Sunday, June 21, 2020

Racism is a Public health Crisis

I want to talk about racism.
Many of you know that in addition to a Medical degree I also have a Masters in Public Health (plus a bachelor’s degree in Human Biology) and so I am particularly interested in the social causes of morbidity and mortality especially those that can be prevented.
Public health is “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.” This is the most quoted definition of Public Health by CEA Winslow a bacteriologist and seminal figure in public health circles in America and throughout the world.
It is clear that the context of peoples lives determines their health and we, as a society, must have an interest in ensuring people can be healthy.
There is a lot of research that supports the idea that 80 to 90% of a person’s overall health is determined by factors outside of clinical medical care. Some of the social things that affect it are: the quality of air and water, the type of work they do, where they live and access to resources and education.
My sense is that this is a watershed moment in America for a variety of reasons, one of which is the pandemic. It feels like finally something has shifted in the American psyche and hopefully the genie cannot go back into the bottle. I am referring to the sudden acute awareness of racism and as the headline in the Harvard School of Public Health magazine last week stated “Racism is a public health crisis”. Apparently sometimes it takes a visual demonstration of man’s inhumanity to his fellow man for things to become undeniably obvious. Facts and figures that have long been long known can no longer be denied.
Racism affects every aspect of the lives of African Americans today resulting in many lives being cut short. Racism affects both the morbidity and mortality of minorities in this country but because it seems too hard a problem to tackle its easier to ignore it.
 “The racial caste system of slavery that operated until the 1960s (known as Jim Crow) and 401 years of systemic racism and structural societal inequality still live on in every aspect of our daily lives. Nowhere is this more apparent than in health outcomes. It has taken a global pandemic—coupled with the visceral, horrifying deaths of George Floyd, Breonna Taylor and Ahmaud Arbery—for many Americans to acknowledge the truth: racism is deadly. This fact is inescapable in the midst of a pandemic which is killing black Americans at nearly three times the rate of white Americans. This disparity is not because of innate susceptibility to the disease; it is because of a wide range of inequalities that have plagued the black community since long before this health crisis began.” Michelle Williams PhD, Dean of the Harvard Chan School of Public Health. 
Montgomery county has the highest Covid -19 infection death rate in Maryland and latino patients are 5 times more likely to be admitted for Covid-19 with a much worse prognosis.
Here are some current stats for Maryland:
Hispanics 32.9% of the cases even though they represent 9% of the population.
African Americans 35% of the cases they make up 30 % of the population. A total of 68% of the cases are therefore minorities, yet whites make up 59% of the population and only 24% of the cases.
The minorities have the ‘triple threat’ to contend with: 1. More exposure, doing essential functions (only 13% of Latinos do jobs that can be done from home). 2.They have more underlying health conditions from poverty and lack of opportunity. 3. Less access to health care and uninsured.
Some one forwarded this video to me and I found it very helpful in understanding the history of racism in this country. It answers one of the questions of why ‘they’ are so angry and suggests we should all care.
It is a little long (15 minutes) but relatively concise considering how much he is trying to cover. I think it is worth watching.
 Rather than lecturing people on how to express their anger maybe we could all try to remove the cause. It won’t be fast or easy, it was after all 400 years in the making but every journey starts with the first step.

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