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Calls Increase For More Focus On Racism As A Key Causal Factor In Health

Racism Called “America’s Contemporary Broad Street Pump”

Inspired by the Black Lives Matter movement, epidemiologists and public health professionals are calling for more intense focus and action on racism as a cause of ill health.

Mary Bassett, health commissioner of New York City, has been one of the leaders in this effort. Bassett published a perspective article in the New England Journal of Medicine earlier this year asking “Should health professionals be accountable not only for caring for individual black patients but also for fighting the racism—both institutional and interpersonal—that contributes to poor health in the first place? Should we work harder to ensure that black lives matter?”

Claiming a responsibility as health commissioner to do more, she pointed out that research on health disparities has occurred, but there has been “a reluctance to address the role of racism in driving these gaps. She identified three actions which could make  a difference.

Three Actions

First, critical research. By studying the ways racial inequality harms health, researchers can spur discussions about responsibility and accountability.

Second, internal reform. She called for renewed efforts to bring more minority persons into the health professions and explicit discussion of how to engage communities of color.

Third, public advocacy. Medical professionals have greater credibility, she asserted, and should publicly assert their commitment to reducing health disparities. 

Bassett reiterated the themes in her article in her delivery of the Dean’s Distinguished Lecture at the Harvard School of Public Health in late October. According to a Harvard news report, Bassett noted how lifespans in some of the poorer neighborhoods of New York City were up to 11 years shorter compared to wealthier ones which sometimes were only a few subway stops apart. “Our passion is driven by the data,” she said, “It’s time to change the narrative and acknowledge these enduring differences have to be changed.”

Hopkins Authors

Cory Bradley and Kelly King writing in a Johns Hopkins School of Public Health fall magazine article call racism a structural issue and a fundamental cause of disease and health disparities facing Baltimore and other cities. It is America’s contemporary Broad Street pump, they assert, and call for candid and critical conversations about racism, segregation, and their effects on health.

They call for “structural reformation” that redistributes power to communities, protects the disenfranchised, and redresses policies steeped in racism. They go further to urge that “all public health professionals must critically examine the role of structural drivers of disparity in their work, such as racism and residential segregation—so that beyond documenting disparities, we move toward a more complete understanding of how racism and racist policies and systems disrupt pathways to health.”

Value Based Research Granting

Bradley and King call for value-based research granting which evaluates applications and research outcomes by how well they actually translate “to deconstruct systems that oppress individuals of color and limit their well-being.” They end by quoting an Australian activist who said “If you come here to help me, you are wasting your time. But if you come because your liberation is bound up in mine, then let us work together.”

APHA Initiative On Racism

Another sign of the reinvigorated interest in racism is the work of CDC epidemiologist Camara Jones who has been elected as the new president

of APHA. Throughout her career, Jones has been a staunch advocate for a greater focus on racism defined as “A system of structuring opportunity and assigning value based on the social interpretation of how one looks which unfairly disadvantages some and advantages others.”

In a recent video discussing her plans as APHA president, Jones reminded listeners that health is not created within the health sectors of clinical or public health medicine but is created in the conditions of peoples’ lives such as housing, criminal justice, education, employment, and so forth. These conditions or social determinants of health are not evenly distributed in society. Jones plans to lead APHA and other national organizations in a national conversation and campaign against racism.

Bradley and King

Camara Jones video

Basset NEJM article


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