Racism as a Public Health Crisis: Three Responses

Exploring Community Actions to Respond to Racism as a Public Health Crisis
County Health Rankings & Roadmaps | January 2021

A note to the reader

There are many ways that government bodies have responded to the intersection of structural racism and public health. Some actions have been taken by states, others by counties, and some by cities. Depending on local decision-making, those government entities have responded with proclamations, declarations,  executive actions, or orders.  To see the full list of responses, please visit visit the APHA website.

Racism: An Underlying Public Health Crisis

Our nation’s public health system has protected communities from diseases, pandemics, and natural disasters for centuries. However, how can our public health system respond to a health crisis that is more insidious and yet less tangible than any disease or natural disaster our country has ever experienced? Racism is an underlying or root cause of health inequities and leads to unfair outcomes between racial and ethnic groups.1 These inequities have persisted for far too long. Different geographic areas and various racial and ethnic groups across the country experience challenges or advantages that lead to stark differences in life expectancy, infant mortality, poverty, and more.

The American Public Health Association (APHA) has declared, “Racism is an ongoing public health crisis that needs our attention now.2

States, counties, and cities across the country are answering the call by declaring racism as a public health crisis or emergency, which is an important first step in the movement to advance racial equity and justice. We have collected stories from some of these communities to lift up why they took this bold step, and how they plan to hold themselves accountable to action.

Each dot shows the location of a municipality, county, or state that has taken action on racism as a public health crisis.  Map created from Declarations of Racism as a Public Health Issue. Accessed January 8, 2021. https://www.apha.org/topics-and-issues/health-equity/racism-and-health/racism-declarations

Key Takeaways

  • Declaring racism as a public health crisis or emergency enables communities to leverage data and multisector collaborations into a plan of action focused on addressing the root causes of health disparities.
  • Declarations, proclamations, and resolutions with the most impact include action steps with government accountability. Meaningful impact in addressing racism as a public health crisis requires culture change and capacity-building within government.
  • Governments at all levels—city, county, and state—can be leaders in declaring racism as a public health crisis and embed anti-racism practices within their policies and systems.          

Minneapolis, Minnesota—A City’s Response

 

“Whether it’s infant mortality, violence, or elevated lead levels—it’s the same map. It doesn’t matter what the topic is—the data create the same map.”

-Gretchen Musicant, Commissioner of Health of the Minneapolis Health Department

Building on Cross-Sector Collaboration

Addressing root causes of disparities is not new for the City of Minneapolis. Neither is their cross-departmental approach. Over her 20-year tenure, Minneapolis Health Commissioner Gretchen Musicant has seen a rise in interdepartmental work as staff realize they can leverage each other’s efforts for greater impact. The city committed to taking this collaborative approach in December 2017 when it created the Division of Race & Equity, which works to integrate racial equity into all levels of city policy, practice, and partnerships. By 2018, Minneapolis officially integrated a racial equity framework into its strategic planning process for the first time in its history and adopted the Strategic & Racial Equity Action Plan (SREAP). This milestone enabled the city to align its racial equity action plan within individual department systems and budgets, holding each department accountable for implementing and tracking its progress toward the city’s equity goals.

SREAP Priority3 Department/Division Ownership
Operational Priorities  
Diversify Our Spend
  • Procurement
  • Civil Rights
Diversify Our Workforce
  • Human Resources
Use Data That Shows Results by Race
  • Division of Race & Equity
  • City Clerk
Engage Diverse Communities
  • Division of Race & Equity
  • City Clerk
  • Neighborhood & Community Relations
Policy Priorities  
Promote Housing Stability
  • Regulatory Services
  • Community Planning & Economic Development
Support Inclusive Economic Development
  • Community Planning & Economic Development
Improve Public Safety
  • Minneapolis Health Department
  • Minneapolis Police Department

 

A Convergence of Crises Sparks the Resolution

The ongoing impacts of COVID-19 and the murder of George Floyd at the end of May 2020 further heightened the need to address racism in Minneapolis. In response, the city officially declared racism as a public health emergency. “When you think of policy, that’s how it happens. Similar to the way tobacco policies were passed—you build awareness along with momentum for change,” says Musicant.

Fueled by the power of community voice, City Council Vice President Andrea Jenkins championed the effort to create and pass the resolution. She collaborated closely with representatives from several of the city’s departments including the Division of Race & Equity, the Minneapolis Health Department, Neighborhood and Community Relations staff, and the University of Minnesota’s School of Public Health.

“Until we name this virus, this disease that has infected America for the past 400 years, we will never, ever resolve this issue. To those who say bringing up racism is racist in and of itself, I say to you, if you don't call cancer what it is, you can never cure that disease. And so in an effort to try and cure this disease, I am stating exactly what everyone else has witnessed, and that is racism.”

