Why racism should be declared a public health emergency

Yale University has just published a study documenting the high death rate of black Americans and years of potential life lost due to preventable deaths. The findings were shocking and sobering: 1.63 million premature deaths of black Americans between 1999 and 2020 led to a loss of more than 80 million years of life compared to the white population. These disparities are linked to higher death rates among African Americans from cancer and heart disease. But the substantive reason, medical experts tell us, is racism.

In light of these findings, it is time for public officials, starting with mayors and governors and all the way up to the president, to declare racism and the health disparities associated with it a public health emergency. Authorities must act now to save more black lives, and that action must include putting their money where their mouths are.

Data from the Yale study most strikingly contradicts the myths and lies promoted by right-wing conservatives that African Americans have gained strength and leverage since Barack Obama was elected president in 2008. On the contrary, the study concludes that after the baseline progress during In the early years of the study, from 1999 to 2011, the racial difference in the death rate increased greatly.

Clyde Yancy, a cardiologist at Northwestern University who was one of the authors of the Yale-led study, said the excess deaths among African Americans during the study period — disparities that worsened in the first year of the COVID-19 pandemic — were not a result of of genetics, but reflected the adverse effects of America’s history of racism and discrimination, effects that show up in housing, education, and other areas.

That means “all of these deaths were preventable,” Sandra Elizabeth Ford, former special assistant to President Biden for public health and science, said in a telephone interview. “It is not enough to have good health care. We need affordable housing and good jobs that aren’t overly stressful. In this country, we have yet to marry the health care system with the social service system. Until we do that, we will continue to have disparities that lead to deaths.”

Public officials at all levels of government must heed the advice of medical experts and work to link their government’s social services to health systems. This necessarily entails being more intentional about investments in housing and job training and ensuring that these investments have public health components. As is often the case, bureaucrats work in silos and don’t collaborate as they should. With so many black lives at stake, we cannot afford to continue old patterns of work in isolation.

Both Yancy and Ford point out that education is a key social determinant of health. I asked Ford exactly what that means. She said that without proper education, one “may have trouble finding a job that offers health care benefits.” Low literacy rates, often associated with inadequate education, “can result in individuals having difficulty reading or understanding health issues,” she added. Improvements in education could be achieved if public officials and educators worked together (and if state legislatures did not distract them with a host of cultural issues unrelated to education and public health).

The work that school systems and local governments must do in partnership must begin before kindergarten. According to the Yale study, health disparities begin to emerge at preschool age, especially after the first year of birth. “We need strategies that target early childhood health and the prevention of heart disease and cancer, some of the main drivers of these disparities, to build a more equitable future,” said César Caraballo, lead author of the study.

There is sufficient funding available at the national level to strengthen local efforts in education and maternal health. Funding from the National Institutes of Health, for example, supports initiatives such as Tufts University’s Center for Black Maternal Health and Reproductive Justice. The National Institute on Minority Health and Health Disparities funds the Health Disparities Center of Excellence at the Morehouse School of Medicine in Atlanta. When centers like these connect with the activities of trusted community health centers, they prove to be highly effective.

Finally, I want to return to an earlier point: the need for public officials to adequately fund initiatives that can address preventable deaths, such as those documented in the Yale study. In addition to the human tragedy of shortened lives, these 1.63 million deaths cost society billions of dollars in lost human capital, labor, creativity, tax revenue, and other quantifiable contributions to our economy.

For over a century, Americans have debated whether they should pay reparations to African Americans for past and present abuses. Here’s an opportunity to settle this debate once and for all. Starting with a sincere apology, public officials at all levels of government must establish what might be called a reconciliation trust fund aimed at eliminating preventable deaths of black Americans.

This fund must address racism in education, jobs, housing, and other social determinants of health, in particular by targeting research to reduce death rates for all Americans from cancer and heart disease. Among other things, these funds would support programs that provide medical and health services to prevent premature deaths of black mothers and babies. Improvements in these areas should contribute to a longer, healthier life for all Americans, especially black Americans.

For a decade now, African Americans and their allies have tried to rally the nation around the slogan “Black Lives Matter”. Now that Yale has published this landmark study, society must act to prove that black lives really matter.

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