How Systemic Racism Is a Public Health Crisis

YOUNGSTOWN, Ohio – In the wake of George Floyd’s death at the knee of Minneapolis police officer Derek Chauvin on Memorial Day, there were nationwide reckonings with how racism has been built into every facet of American life.

There were discussions over how Black people are portrayed in media, the origins of the American police system and its use of force, the state of public education in Black communities, patronizing Black-owned businesses, the still-evident impact of federal redlining housing policies in the 1940s and ’50s, and inequities in health care for minorities, especially Black communities.

On Juneteenth – the holiday that celebrates the day when slaves in Texas were finally freed, 2½ years after the Emancipation Proclamation – the city of Youngstown declared racism a public health crisis, setting in motion a process that aims to mitigate those inequities. Warren passed a declaration of its own shortly after, as did the Mahoning County Mental Health & Recovery Board and Mahoning County commissioners and dozens of other municipalities and agencies nationwide, including all of Ohio’s major cities.

“It’s devastating that it took a pandemic to actually get a spotlight on what has been happening in the community for a very long time, that those who work in and serve the community have seen. We’ve known this all along,” says Leigh Greene, director of Youngstown’s Office of Minority Health.

By the definition as laid out by the Centers for Disease Control, systemic racism – that is, policies and structures that hurt minorities rather than individual acts – is a health crisis. The federal agency’s four criteria are a health condition that places a large burden on society and is getting worse despite control efforts, unfair distribution of the burden, evidence that preventive solutions could reduce that burden and that such strategies are not in place.

While the latest discussions were sparked by Floyd’s death – as well as many other Black men and women at the hands of police in recent years – the coronavirus pandemic also highlighted the inequities in health care Black communities face. A report by The New York Times found that the national virus infection rate was 62 per 10,000 people for Black people, nearly triple the rate for white people.

Locally, the difference was starkest in Columbiana County, where the rate was 167 per 10,000 people for Black residents and 36 per 10,000 for white residents.

Zooming out to the larger picture of health, the inequities are clear. Citing data the CDC collected, the American Association of Family Physicians reports the average life expectancy is four years shorter for Black Americans than white Americans. Black people between the ages of 35 and 64 have twice the risk of high blood pressure than their white peers and those between 18 and 49 are twice as likely to die of heart disease. The widest gaps in outcomes, the doctors’ association reports, are chronic diseases, which include diabetes, asthma and cancer.

“Being Black by itself doesn’t cause poorer health,” said Dr. Kevin Kovach, population health manager for the American Association of Family Physicians, in the report. “It is the systematic discrimination and racism that cause poorer health. Without systematic discrimination and racism, we wouldn’t have the large disparities between white and Black Americans. Same with poverty: being poor by itself doesn’t cause poorer health, but not having sufficient resources to support good health is a driver.”

Many of these outcomes are driven by the social determinants of health. Michelle Edison, Mahoning County Public Health’s Pathways Hub coordinator, says those environmental and societal factors account for 80% of total health, far outweighing the effect of medical care.

“When you talk about food insecurity, there are agencies that need to be at the table because that’s a social determinant of health,” she says. “It’s if they live in an area without access to food or the resources to potentially have exercise – they may not even have playgrounds that are safe or taken care of –  or they live in an area with a high pollution rate because of factories in the area.”

Even issues such as access to fresh food and transportation contribute to negative health outcomes. Urban centers such as Warren and Youngstown have no readily available fresh produce aside from farmers markets and the occasional convenience store. But those options aren’t a replacement for a full-service grocery store.

“There are no grocery stores or anywhere you can get fresh fruit and vegetables without having to make a double transfer on a WRTA route,” Greene says. “Going to the store can be a half-day experience. That deters people from doing the things that are essential and promote good health.”

And without easy access to a doctor’s offices, people are more likely to skip appointments and wait longer for their health to worsen before they seek care.

“When you have to schedule an appointment, wait for the ride, possibly share a ride with someone who has to be dropped off before you, then wait after your appointment to be picked up again. Imagine doing that with children. That’s so time consuming,” she says. “It’s hard work to be poor. It’s hard work to not have these resources readily available to you.”

There’s also the emotional aspect of Black life. Racial profiling disproportionately affects people of color and the events can cause mental health issues – or in worst case scenarios, death. It’s not just the stress of a single incident in itself, Greene says, but the cumulative effects.

“When you go into a store, you know you’re being watched. It’s something you deal with on a daily basis and it’s exhausting. You have to experience that every day. When you get up, you have no idea if it’ll be a good day or not,” she says.

High levels of stress can contribute to the chronic health issues that already affect Black people at higher rates than their white counterparts.

The effects of profiling reach beyond health, too. Greene points to the event of getting pulled over and having a car searched. Even if nothing is found and the officer sends you on your way, that can still be half an hour of time gone. If it happens on the way to work, that time adds up and can lead to being fired.

“The stress of being profiled is time-consuming,” she says. “If you have high blood pressure and are going through this event where everyone’s driving by and all eyes are on you, it all gets incorporated into your being.”

So while local governments issue declarations to deal with public health, the solutions to those racial disparities are broad. To solve those inequities and the systemic racism that has led to them, every aspect of life needs to be considered.

“The topics we identified that are affected by racism the most are employment, education, crime, housing, health care and criminal justice. Those play a vital role as it relates to the health and welfare of African Americans,” says Cheryl Saffold, Warren’s 6th Ward councilwoman, who introduced the resolution to declare racism a public health crisis in the city.

