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Unlike a pandemic or emergency, there is no epidemiological definition for public health crisis.
Experts at the Boston University School of Public Health tried to solve this.
They explored the distinction between immediate and important and how politics, perceived risk, and affected groups shape the concept of a crisis. For example, they juxtaposed the number of deaths caused by terrorism and by gun violence with action taken by the U.S. government. Between 2001 and 2013, 3,380 Americans were killed by terrorism and 406,496 Americans were killed by firearms on U.S. soil; yet the U.S. spent trillions on the War on Terror and failed to pass gun control legislation.
They conclude that people often confuse the immediate and the important, and that the important often fails to receive the same crisis-level of concern as the immediate.
Moving forward, they suggest a public health crisis must meet three qualifiers:
- The problem must affect large numbers of people.
- It must threaten health over the long-term.
- It must require the adoption of large-scale solutions.
Putting the Premature Death of Black People to the ‘Public Health Crisis’ Test
Using these three qualifies, we tested a specific health outcome of racism first, the premature death of black people:
- The problem must affect large numbers of people. The premature death of more than 3.3 million U.S. Blacks affects a large number of people.
- The problem must threaten health over the long-term. The premature death of roughly 83,000 Blacks each year for 40 years threatens health over the long-term. The U.S. National Institutes of Health report that multiple studies suggest that experiences of racism or discrimination raise the risk of emotional and physical health problems, including depression, cardiovascular disease, hypertension, and even death.
- The problem must require the adoption of large-scale solutions. Because disparities in death rates are associated with racist policies and practices that created the segregated and depressed neighborhoods in which Blacks live, learn, work, and play, large-scale solutions are needed.
The health outcome checks out as public health crisis.
However, this designation could lead to individual-level interventions rather than large-scale, upstream systemic change.
For example, disparities in child poverty and food insecurity among Latinos and Blacks could also be considered public health crises by this definition, when in fact, these social outcomes are also rooted in systemic racial injustices. Thus, it’s important to focus on the root causes of the health/social outcome as the crisis, rather than the outcome itself.
So, let’s test systemic racial injustices as a public health crisis.
Putting Racism to the ‘Public Health Crisis’ Test
Using these three qualifiers, we put racism to the test:
- The problem must affect large numbers of people. Through discriminatory housing, land use and transportation policies; unfair local and state school finance systems; and unjust labor laws, systemic racial injustices have negatively impacted created racially segregated enclaves of concentrated poverty, impacting a majority of the roughly 100 million Blacks and Latinos in America.
- The problem must threaten health over the long-term. Through plans, policies and practices, racial injustices have reinforced and perpetuated racial and socioeconomic segregation and systematically denied equal opportunity to Black and Latinos, thus threatened health since the 1920s.
- The problem must require the adoption of large-scale solutions. Because systemic racial injustices are rooted in policies, regulations and laws at the local, state, and federal level, large-scale solutions are needed.
It checks out. Systemic racial injustices affect a large number of people. Injustices threaten health over the long-term. They also require the adoption of large-scale solutions.
Racism is a public health crisis.
In addition, numerous health organizations agree. The American Public Health Association finds racism to be a barrier to health equity. The American Psychological Association, the American Medical Association and the American Academy of Family Physicians have declared hate crimes a public health concern.
Take Action: Get Your City to Declare Racism a Public Health Crisis!
Racism is a public health crisis.
Amid protests for racial/ethnic justice, U.S. city leaders are creating city resolutions to declare racism a public health crisis and commit to specific actions, as a first step toward lasting and meaningful change.
Download the free Salud America! “Get Your City to Declare Racism a Public Health Crisis” Action Pack to get input from local advocates of color, start a conversation with local leaders, and build local support for a resolution to declare racism a public health issue along with a commitment to take action to change policies and practices.
The Action Pack was created by Dr. Amelie G. Ramirez, director of the Salud America! Latino health equity program at UT Health San Antonio.
These declarations are “long overdue” and “a start” to toward lasting, meaningful change, said Dr. Allison Agwu, an infectious disease specialist and associate professor at Johns Hopkins School of Medicine, told The Guardian.
“If you declare something an emergency, you’re also saying it’s imperative to address the problem,” Agwu said.