Our Right To Health
Last summer, I wrote a letter to the Centers for Disease Control and Prevention (CDC) asking that they acknowledge racism as a public health threat. If you don’t know: the CDC has a set of four criteria that is used to assess a public health threat in the United States. No surprise, the human cost of racism in the United States indeed meets these four criteria, yet nothing has been done at a systemic level. I decided to take the CDC to task about this.
The US reputation for tolerating racism is well-known. The physical, emotional and social damage passed from generation to generation — people of all color — still exists. Chronic stress, medical expenses, and gun violence paint only part of the horrendous picture.
Since I wrote that letter (and consequently received a response that acknowledged my claim), I’ve had many conversations and exchanges with people who hold various levels of resistance to agreeing that racism is a public health threat. It’s allowed me to gain some insight into the very soul of our culture. It leads me to believe that I have been asking the wrong question.
Why isn’t the CDC doing its job?
I initially started my non-profit, Right To Health, to focus primarily on heart disease. Experience had led me and my team (mostly healthcare workers, wholly volunteer) to conclude that the real, underlying health issue for many people of color is the constant stress of dealing with racism every single day of their lives. As I followed on with further research and talking with others across the country who were deeply committed to addressing these disparities, I began a series of correspondence with the CDC and more recently, the NIH. Both institutions have a long, politically charged history with how they address “minority health disparities.” Go to their website and read the report. To many of us who have been deeply focused in understanding the root causes of “minority” health disparities, these policies are not reversing the global and sustained problem brought about by cultural thought errors such as racism. The responses I received from the CDC basically boiled down to “No thanks, but here’s what we are doing instead. If you have any other suggestions, feel free to share them!” WTF.
Bias at all levels
Many of us are aware that as humans, we are relentlessly affected by the minute signals we receive from others. What directs those responses are often driven by implicit or unconscious bias. Getting on the bus and paying fare to the bus driver. Ordering a coffee. Raising one’s hand in class. Shopping for a pair of pants. These signals can be either affirming (positive feedback from bosses or a nod from a stranger) or negative (looks of fear and/or disdain, commercials that subtly shame obesity or facial acne). Racism works this way: apparent yet hidden. We know that subtle and sometimes not-so-subtle messages about the inferiority or historical treatment of people of color often lead to present-day bias. Negative messages are routine in our society. What we also know is that these subtle messages contribute to what we now know as social determinants of health that demonstrate a profound effect on health outcomes such as heart disease, diabetes, depression, chronic pain and many of the other common complaints that I treat at my office as a PA-C. Compounded by socioeconomic factors and barriers to care like poverty, a justified mistrust of the medical system, access to employment, healthy food choices, and transportation to and from services leave little to the imagination as to why people are stressed and why racism fuels this toxic system.
If, as I suspect, those leading policy at the CDC feel that the issue is just too large to address, then I put the onus back on the CDC. They are the ONLY appropriate institution empowered enough to create and employ change to address racism as a public health threat. The question of what “else” can be done besides the obvious declaration of racism as a public health threat is simple: nothing else will be sufficient or effective.
Above all else, here’s the thing: racism is a risk to the health of ALL Americans. This has been more recently evidenced by a plethora of socio-cultural ills including an increasingly at-risk, white middle class. As long as American leading healthcare institutions like the CDC refuse to fulfill their mandates (and continue the spent “minority health” narrative), this country will never find a cure.
It’s time we speak up and do something about it.