Late last month, the Healthcare Anchor Network, a coalition of more than three dozen health systems in 45 states and Washington, D.C., released a public statement declaring: “It is undeniable: Racism is a public health crisis.” In the wake of the killing of George Floyd in May, many states, cities and counties across the United States issued similar declarations, according to the American Public Health Association.
While it is becoming clear that ZIP code may matter more to longevity than genetic code, some public health experts have been sounding the alarm for decades. Indeed, poverty and racism have an enormous – and devastating – impact on health, according to a panel of experts brought together for a webinar hosted by U.S. News & World Report as part of the Community Health Leadership Forum, a new virtual event series.
In Chicago, as just one example, life expectancy between some neighborhoods can vary by 30 years, because of factors like access to health care, education, nutritional food sources, income and what many call systematic disinvestment dating back decades.
COVID-19 has made such inequities impossible to ignore. Expected at first to be “the great equalizer,” hitting all demographics equally hard, the novel coronavirus has caused impoverished, mostly Black and underrepresented minority populations to suffer far more death and ill health effects than their white peers.
COVID-19 “attacks vulnerabilities in a truly diabolical way,” said featured speaker Wes Moore, chief executive officer of Robin Hood, one of the nation’s leading anti-poverty organizations.
“We are going to need a concerted and a collective effort to deal with a calcified and hard problem” of poverty and racism and how they influence health, Moore said. Half of the population of New York City lived in poverty for at least one year over the past four years, Moore said, and the probability of dipping back into poverty within a year was 37% – even before COVID-19 hit. “The data continues to reinforce the fact that … [poverty] is not a choice of the person who is feeling the weight of poverty, it’s society’s choice,” Moore said.
Those in poverty are far more likely to have preexisting conditions like asthma, diabetes and obesity, Moore noted, putting them at greater risk of death from COVID-19 and other illnesses.
In his new book, “Five Days: The Fiery Reckoning of an American City,” Moore examined the 2015 death of Freddie Gray and its aftermath in the city of Baltimore. Moore wrote that Gray, born premature and underweight to a heroin-addicted mother, had grown up in poverty and was exposed to lead at a far greater rate than the limit recommended by the Centers for Disease Control and Prevention. “Freddie Gray never had a shot,” Moore said, because he was failed by every social system, including the health system, and not just law enforcement.
Yet Moore remains optimistic. “We are not yet what we can be; our responsibility to get there is our responsibility to get there,” he said. Citing a famous saying of Dr. Martin Luther King Jr., Moore said that the moral arc of the universe “doesn’t bend towards justice because of gravity; it bends towards justice because we force it there.”
Taking Action to Address Racial Disparities
The fact that COVID-19 has unequally devastated communities of color “was not a surprise to any of us who understood the historic disproportionality of Black deaths in this country,” said Dr. David Ansell, senior vice president for community health equity at Rush University Medical Center in Chicago. Chicago, for example, has seen about 3,200 excess African American deaths compared to whites every year since 2009 – well before COVID-19. “The surprise was that people are surprised,” Ansell said.
Ansell was part of a panel discussion moderated by Joseph P. Williams, senior editor for U.S. News, who noted that systemic racism and COVID-19 “go hand in hand,” and asked what could be done to address the poverty-health connection.
“We have to go beyond saying a thing or noticing a thing to acting,” said Dr. Camara Phyllis Jones, a senior fellow and adjunct associate professor of community health and preventive medicine at Morehouse School of Medicine in Atlanta. It starts with identifying how racism specifically impacts a particular community or organization, she said. “‘How is racism operating here?’ is a legitimate question because racism is not a cloud or a miasma that we can’t get a handle on,” Jones said. If “I use that set of structures, policies, practices, norms and values, in 10 minutes I could, for any sector, generate at least 5 to 20 levers for intervention.”
“When we’re declaring racism as a crisis or a threat or a concern, what we’re really saying is that it requires a rapid response,” said Regina Davis Moss, associate executive director of the American Public Health Association. That entails analyzing data, allocating resources and dismantling the systemic systems of racism and poverty. “What ultimately is going to distinguish whether or not these are simple declarations or simple refrains or purely symbolic is that action,” she said.
Social determinants of health such as economic and educational opportunity and housing conditions are “structural in nature, and therefore in our control,” Ansell said. But the panelists agreed that it will take what Ansell called “a Marshall-type Plan” of coordinated efforts by every stakeholder working directly with those in affected communities to identify, address and act on racial health inequities.
Giving community members an equal seat at the table versus imposing outside solutions on them is also imperative, panelists noted. “We need the whole society to do this,” Ansell said. In Chicago, Rush has embarked on a collaborative effort called West Side United to improve the lives of some 600,000 residents across 10 communities in the city, Ansell noted.
The task is enormous, but the panelists remained hopeful. “We are at an inflection point in history,” Ansell said. “These are not just ideas. … People are getting animated about solutions.”