Moving beyond Racism as a Public Health Crisis declarations

At the beginning of this series, we discussed how declarations alone are not enough to ameliorate the unending public health crisis—racism.  

Our blog series has covered various topics to show how multifaceted this issue is, and why it is imperative that institutions and governments take collective, actionable next steps to end it. Systemic racism is embedded in healthcare, much like all larger systems and has led to negative impacts in Black maternal and infant health and for Black health care workers. Racism has created disparities leading to the criminalization of multi-system youth, has led to the racialized murders of Black and Brown citizens at the hands of police and in supermarkets, as well as gun violence against them. There are even sundown towns still in existence today in the United States and in the State of Ohio.

 Racism has created disparities leading to the criminalization of multi-system youth, has led to the racialized murders of Black and Brown citizens at the hands of police and in supermarkets, as well as gun violence against them.

Many local efforts to declare racism as a public health crisis have been made by government entities, towns, cities, and nonprofits across Ohio, but now there is a need to take action. This blog post is the first of three blog posts examining what can be done to make substantive changes after the declarations and to move beyond performative measures.

Three steps to moving beyond declarations (that you can do right now)

Dr. Camara Jones launched a National Campaign Against Racism during her presidency at American Public Health Association (APHA) with an agenda to take steps to end racism and its effects on health outcomes. The campaign was created acknowledging that the denial of racism’s effects today is what has kept us behind as a nation. During a 2020 Bray Health Leadership lecture for Oregon State University’s College of Public Health and Human Services, she offered these 3 tasks with tools from her campaign to move beyond declarations:

1. Name racism and understand the forms it can take
2. Identify the mechanisms by which racism operates
3. Organize to strategize & actPart 1 of this series will focus on Steps 1 and 2.

Step 1: Name racism

Naming racism requires acknowledging that it is the root cause of many of the disparities and adverse outcomes for Black and Brown individuals in health and ALL socioeconomic issues. We may often attribute some disparities to socioeconomic issues in order to deflect or deny the issue of race, ignoring that these issues are symptoms of racism.  

Dr. Jones defines racism as “a system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call “race”), that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources.”  

She has created multiple allegories to help illustrate the constructs of race, and a framework for understanding how racism operates on 3 levels:

• in institutions and systems
• between members of society
• individually internalizedSeeing racism as systematized helps us to understand that it was built with intention, that institutions marginalizing specific groups are not “broken” and work as they were intended to, and that racism’s existence is about more than a “few bad apples.” Creating distinctions between ourselves and those “few bad apples” is not enough. Anyone—even the oppressed—can perpetuate racism, because we have been conditioned to live and interact within its confines. Many still do not believe that it exists or that it pervades society today. It can be difficult to see the inequities faced by others when we are not actively looking or touched by them. Therefore, looking and acknowledging has to be the first step.

 It can be difficult to see the inequities faced by others when we are not actively looking or touched by them. Therefore, looking and acknowledging has to be the first step.

Step 2: Identify the mechanisms by which racism operates

Next, we have to ask, “How is racism operating here?” Because racism is systematized, solutions on a larger scale will be required. Dr. Jones explains that it is important to remember that racism has identifiable “levers” that CAN be addressed. One mistake we often make is to believe that racism is an issue that is too big or intangible to be solved. It is easy to become overwhelmed or fatigued in the process of change and to give up, ignore that it is a problem, or continue with the status quo. This is true for White and BIPOC individuals alike, whether it is because of guilt, comfort, or the feeling of safety.  

In her lecture, Dr. Jones provides insight on 4 categories of mechanisms that can be investigated to understand how racism operates:

1. structures
2. policies
3. practices and norms
4. values‍

Decisions, decisions, decisions

She explains that each of these categories act as "elements of decision-making”. Structures are described as the “who, what, when, and where” of decision-making, in which actors decide who is “at the table” and gets to be involved in setting the “agenda” of decisions that impact everyone in society. Policies are then written for “how” decisions will be implemented, while practices and norms are described as the “unwritten how” for customs, ideas, and beliefs that are normalized in executing those decisions. Lastly, values are the “why” in decision-making—the beliefs that fuel the reason behind why certain decisions have been made.  

Dr. Jones encourages that we use this identification process in every space that we interact with. Some examples she offers are: the workplace, our children’s schools, in healthcare systems, and in the criminal justice system, especially with regards to sanctioned police violence against Black and Brown individuals.  

The APHA has also designated police violence as a public health crisis. To demonstrate how to use this tool to identify mechanisms of racism operating in a problem, Dr. Jones shared two illustrations for examining police use of force and COVID-19. For instance, when asking how racism operates in unarmed Black and Brown citizens being killed by police, she used the following exercise:  

Unarmed Black and Brown citizens are being killed by police  

How is Racism operating here?  

Identify the mechanisms:

Structures—without tools like civilian review boards to hold officers accountable;

Policies—we rely on the trial by jury system alone to lead to indictments;

Practices—Black and Brown communities are then over-policed, leading to more police interactions;

Norms—the culture of policing leads many officers to stay silent about incidences of misconduct and to be rewarded for use of force against citizens;

Values—society views Black men as a threat, and see Black and Brown citizens as “other,” making it easier to justify the excessive use of force against unarmed individuals

There are many other structures that we may come in contact with that can stand to be examined, and this example helps to illustrate a starting point for doing so. Dr. Jones offers that because racism is embedded in the institutions and popular culture that we engage with every day, it operates on “auto-pilot” to benefit white Americans above all groups, and does not require “an identifiable perpetrator,” even when they are not actively being racist towards others.

Examine evidence of dual realities

Dr. Jones suggests that all of us—leaders, organizations, individuals—can begin this step by searching for “evidence” of dual experiences in the above mechanisms for different groups. We should always ask if other individuals who are Black or Brown, and who may also live at the intersection of other identities (e.g. living with a disability, LGBTQIA+, gender identity, sexual orientation) are experiencing something different than what we are in our institutions, organizations, schools, healthcare and criminal justice systems. From there, we can investigate further what levers are behind these dual realities.

 Leaders, organizations, individuals—can begin this step by searching for “evidence” of dual experiences in the above mechanisms for different groups.

Parts 2 and 3 of this blog series will focus on barriers to moving past declarations and the final step that Dr. Jones offers to move past making declarations, and merely performative action against racism. In the meantime, you can begin to take the first 2 steps, use the tools offered above, and stay tuned.  

‍