Working as a nurse at the St. Vincent Medical Center in Toledo, Ohio in the 1950s and 1960s, Mary Gregory saw a healthcare system that was broken. In fact, just getting to that position was a struggle: After initially being rejected from the St. Vincent School of Nursing, in 1951, Mary became its first black graduate. Thanks to post-World War II immigration to the small, industrial city — including a wave of African-Americans relocating from the South — Toledo hospitals’ resources were stretched thin. But Mary knew that the solution was to bring medical care directly to the people who needed it. After working with her local health department to write a grant, Mary received funding to create a mobile health unit to take out into communities of color and conduct testing for sickle cell disease.
Eventually, Mary had tested every person of color she could reach in northwestern Ohio and southern Michigan. And she didn’t just conduct the testing: Mary also got the patients referrals for genetic counseling, as well as other services that they needed to maintain their health. After that, she turned her focus to heart disease, knowing it was another major killer of people of color, performing cholesterol tests in her mobile unit, in addition to providing counseling for the patients and referrals for getting the medical treatment they needed. Mary’s daughter, Leslie Gregory, joined her mother in these mobile testing units in the late 1960s and early 1970s. “That’s when I started poking fingers and talking to people about their cholesterol levels — in my teens,” she tells Rolling Stone. “And it drove me into medicine.”
Initially, though, Gregory wanted to be a firefighter like her father, but after passing the physical agility test, she was told that she wasn’t safe in the profession, because as a black woman, it would be difficult to know if she could trust her colleagues enough to not leave her abandoned in a fire. Instead, she attended the Ohio State University, and wrote her freshman paper on the impact of stress on the heart — something she had witnessed firsthand when her father died of a heart attack at a young age. She eventually became a physician assistant, and now works as a full-time clinician in Portland, Oregon.
Gregory is also the director of Right to Health, a nonprofit organization working to address inequities using a restorative and health perspective. Since she founded it in 2006, one of the primary goals has been getting the Centers for Disease Control and National Institutes of Health to declare racism a public health crisis. But Gregory wants to do more than raise awareness of the impact of racism on public health — she also has specific, actionable plans to accomplish this, based on her mother’s original protocol.
Though the idea of recognizing racism as a detriment to public health isn’t new, it has gained traction since the police killing of George Floyd and the subsequent protests around the country. On top of that, people of color — African Americans in particular — have been disproportionately affected by the COVID-19 pandemic. And thanks to the coronavirus outbreak, we’ve had a crash course in public health over the past few months. For the first time in our lifetime, we’ve had to grapple with the idea of relinquishing some of our own autonomy and freedom in order to help the greater good — in this case, the health of the public. And though we still have a long way to go, we’re finally getting used to thinking of health in terms of our interconnectedness, rather than solely on an individual basis. With public health being top-of-mind for many people right now, it’s the ideal time to use that language and framing to take on systemic racism.
Already, several cities and counties have recently passed laws declaring racism a public health crisis, and a bill has been introduced in the Ohio legislature that would make it the first state to do so. But what, if anything, will these new laws accomplish? Are these hollow, symbolic gestures that local governments pass for optics, or the first steps to achieving actual change? Here’s what public health experts and legislators have to say about the potential impact of these laws.
Why frame racism as a public health crisis?
When it comes to discussing racism and public health, words matter. Specifically, Gregory says that it’s important to refer to racism as a public health “crisis” instead of an “issue.” Not only is it more accurate, she says that racism also meets the four criteria the CDC requires in order for something to be considered a public health problem. That means that (1) it places a large burden on society that continues to increase, and (2) impacts certain parts of the population more than others. In addition to that, (3) there’s evidence that preventative strategies could help, but (4) this hasn’t happened yet. And while we’re on the subject of words, Gregory wants to remind us that when we talk about “race,” we’re really talking about skin color. “There is one race on this planet — homo sapiens — and to use the word ‘race’ in talking about skin color is our first mistake,” she explains.
The roots of institutionalized racism run deep, impacting the health of people of color in every aspect of their lives, including access to education, housing, and job opportunities — not to mention the persistent threat of police violence. Each of these factors have both direct and indirect public health implications, like the drinking water in Flint, Michigan, for example. In that case, aging pipes in homes in predominantly African American neighborhoods, and being consistently overlooked for routine infrastructure improvements, resulted in thousands of children getting lead poisoning from drinking water from the public supply. More recently, we’ve seen this play out during the COVID-19 pandemic, with communities of color being infected with the virus at disproportionately high rates thanks to not having access to adequate health services, including coronavirus testing and treatment.
