More towns should declare racism a public health crisis
“My friend said you would be helpful,” remarked my 40-something year-old new patient, a Black woman enduring chronic pain from a motor vehicle accident. The referenced “she” was a long-term patient of mine, another Black woman with chronic pain.
My new patient’s tired eyes said it all; she came to me wanting to be heard and not dismissed as a “drug-seeker.” We all have implicit biases — shortcuts for sizing up a situation, and healthcare providers tend to provide better care to those who are like them. Due to a relative paucity of physicians from minority groups, Black people have less opportunity to receive care from someone of their same race. This is one example of where racism exists in medicine and is a small piece of what accounts for disparities in health outcomes.
Black residents in Connecticut have shorter lifespans and more chronic disease than the white majority. The human genome project confirmed that there is no biologic explanation for race. Race is a social construct; a way people have classified themselves based on physical characteristics. The higher infant mortality rate, higher emergency room use for asthma exacerbations, and higher complication rates from diabetes among Black Connecticut residents cited in a 2020 report by Connecticut Health Foundation cannot be explained by biological differences. Racial biases and disparities in health care delivery certainly affect health outcomes. However, the World Health Organization reminds us that access to quality healthcare is a small factor in determining health. Functions of our environment such as where and with whom we live and work have a far greater impact.
Racial disparities in living conditions are prominent in Connecticut, a segregated state where there has been disinvestment in Black neighborhoods. Black residents cluster in the poorest sections of Connecticut’s cities. In these areas there is greater exposure to lead and poor air quality. Connecticut’s cities bear the highest asthma admissions and costs compared to surrounding towns. Schools are of lower quality.
Poor living conditions and educational opportunities lead to less opportunity and advancement, more crime, drug and alcohol use, and violence. Chronic stress takes a toll on health and leads to chronic disease.
No one of us caused these disparate living conditions and opportunities for health, but we are all responsible and must act if we want our communities to achieve their most vibrant potential. COVID-19 and police brutality, both which disproportionately affect Black people, have spurred a movement to address racism as a public health crisis. Sixteen towns, including New London, have passed local ordinances declaring racism a public health crisis.
Smaller wealthier shoreline towns have yet to adopt the ordinance, yet, it is necessary for all our communities to do so: racism doesn’t have boundaries. Via local Marches for Justice, Connecticut residents are crying out and more voices are needed so our government officials hear loudly that Connecticut must address its health equity crisis.
How do we do better? A key piece of any ordinance declaring race a public health crisis is data collection, a necessary first step in understanding the disparities and how to address them. While not biologically different, race is a marker of historic disadvantage and way to assess and ensure our policies are advancing the health of all. The ordinance allows individual communities to assess where racism exists within their communities and develop policies to dismantle it. Example action steps for Connecticut towns are the creation of affordable housing and early childhood programs.
In addition to asking our town governments to consider a declaration of racism as a public health crisis, we can work together to dismantle systemic racism by recognizing we are living in a racist society that has advantaged white people and disadvantaged Black people. Acknowledging privilege and supporting the advancement of the oppressed peoples is the most important way we can move forward.
Mellisa A. Pensa is a family physician and clinical lead for health equity at Fair Haven Community Health Care. She is part of the REACH Steering Committee in New Haven. She is an assistant clinical professor at the Yale School of Medicine and an associate clinical professor at Quinnipiac University Netter School of Medicine. She lives in Old Saybrook.
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