New York City has declared racism a public health crisis—joining more than 200 municipalities, health agencies, and officials across the country calling for efforts to address racism's impact on health and advance health equity.
According to the American Public Health Association, various entities and elected officials have called out racism's detrimental health effects and announced efforts to address it.
For example, CDC director Rochelle Walensky in April declared racism "a serious public health threat that directly affects the well-being of millions of Americans" and "the health of [the] entire nation"—calling attention the pandemic's disproportionate impact on communities of color.
To address the effects of racism on health outcomes, Walensky said CDC planned to make new investments in racial and ethnic minority communities and expand internal efforts to foster greater diversity. In addition, CDC launched a "Racism and Health" portal to bring attention to how racism impacts illness rates and life expectancy among different groups.
In addition, the American Medical Association (AMA) in May released a report acknowledging its own troubling history and pledging to "play a more prominent role" in advancing health equity. In the report, AMA outlined a three-year action plan, which included embedding social and racial justice in all areas of the organization and building alliances with historically marginalized and minoritized physicians and stakeholders.
In a statement, AMA president Gerald Harmon said while the organization has a lot of work to do, its plan is "a step forward in a much longer journey."
The New York City Board of Health on Monday declared racism a public health crisis and passed a resolution calling for the NYC Health Department to ensure a "racially just recovery" from the Covid-19 pandemic, the New York Times reports.
According to David Chokshi, NYC's health commissioner, the Covid-19 pandemic has "magnified inequities, leading to suffering disproportionately borne by communities of color in our city and across our nation."
"Why do some nonwhite populations develop severe disease and die from Covid-19 at higher rates than whites?" Chokshi said. "Underlying health conditions undoubtedly play a role. But why are there higher rates of hypertension, diabetes and obesity in communities of color? The answer does not lie in biology. Structural and environmental factors such as disinvestment, discrimination, and disinformation underlie a greater burden of these diseases in communities of color."
In the resolution, the board asked the city's health department to work with other agencies to address systemic racism within policies, plans, and budgets that affect health, including land use, transportation, and education. According to Axios, the board also directed the department to research its own historical biases and "participate in a truth and reconciliation process with communities harmed by these actions when possible."
In addition, the NYC Health Department will make recommendations to Mayor Bill de Blasio's Racial Justice Commission and establish a Data for Equity internal working group aimed at applying an "equity lens" to public health data, the Times reports.
Michelle Morse, CMO and a deputy commissioner at the health department, said while the resolution is "a hopeful milestone," it's only one piece of a much larger puzzle, the Times reports.
"One of the ways that racism is expressed at a policy level is inaction in the face of need," Morse said. She said updating the city's health code and investing in disadvantaged areas were key strategies in the resolution's plan.
Separately, Kitaw Demissie, dean of the School of Public Health at SUNY Downstate Health Sciences University, agreed that the resolution was a good start. "I like the idea, that they're focusing on this issue," he said. "Now the most important thing is to see its implementation, to see the investment, and to see the changes that are going to come."
He added, "Covid-19 was like a magnifying glass for us to see what has already been in existence for a long time. Racial/ethnic disparities in health have been a pandemic." (Zraick, New York Times, 10/19; Falconer, Axios, 10/19)
Racism has been a public health crisis for a long time. And while we applaud the New York City Board of Health for officially declaring it as so, what follows after this declaration is what actually matters.
Over the last few months, we've seen plenty of new commitments to health equity across the industry. But how many of these commitments are making a true and sustainable impact? Some commitments often aim at advancing equity with efforts that are merely passion projects—relatively one-off programs or investments dedicated to pet issues based on the personal interests of small but mighty teams—not true organizational transformation. Other commitments rely on partnerships that don't go far enough. The only way to make a dent in the massive challenge of racism in health care is to push for large structural change, because yes, racism is systemic.
In the absence of top-down change from policymakers, the onus rests on the shoulders of health care leaders to use whatever leverage they have to push the industry—and each other—toward this structural change.
Let's make sure we are on the same page here: relying on disjointed efforts or one-off equity educational sessions will not move the needle. Equity is not something that folks should be able to opt-into learning or thinking about. Racism is a crisis, so make sure your actions address that level of severity. To do that, equity efforts should be engrained into the very roots of your organization, including in leadership roles, hiring practices, and funding decisions. Every department, team, and individual should be held accountable to equity goals that align with their work. For example, as our colleague Micha'le Simmons recently said: 'If your mission as a health care organization is to deliver patient-centered, high-quality care, we cannot deliver on this mission unless we address racism.'
Racism, like all inequities, are deeply complex issues. There will be some elements of your equity strategy that don't naturally fit into the mandate of existing departments or teams—or that cut across multiple at the same time. To tackle special equity goals and coordinate across the organization, create a dedicated team with sufficient resources. This often looks like creating a C-suite role, equipping them with the necessary staff and funding, and holding them accountable for tangible progress.
However, there is a potential bottleneck here: many health care leaders believe in the moral case for advancing health equity, but they struggle to secure these dedicated resources from senior executives without proving reduced costs or improved revenue as a result. Demonstrating a financial return can take years and varies on the organization's position in the industry. To bolster the value proposition, review five ways that health equity supports business priorities beyond financial ROI here.
Even with the most equitable and strategic approach, no one single organization or section of the industry can accomplish structural change alone. We need key stakeholders to work together, and this even means collaboration among competitors. To forge successful partnerships across the industry (including competitors), the following steps are critical:
We discuss each of these components in depth here.
New York City may be one of the first cities to formally declare racism a public health crisis, but this doesn't mean your community is exempt from the legacies of structural racism. Don't wait for a formal declaration—act now.
For a curated list of our podcast episodes on racism and health equity, click here. In this list, you will find episodes featuring CEOs who tore up their old mission statements, SVPs who discuss women and women of color representation in leadership roles, and experts from Advisory Board who share research-backed insights on equity.
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