Beyond that, the stress of dealing with racism is, in itself, a major public health problem. “Anti-black racism is engrained in the fabric of American society. Black people experience systemic racism — a chronic stressor — throughout their lifetime, which negatively impacts physical, emotional, and mental health,” says Dr. Faith E. Fletcher, assistant professor of health behavior at the University of Alabama at Birmingham School of Public Health. For example, according to the American Psychological Association, the stress associated with racism increases the risk for several chronic conditions like heart disease disease, diabetes, and both inflammatory and autoimmune disorders. “As a field, we must begin to address the fundamental cause of much of the experienced intergenerational trauma for blacks in America — systemic racism, rather than merely focusing on the symptoms, like chronic stressors and trauma,” Fletcher explains.
So why is framing racism in terms of its impact on public health getting more traction now than before? According to Dr. Leon McDougle, president-elect of the National Medical Association, it’s the result of a confluence of events. “Namely, the disparate outcomes that we’re observing with COVID-19, which has energized community organizations to develop plans to counteract these untimely and tragic deaths. Also, the galvanization of the nation seeing a series of murders of black people on television,” he tells Rolling Stone. “Racism and police-involved violence are social determinants of health, so that’s the framework [through which] I think they should be viewed.”
Now that more people are acutely aware that public health is more than food safety inspections, it makes sense to address racism in this capacity. “There are two viruses that are plaguing our communities, and the coronavirus is one of them, and racism is the other,” Ohio House Minority Leader Emilia Sykes, who has a master’s degree in public health, tells Rolling Stone. “Coronavirus is novel. It just came into existence — at least in human form— in the last year. Racism has been around at least the United States for 400 years. So, while the coronavirus is certainly dangerous and has been deadly, racism has a long history, and its ability to permeate through several different institutional structures that have lasted over generations is far worse.”
But it goes beyond the coronavirus pandemic and the most recent incidents of police violence. These are only the most recent examples of the many ways the deck is stacked against people of color when it comes to their health, and why Sykes sees passing a law recognizing how racism affects public health as an important first step to dealing with it.
What can these laws actually do?
It’s frustrating for Sykes when people dismiss laws positioning racism as a public health emergency as being only symbolic, and not capable of facilitating real change. In fact, Sykes says she has faced pushback from both Republican and Democratic colleagues, who point to other pieces of legislation that the state has passed reducing criminal penalties as being a sufficient way of addressing racism. But she says they’re not enough, because those laws never get to the root causes of problems, meaning that they’re destined to happen again. One of the aims is to break that cycle.
“If you are telling me — a black person, a black legislator, a black woman, a black leader — ‘This is what we’ve done to help your people: Take it and don’t question it,’ that is the problem that we’re dealing with,” Sykes explains. “The fact that these people believe that they know better about what I need and my community needs — that’s white supremacy at its finest. And they are exhibiting it every time they fight us on this resolution by saying it’s not significant. You can’t tell me it’s insignificant for a governmental body to essentially say ‘black lives matter,’ because for 400 years we’ve been told that we don’t matter, in words and in actions.”
And while legislatures may be willing to pass laws on what Sykes refers to as “low-hanging fruit issues” like criminal justice reform, healthcare, and housing policy, many aren’t willing to take the next step and address racism directly. Sykes uses the infant mortality rate in Ohio as an example. With black babies dying at disproportionately higher rates than white babies, there has been work on legislation designed to decrease this statistic through actions like making Medicaid coverage more accessible, and giving out cribs for babies. “But what has been missing for a large portion of this conversation is the impact that racism has on the women who carry these babies, which creates a physiological change in chronic inflammation, which makes it a hostile environment for an infant to live in,” Sykes explains. “Everybody has the same goal: we want these babies to live. But not so much so that they’re willing to tackle racism.”
At this point, the bills don’t contain specific allocations of funds directed at programs designed to reduce racial health disparities. But Sykes says that this isn’t always possible. “We are sometimes prohibited by law from saying ‘we want to allocate XYZ dollars to black people’ — that would usually be some type of violation of federal law protection,” she explains. But what legislatures can do, Sykes says, is create goals for addressing different aspects of racism, and then ensuring that the people who evaluate these goals do so using a new set of benchmarks, rather than relying on institutions that contribute to systemic racism.
