Amid the national reckoning over systemic racism in the midst of the pandemic this past summer, Michigan joined Ohio, Wisconsin, and more than 60 local governments in declaring racism a public health crisis. Yet as we sat in our October medical school Zoom session discussing racial health disparities with our classmates, many of us noted that once more the connection between racism and health had been proclaimed with no follow-up actions.
Declarations that racism is a public health crisis, while good steps, must generate tangible results in order to have any meaning. Every level of government must establish sufficient funding for research into the public health effects of racism in order to fully characterize the problem and propose paths to reducing harm, just as we do with other major health risks.
We already know that racism is associated with a variety of poor health outcomes for Black Americans. Structural racism was and is baked into policies that affect health, from long-standing Medicaid infrastructure that still allows de facto segregation in nursing homes, to studies that show connections between historical redlining and worse health today.
We propose the following actions for governments at all levels in order to make material progress on confronting racism as a public health crisis.
Passing The Anti-Racism in Public Health Act of 2020
The Anti-Racism in Public Health Act of 2020, introduced last September by Sen. Elizabeth Warren (D-Mass.) and Reps. Ayanna Pressley (D-Mass.) and Barbara Lee (D-Calif.), seeks to amend the Public Health Service Act to carve out money for research, data collection, and grants for interventions focused on racism and public health. Their proposal provides for states to facilitate collaborations between state health departments and state universities to conduct such research. Although the bill currently gathers dust under a referral to the Senate Committee on Health, Education, Labor and Pensions, state legislatures could use the template and pass similar bills to give meaning to their anti-racist declarations.
Increasing Federal Research Dollars
National leadership must enable the NIH and CDC to financially support research into how structural trends in healthcare such as provider consolidation, clinical trial infrastructure, and patient payer-source affect racial disparities in outcomes. With the overwhelming body of evidence on the associations between social factors and health outcomes, these federal institutions should fund research on the potential causality between problems such as gun violence, a lack of housing, uneven healthcare access, and racial health disparities. To enable such studies, the Dickey Amendment that constrains funding on public health research into gun violence must be nullified.
Prioritizing Black Medical Students
Increasing the number of Black physicians is key to improving the health of the Black community. As just one example, Black women are three to four times more likely to die in childbirth than their white counterparts; however, this disparity is halved when Black mothers receive care from a Black physician.
Unfortunately, progress on racially diversifying medical schools has been very slow, with Black students still underrepresented amongst medical school applicants and matriculants. For example, the University of Michigan Medical School Class of 2024 is barely 3% Black despite serving a state that is about 13.4% Black. As a state institution, the university has an obligation to provide for the health needs of its state that it is failing to perform with such underrepresentation.
To finally solve this much-discussed problem, the AAMC should call on each accredited medical school to publicly publish statistics around race for enrollment and retention for all classes, starting now. The data should be used to set tangible, enforceable goals for improving diversity within AAMC member schools by 2030. This system would put public pressure on schools to adequately diversify their classes and would allow Black students to gain better insight into the schools that would support them once they arrive.
Closing COVID-19 Disparities
COVID-19 has adversely affected the Black community due to the disproportionate burden of chronic illness, reduced access to healthy foods and preventative treatment, and lack of adequate workplace support within the community, all impacted by structural racism. In order to tackle this issue, all states that have made racism a public health crisis should expand Medicaid health services if they have not already done so, such as Wisconsin. The expansion would ensure that Black workers, who are disproportionately working class and not able to work in socially distanced settings, can get necessary care. Local governments should use tax incentives to help bring more fresh foods and produce, as well as gyms and parks, into neighborhoods that lack such access. Hospitals, with increasing economic roles in communities and requirements as nonprofits to provide community benefits, can also play a role by having food pharmacies available to both patients and members of the wider community.
Racism is a harrowing public health crisis that shortens lives, costs millions, and saps the potential of many Americans. Gone are the days where passive gestures such as diversity training sessions or bringing together broad councils, are enough. We need to invest in our communities at every level, supporting good health and good healthcare. Political declarations without actions feed a sense of nihilism and herald the declining efficacy of our institutions. It is time we embrace the fierce urgency of now.
Victor Agbafe is a medical student at the University of Michigan and a former volunteer with the Harvard Citizenship tutoring program. Rachel O’Reggio is also a University of Michigan med student. Erika Lynn-Green is a Harvard Medical School student.
Last Updated February 12, 2021