Warren 6th Ward Councilwoman Cheryl Saffold introduced the city’s declaration of racism as a public health crisis. As its next step, City Council is assembling a team to examine health inequities in the city.

She points to the homicide in late June at Quinby Park in her district and how systemic issues can have a deleterious impact on health.

“People are scared to go to the park because of the killing. You can imagine how that affects people who were using the park to exercise,” she says. “If I’m nervous about going to the park because there was a killing. That makes my blood pressure go up, which could cause me to have a heart attack. We know that the health of African Americans, we don’t live as long as other cultures because we have all these other underlying issues.”

Beyond that, there’s the matter of keeping the park safe to ensure the community can use it. Saffold has requested that Mayor Doug Franklin have the city install better lighting, surveillance cameras and increase police patrols, as well as ticketing those in the park after it closes at dark. But in researching for the request, Saffold could find no ordinance on the books that would allow the enforcement of those tickets.

“We’re working with the law department to find out more. If there isn’t one, there needs to be legislation to address it,” she says.

In short, the park – in a predominantly Black neighborhood – isn’t as safe as it could be because city laws don’t allow it.

In Youngstown, 1st Ward Councilman Julius Oliver intends to focus his efforts on education. A 2015 study by Virginia Commonwealth University found that higher levels of education are linked to reduced rates of diabetes, heart disease and even arthritis. Improving the school system, Oliver says, can also play an important role in breaking down prejudices.

“You can use it to teach people the right thing or teach them the wrong thing. The way things are right now, it teaches white and Black people alike that Black people are the inferior race and that our origin starts in slavery. It doesn’t teach the contributions we’ve made to humanity across the centuries and around the globe,” Oliver says.

If history books delve into the history of Black people at all, it usually has to do with the Civil Rights Movement and the work of Martin Luther King Jr., Oliver says. What kids don’t see in books is other contributions, such as pre-colonial African empires or modern inventors.

“They don’t hear about the guy who invented the Super Soaker [Lonnie Johnson] or the inventor of gas masks [Garrett Morgan] or a pioneer in cellphone technology [Henry T. Sampson],” Oliver says.

Oliver is also working on effecting legislation that would require companies getting money from the city to hit a threshold for the number of city residents and minorities hired. Doing so, he says, would provide Youngstown residents with more job opportunities and help to diversify companies.

“Racism and prejudice is built into everything and if you don’t understand that, you hire the people that you’re around and that you’re most comfortable being with,” he says. “Most businesses aren’t in inner city neighborhoods or leaders didn’t go to a Black high school so they don’t think twice about it. We want to make people give a second thought to hiring people that don’t look like them.”

Through the declaration of racism as a public health crisis, the stage is set for other improvements at the government level, Oliver and Saffold say. In Warren, its 6th Ward councilwoman says, just four of the city’s 70 police officers are Black; the city’s population is 27% Black, according to the 2018 Census Bureau estimate. She’d also like to see more Black people hired by Trumbull County.

In Youngstown, Oliver says the effort requires doing away with unwritten rules, such as the federal policy of not issuing mortgages in predominantly Black neighborhoods – a practice best known as redlining – that, while the practice has been off the books for more than 50 years, still affects families today.

The neighborhoods where they were allowed to buy homes were usually the least desirable properties, often close to industrial centers or areas where pollution was rampant. As far back as 1971, the Council of Environmental Quality noted a link between race, income and the potential exposure to pollutants.

“Racism is built into certain policies because it leaves out segments of the population when it comes to protections, equity, fairness. Policies aren’t written to include Black people. Those kinds of markers get passed down without ever thinking about it,” Oliver says. He notes as another example that a deadly threat for Black people – lynching – was made a federal crime only in February.

The process of making these changes will not come quickly. Edison points to Mahoning County Public Health’s work on addressing the infant mortality for Black families. Locally, the infant mortality rate for Black babies is three times higher than it is for white children, a result in part to chronic health conditions that affect mothers. Statewide in 2017, just nine of Ohio’s 88 counties, including Mahoning County, accounted for 90% of Black infant deaths.

“It’s not something that’s unique to Mahoning County or even Ohio. You see it nationally. That is how racism as a public health crisis manifests itself,” Edison says. “There are [some rates nationally] that have been seven to eight times higher than those of non-Hispanic whites.”

Looking at other cities that made declarations earlier and got a head start on the Mahoning Valley, those communities are still working on their problems, Mahoning County Public Health commissioner Ryan Tekac says.

“We understand that in Mahoning County, as well, that if this is to be a trustworthy effort, then not only are leaders involved, but also the community,” he says. “This is not going to be a one and done. This is going to take many years to get where we need to be.”

Mahoning County Public Health, Youngstown City Council and Warren City Council are all working to create committees that will examine how systemic racism manifests locally, look at best practices used elsewhere and gather community feedback. While it will take time for these committees to create recommendations and to have those suggestions put into place, getting legislation in place is the first step toward working out a solution.

“There has to be that commitment,” the city of Youngstown’s Greene says.

“It’s taken 400 years to get to where we are. It’s going to take time to fix. … It won’t be overnight, but it’s happening. If you just keep chopping at a tree, eventually it will fall.”

Pictured: Leigh Greene, director of Youngstown’s Office on Minority Health, says the lack of easy access to fresh food and medical care contributes to the racial disparities in health outcomes across the city.