Throughout history, groups with resources and power have sought to exert control over other groups through violence. Terror and subterfuge were key tools in the subjugation and genocide of Native Americans and the theft of their lands. From the 16th to the 19th centuries, the Trans-Atlantic Slave Trade Database suggests that 12.5 million Africans were kidnapped and shipped to the Americas. We have seen near-enslavement of Latinx and Asian persons for forced farm or railroad construction labor in the 19th and 20th centuries.
These legacies persist across time and America is in the midst of three interrelated crises, the SARS COV-2 pandemic, economic disruption and extensive civil unrest in the aftermath of the killing of George Floyd by Minneapolis police. Protestors have come out in force across the globe to oppose the racist incarceration of untoward numbers of Black and Brown people, and their murder at the hands of police. Recent events have emphasized the ongoing and persistent problems of structural racism in the United States, which goes hand in hand with injustice and inequality. Racism must be addressed through government policies and action, but racism is not simply a political issue, it is a public health issue.
Now more than ever, as a school of public health, we need to reaffirm and expand our commitment to our mission statement: “As an academic public health community, we recommit to our deeply held tenets of public health: human rights, social justice, and health equity for everyone, everywhere.”
Racism as a public health crisis is glaringly apparent in data showing that police violence kills Black Americans at close to three times the rate of White Americans. The COVID pandemic is disproportionately killing Black Americans; U.S. counties with a majority of Black residents have three-fold higher rates of infection and nearly six-fold higher rates of death as compared to counties with predominantly White residents. The COVID pandemic emphasizes how crowding and inequities in housing and work conditions can provide fertile ground for virus transmission.
Racial disparities in public health result from multiple, concurrent health risks at the individual and system levels. Social determinants of health are key drivers of inequities and include factors such as socioeconomic status, education, neighborhood, networks of social support, and access to health care. Extensive, persistent, and avoidable health inequalities by race have been well documented. Black and Brown Americans have historically experienced disparities in access to education, employment opportunities and inherited family wealth. Food deserts, areas where it is difficult to find affordable and healthy food, are more common in communities of color than in predominantly White communities across the United States, even when controlling for poverty levels. Black Americans experience 2.3 times higher infant mortality as Whites and Black American mothers are more than 2 times more likely than White mothers to receive late or no prenatal care. Chronic stress caused by racism and discrimination give rise to a cascade of adverse health outcomes including high blood pressure, accelerated aging and immunodeficiencies.
Each of us as individuals, and each of the disciplines of public health have a role to play in addressing the systemic and pervasive health challenges associated with racism. Members of the YSPH community are already doing this work in earnest. Examples are faculty studying relationships between mass incarceration and the impact on health, making innovative links between eviction as a form of housing instability and risk of sexually transmitted diseases, and developing interventions to prevent asthma in children of color. Current public health practitioners are essential in the work ahead and our current and future students are critical to success in mitigating and ultimately eliminating racial and social inequities. YSPH will launch a new Social Justice concentration in the fall. Courses and applied practices experiences will focus on race and other identities such as class, gender and sexual orientation. Social Justice students will elucidate how historical and current systems of privilege and power create and perpetuate unequal, avoidable, and unjust burdens on health. First, the concentration seeks to help students understand these issues with analytic rigor. Then, it will empower students with the diverse skills needed to tackle, intervene and correct injustices.
We at YSPH are committed to unearthing and documenting systemic racism in health and to forging the policies to correct them. We know that as a school and as individuals, we must take personal responsibility to address systemic racism, anti-Blackness, and White supremacy. Our commitment to this work must focus both externally and internally, including sensitivity regarding micro-aggressions in our workpace. We stand with our colleagues across Yale University and the Association of Schools and Programs of Public Health, who recently issued a statement “Racism is a Public Health Crisis.”
We can and will do more.
Melinda Pettigrew, Ph.D., is a professor and senior associate dean of academic affairs at the Yale School of Public Health. Sten Vermund, M.D., Ph.D., is a professor and dean of the school.
This is the first in a series of essays by Yale School of Public Health faculty, alumni and students on the issues of race and racism in the United States following the killing of George Floyd and the ensuing protests against police brutality throughout the United States. We remember, too, Ahmaud Arbery, Breonna Taylor, Rayshard Brooks, and countless Americans who came before.