- City Council Vice President Andrea Jenkins, May 28, 2020

A Resolution Backed by Data and Action

The data used to make the case for the resolution already existed within the city’s tracking systems and included indicators grounded in research. People couldn’t ignore that they were seeing the same data trends for different factors in maps of the city—COVID-19 was no exception, it presented a new health challenge but still spotlighted the same conditions that have created disparities that have been seen time and again. The resolution also cites examples of historical, systemic, political, and economic racism that have had lasting impacts in the community. The resolution includes ten specific actions to keep the city accountable to its residents, and its use of the term “emergency” infuses a sense of urgency to act. The Minneapolis City Council and Mayor Jacob Frey passed the resolution declaring racism as a public health emergency on July 17, 2020. Each of the actions outlined in the resolution have been assigned to a department within city government that will report their progress to the city council on a regular basis. Specific stipulations to develop annual reports with racially disaggregated population health data were included to ensure data guide current efforts and inform future progress.

Investigating the data

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Graphic showing median income patterns in Minneapolis

"White non-Hispanic residents in Minneapolis make approximately three times the income of black and American Indian residents; the median income in 2016 for white non-Hispanics was approximately $65,000, while the median incomes for blacks and American Indians were $20,871 and $22,476, respectively. And since 2000, white non-Hispanic and Asian households have seen increases in median income while black and American Indian households have experienced an approximately 40 percent reduction in median income"

- Minneapolis 2040 plan 

Eliminate disparities. Accessed January 8, 2021. https://minneapolis2040.com/goals/eliminate-disparities/

Milwaukee County, Wisconsin—A County’s Response

 

“This resolution and where we are today is the result of decades of work and collaboration among the public, government, philanthropic groups, and nonprofit organizations in our county.”

- Jeff Roman, Executive Director, Office on African American Affairs, Milwaukee County

Addressing Historic Racial Disparities

There was widespread awareness about the inequities across health, housing, income, and other factors long before Milwaukee County declared racism a public health crisis. Data showing major gaps in life expectancy between racial and ethnic groups and stark differences in infant mortality measures have remained unchanged for decades. “The realization that racism is the root cause of these disparities is apparent to the community. Many people consider this declaration a historical event; conversely, the people most impacted by these disparities (the Black and Brown community) believe this declaration and corrective actions were long overdue,” says Jennifer Harris, Research and Program Manager, Office on African American Affairs, Milwaukee County.

Government officials, community leaders and residents agreed about the need to address longstanding racial disparities. In response, Milwaukee County established the Office on African American Affairs in 2017. The office was created with significant community input and is seen as integral in recognizing and resolving the county’s racial inequities and to enable all members of the community to reach their full potential.

Building a Culture of Equity and Anti-Racism

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Milwaukee County courthouse, flying LGBTQ+ Rainbow flag and Pan-African flag
Milwaukee County Courthouse, photo provided by Isaac Rowlett

The Office on African American Affairs is charged with serving an integral role in recognizing and resolving the County’s racial inequities by facilitating learning about race, equity, and entrenched bias within Milwaukee County government. The office conducts trainings with county employees across all departments to build a culture of equity by openly acknowledging and addressing practices that have historically excluded groups. They’ve drawn on the expertise of partners, including the Government Alliance on Race and Equity and the Mobilizing Action Toward Community Health (MATCH) program at the University of Wisconsin Population Health Institute, to bring quality learning and development opportunities to the county.

These trainings have had personal and professional impacts, giving employees new perspectives on data and a better understanding of historic policies like redlining and how structural and institutional racism has shaped their community. County staff are invested in advancing equity. Racial Equity Ambassadors across multiple departments engage in ongoing conversations about racial justice issues with their peers and coworkers. Racial Equity Ambassadors have created and implemented initiatives, such as racial equity action planning, that focus on moving the needle closer to racial equity.

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Health and Equity Framework from Milwaukee County
Racial Equity Framework. Accessed January 8, 2021. https://county.milwaukee.gov/EN/Vision/Racial-Equity-Framework

Action to Change the System

Milwaukee County was first in a wave of communities to declare racism as a public health crisis. Their resolution was unanimously adopted by the 18-member Board of Supervisors on April 25, 2019. The resolution includes commitment to changing government policies, increasing diversity in the county workforce and leadership, and providing ongoing capacity building to foster a culture of equity and anti-racism.