Along the same lines, McDougle says that ideally, these resolutions should include ways to hold governmental systems accountable for implementing policies designed to improve public health for people of color. In the Ohio bill, for example, this takes the form of a proposed working group responsible for addressing and overseeing the implementation of specific measures, like providing training to a variety of public officials on workplace biases. “While it might not seem as impactful as an allocation of a certain dollar amount, it will be, because it’ll completely change the structures,” Sykes explains. “It’ll start dismantling systems so that people actually have the opportunity to get ahead if they work hard.” Right now, most people of color are set up to fail. “Systems are set up only for certain people to be successful,” she says. “And the others are just exceptions to the rule.”
That’s not to say resources and funding aren’t important. As McDougle points out, another aim of these resolutions is “to rally resources to address these disparities that are rooted in racism as it pertains to origins of the city.” Similarly, Fletcher says that if we are truly committed to alleviating healthcare disparities in the United States, we have to invest in public health research and education that acknowledges, documents, and addresses the adverse health outcomes associated with systemic racial injustice. This means not only funding more researchers of color, but also ensuring that populations and communities of color are included in research projects in a way that isn’t exploitative, and guarantees that these participants reap the benefits resulting from the research. “Justice, which is central to the mission of public health, calls for examining racism in all systems, sectors and policies — including those related to healthcare, the economy, housing, and education — to promote health equity,” Fletcher says.
When will we start seeing results of these laws?
The passage of legislation officially recognizing the role that race plays in public health is a crucial first step. The next step is putting specific policies in place that directly benefit communities of color — which Gregory knows can be a challenge. Since beginning her activism work in the area of racial health disparities and inequities, Gregory says that a problem she faces repeatedly is people being overwhelmed by the scope of systemic racism and saying that there’s nothing we can do about it. “And I’m saying no, that’s not true. We know what to do about it, and it needs to be in the hands of clinicians like me,” she says. “Framing racism as a public health risk means clinicians need to be leading this struggle.”
And then there’s fear. In Gregory’s experience, some people are afraid that approaching racism in terms of its public health implications could mean losing the institutionalized advantages they’ve always thought of as “normal.” But Gregory doesn’t see it that way. “It’s a clinical issue — it’s not like we’re going to take your privilege away,” she explains. “The fear around loss of privilege is palpable. I can see people’s blood pressure going up just talking about it.”
When it comes to implementing specific public health programs to combat racism, Gregory recommends doing it at the community level. This way funding can go directly where it’s needed, based on the most pressing concerns in a particular area, and local clinicians are consulted about where and how the money is spent. This also means not only listening to clinicians of color, but also recruiting people of color to become clinicians. “We’ve got to move from intention to action, and we’ve got people like me out there doing it — I just need the funding and the support to be able to do it,” she adds.
If this plan sounds skeletal, Gregory says that’s by design. ”It gets filled in appropriate to the region that we’re trying to reach,” she explains. “As we know, viruses, like racism, have different expressions in different regions, and that’s how the public health approach can be so incredibly appropriate for racism. Because we know that racism — just like a virus — doesn’t look the same in Philly as it does in L.A. It doesn’t express in the same way. And to address it, we need regionally appropriate interventions.”
But there is one consistent aspect of all of Gregory’s plans, regardless of region: that the work must be done with love and compassion. This means not only being able to sit face-to-face with a clinician and getting human-to-human contact, it also involves recognizing the humanity in medicine and health by telling and listening to personal stories, so others are able to put faces on an otherwise overwhelming systemic problem. “Clinicians have been trained to look at this stuff — we know what’s coming,” Gregory says. “Let us be proactive. This constant waiting until someone gets shot and then cleaning up the mess — it’s not working. We know it’s a problem. We know the next shooting is just around the corner. Give us the information and infrastructure we need to help prevent it.”
One of the first things Gregory would do with funding is implement her mother’s protocol: having mobile units go directly into communities of color to provide the testing, treatment and other health interventions they need. In fact, she says that had her previous proposal for a mobile unit been funded, she would have been able to conduct COVID-19 testing in different parts of Portland, likely reducing the number of deaths in the city. “We’ve got clinical data that tells us what we need to be doing,” Gregory says. “I know what to do. I need the mic. I need the infrastructure, I need the funding. That’s all. It seriously is not that damn complicated. It just becomes complicated in the face of fear.”
And according to Sykes, addressing racism as a public crisis won’t just help black people — it’ll help every single person in this country. “This is not ‘us versus them.’ It’s us versus oppression, us versus alienation, and hatred,” she says. “There should not be any reason why people can’t grasp this and want to support it because this is supporting every human being — eliminating systemic oppression. And if we want to get to all of these societal ills that we are trying to deal with — from education issues to health disparities, to joblessness and crime — you have to give people an opportunity to survive and to thrive. And without eliminating racism, which is at the root of so many horrific policies, we will never get there.”