease Control and Prevention, said in a recent statement.

“As a result, it affects the health of our entire nation. Racism is not just the discrimination against one group based on the color of their skin or their race or ethnicity, but the structural barriers that impact racial and ethnic groups differently to influence where a person lives, where they work, where their children play, and where they worship and gather in community. These social determinants of health have lifelong negative effects on the mental and physical health of individuals in communities of color.”

Jourdyn Lawrence is a social epidemiologist whose work focuses on the health implications of racism and discrimination among middleaged and older adults. She earned a master of science in public health from the University of South Carolina, and is currently a doctoral candidate in population health sciences at the Harvard T.H. Chan School of Public Health, as well as a doctoral affiliate with the Françoisxavier Bagnoud Center for Health and Human Rights at Harvard University and the Center for Antiracist Research at Boston University. She shared her perspective on this new approach and commitment to understanding and treating racism as a serious public health threat.

(This email interview has been edited for length and clarity. For a longer version of this discussion, visit sandiegouniontribune.com/ sdut-lisa-deaderick-staff.html.)

Q:

The CDC noted that social determinants of health (i.e. the conditions in the places where a person lives, learns, works and plays) affect a wide variety of health risks and outcomes. Can you talk about how a line can be drawn from the conditions of these various places to the kinds of health issues a person may experience?

A:

Let us use racial, residential segregation as an example, with a hypothetical Black neighborhood called Neighborhood A.

Neighborhood A came to be, not by chance, but by unjust federal policies and private, individual-level support. These together created discriminatory zoning policies, redlining and mortgage discrimination to keep Black and White communities segregated. This creation of Neighborhood A is the result of institutional racism.

Through repeated institutional divestment — think jobs, loans for home renovations/maintenance, infrastructure and education — from Neighborhood A, the lived environment looks different. There are fewer socioeconomic resources (e.g., lower educational resources and quality; fewer employment opportunities provide a livable wage). There are increased concentrations of poor-quality housing and people experiencing poverty. There is also lessened access to, and quality of, health care services and a built environment that does not facilitate the practice of healthy behaviors. These factors, individually, have all been documented to be associated with poor health outcomes. This example shows how social factors beyond the individual can also shape individual and neighborhood health.

We also see distinctive effects of segregation on Indigenous communities’ health and well-being. However, policies and individuals achieved segregation differently among Indigenous communities, including through violence, broken promises from the U.S. government, land-theft and forced removal.

Q:

What’s your response to people who argue that racism isn’t the cause of higher rates of health conditions like diabetes, hypertension, asthma or heart disease for racial and ethnic minorities in the U.S. Instead, they say, it’s a matter of making the choice to eat healthier foods, exercise more, etc.?

A: It does not have to exist as a dichotomy; social factors, specifically racism and individuallevel practices, shape health. However, we should understand that racism structures whether individuals have access to quality foods. It shapes whether communities have environments that facilitate exercising, whether individuals have time to do these things, and navigating socioeconomic circumstances that often encompass lower-paying jobs. Though people can make individual choices, these are restricted by what is available in the social spaces — shaped by politics, economics and institutions’ priorities — where people work, live or play.

Q:

Late last year, the American Medical Association also called racism a threat to public health. They further adopted new policies to recognize and support race as a social construct, rather than a biological determinant, and that it is distinct from ethnicity, genetic ancestry or biology. Why does this particular recognition and distinction from the AMA matter, with regard to addressing these public health issues?

A:

This distinction from the AMA is significant because medicine, in general, has shaped many of the pervasive beliefs of race, at a genetic level, being the driver of an individual’s health, ability or behavior. Biomedical perspectives treat race as if it were not created. As if the racial and ethnic categories in the United States do not change.

This announcement from the AMA begins medicine’s reckoning with medical racism. It now opens opportunities to remedy a history of forced sterilization of Black, Indigenous and Hispanic/latinx women; documented violations of medical ethics; and practices of involuntary medical experimentation of Black women for cancer and gynecological research. Shifting from focusing on individual actions as drivers of health inequities, allows medical systems to address individual-level social needs in their treatment and assessment practices. However, it should be noted that naming racism or changing how we view race is not where we stop. These should be placed in action through anti-racist policies and practices and efforts to remedy previous and present-day harms.