Milwaukee County has already made strides in putting action behind their declaration. They developed a Racial Equity Budget Toolkit to ensure all fiscal decisions incorporate an equity framework. They used the toolkit while updating the county’s strategic plan (the first update to the plan in 20 years). The county is also collaborating with its 19 municipalities to leverage and coordinate racial equity efforts across jurisdictions.

Nevada—A State’s Response

 

“More than 100 studies have linked racism to negative health outcomes, including research supporting that cumulative experiences of racism throughout one’s life makes racial and ethnic groups particularly susceptible to chronic health conditions that lead to otherwise preventable deaths.”

- Tina Dortch, Program Manager for the Office of Minority Health and Equity, Nevada Department of Health and Human Services

Data That Are Impossible to Ignore

Nevada state government’s commitment to capture and track data across race and ethnicity has grown notably in recent years. In 2005, the Nevada State Legislature created the Office of Minority Health, which later broadened its title and scope as the Office of Minority Health and Equity. The office plays a key role in putting equity data into action, leading governmental equity efforts, and providing training and educational opportunities. The office collaborates closely with the Nevada Minority Health and Equity Coalition, a nonprofit group located at the University of Nevada at Las Vegas, to amplify outreach efforts and ensure that equitable health considerations factor into decision-making across sectors.

Nevada is increasingly diverse in race and ethnicity. A growing segment of the state’s residents are at risk of poor health outcomes that can be linked to racism. Racial disparities can be found across health outcomes as well as many of the social determinants of health like housing, jobs, and education. COVID-19 highlighted racial inequalities within Nevada’s historically excluded communities and has motivated community activists and governmental leaders to identify and act upon the root causes of disparities.

Investigating Nevada Data

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Diagram of children living in poverty

In Nevada, state values of children living in poverty (orange triangles) range from 10% for White children to 39% for American Indian & Alaska Native Children. To investigate disparities and how health may vary for counties and among racial/ethnic groups within your state, please visit the 2020 County Health Rankings State Report - Interactive Diagram

A Crisis Presents an Opportunity

As COVID-19 drew more attention and concern about poorer health outcomes for Nevada’s communities of color, it presented an opportunity for action. The idea of a proclamation to declare racism as a public health crisis began within the Office of Minority Health and Equity to recognize the existence and impact of systems with ingrained inequities that might result in further exacerbation of inequities. The office collaborated with the director of the Department of Health and Human Services to present a framework to Governor Steve Sisolak, which ultimately became the state’s anti-racism proclamation.

Significant consideration was taken in deciding to issue a proclamation rather than an executive order. Executive orders are typically used to give charge within government, while a proclamation motivates action outside of government. According to Tina Dortch, program manager for the Office of Minority Health and Equity, the proclamation is meant to express the state government’s commitment to act in service with the people—“to end the them versus us mindset and refocus our collective efforts to establish an everyone against racism mindset.” This was important because state government is one of the largest employers and providers of community services in Nevada and has the ability to impact significant numbers of residents. The proclamation of racism as a public health crisis was issued unanimously on August 5, 2020.

For the People: Creating an Anti-Racist Government

The governor made a clear commitment to accountability and action in his public address to proclaim racism as a public health crisis in Nevada. The Office of Minority Health and Equity began laying the foundation that would transform the proclamation’s words into actions with tangible outcomes.

In the first three months after the resolution passed, the office established a Diversity Equity and Inclusion Steering Committee to act on the seven thematic topics of the proclamation. The Department of Health and Human Services is responsible for the proclamation’s initial actions because it is the governmental agency that has the greatest human service-related impact across the state. Professional support will be contracted from a vendor tasked to improve the lives of people by helping organizations identify and actualize anti-racist policies and practices. Ultimately, the improved internal practices will result in culturally sensitive, equitable customer service within all state departments.

Early successes in government and private sector collaboration have also emerged. Since the proclamation was issued, the Las Vegas Convention and Visitors Authority reached out to the Office of Minority Health and Equity with keen interest in using the state’s COVID-19 tracer app to partner in promotion efforts that present the tool to more diverse demographics.  

Ready to learn more and take action?

1. Jones NL. Racism, a Root Cause of Health Inequity, Must Be Tackled Head on. Am J Public Health. 2020;110(9):1258-1259. doi:10.2105/AJPH.2020.305823

2. Racism is an ongoing public health crisis that needs our attention now. Accessed January 8, 2021. https://apha.org/news-and-media/news-releases/apha-news-releases/2020/racism-is-a-public-health-crisis

3. The Division of Race & Equity. Strategic & Racial Equity Action Plan. City of Minneapolis; 2019. Accessed January 8, 2021. http://www2.minneapolismn.gov/www/groups/public/@citycoordinator/documents/webcontent/wcmsp-224993.pdf

 


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