As public health officials, we adhere to the Centers for Disease Control and Prevention (CDC) charge of protecting and improving the health of all people and their communities. We do this by promoting healthy lifestyles, implementing community engagement strategies, using evidence-informed science to investigate disease, and detecting, preventing and responding to infectious diseases.
Inherent in our approach to disease prevention is the embrace of health equity, which states that all individuals should have access to the resources they need to reach their full health potential. As the COVID-19 pandemic unfolded in the St. Louis region, it became immediately apparent that a specific population, namely African Americans, were not reaching their full health potential.
By now, most are aware of the COVID-19 pandemic’s devastating, disproportional effect on the African-American community. In the City of St. Louis, as of May 31 African Americans account for 63% of COVID-19 cases (1,234 out of 1,955) and 62% of COVID-19 related deaths (81 out of 130). This is not happening by chance, as we are keenly aware of the social and structural determinants of health that place African Americans and other vulnerable populations right in the line of fire of a highly infectious and lethal viral infection.
While working to fully mitigate the COVID-19 outbreak, we are yet again dealing with another terribly familiar public health emergency: an unarmed African-American male dying at the hands of the police. In this case, George Floyd died in Minneapolis after a police officer knelt on his neck for more than eight minutes. Mr. Floyd’s tragic death has led to widespread protests in Minneapolis, New York, Washington, Chicago, Atlanta, here in St. Louis, and other cities, as African-American citizens and their allies are demonstrating against the persistent, inequitable treatment of people of color (African Americans and other ethnic minorities) by the nation’s unjust criminal justice system.
As we in public health have declared the epidemic of gun violence in America a public health threat, so we must call out the root cause of police brutality towards men of color. That requires affirming racism as a structural determinant of health and developing a strategic plan to unravel and excise it from the fabric of our community.
According to the American Public Health Association, if we are to achieve health equity and create the “Healthiest Nation in One Generation,” we must address injustices caused by racism, which we define as “the state-sanctioned and/or extralegal production and exploitation of group-differentiated vulnerability to premature death.” Professor Julio Frenk, dean of the faculty at Harvard School of Public Health, writes that racism is a public health problem “that contributes to higher levels of stress, greater exposure to risk factors, reduced access to medical and social services, and ultimately to excess levels of disease, disability and death.”
According to data published by the CDC:
-
African-American women across the income spectrum and all walks of life are dying from preventable pregnancy-related complications three to four times the rate of non-Hispanic white women
-
African Americans were 20 times more likely to die from heart disease than non-Hispanic whites
-
African Americans were 1.5 times more likely to be uninsured than non-Hispanic whites, and
-
African Americans have the highest death rate and shortest survival of any racial and ethnic group in the U.S. for most cancers.
Toward that end, we unequivocally and categorically declare that racism is a public health crisis.
We must execute the core functions of public health to mitigate and dismantle structural racism in the same manner that we are addressing the COVID-19 pandemic. We must systematically assess the level of systemic and structural racism in our community, we must develop policies that demolish the systems and behaviors that contribute to structural racism, and we must assure the public that we are sincere in these efforts by consistently communicating with transparency and conducting evaluations that holds the right people accountable.
Fortunately for us, a lot of this groundwork has been laid by the diligent efforts of Forward through Ferguson, Health Equity Works, and other local initiatives. These efforts will require public funding commensurate with the importance of this work. Funding public health has not been a high priority for our country. Nationally, we spend less than 3% of the GDP on public health. At the state level, Missouri ranks last in public health funding, spending $6 per person. Locally, funding for health and human services is approximately 0.5% of the General Fund budget.
We will not be a healthy country, a healthy Missouri, or a healthy St. Louis unless we come face-to-face with the specter of racism that has haunted us for centuries. We must adopt an anti-racist stance that is respectful and inclusive of all individuals. While we acknowledge that even the most assertive program may take a generation to succeed, inaction will only assure us of more tragic events, and more protests after this one passes. The “fierce urgency of now” compels us to action.
Will Ross, MD, MPH, is chairman of the Joint Boards of Health and Hospitals for the City of St. Louis Department of Health. Fredrick Echols, MD, is acting director of the City of St. Louis Department of Health.
