As the summer of 2020 heated up, the nation's racial divisions were once again laid bare.
The COVID-19 pandemic has spread rapidly across the United States, disproportionately sickening and killing people of color, while protests sparked by the killing of George Floyd by Minneapolis police officers have intensified in streets across the country.
Protesters in California demanded change. In response, the San Bernardino County Board of Governors declared racism a public health crisis, joining a wave of municipalities vowing to address long-standing racial inequality.
The four years since have been a meticulous process of data collection and expectation management, both in California and elsewhere, Diane Alexander, deputy clerk for San Bernardino County, told USA Today. While some say progress has been slow, Alexander still believes change can happen.
Finally.
“People need to understand that we've been fighting for this job since slavery, and people are hoping that Rome will be built in a day,” Alexander said. “It's not going to happen.”
And some declarations are facing new opposition amid a wave of backlash against diversity, equity and inclusion efforts.
“Progress has been steady but slow, but I think it's to be expected given the significant shift and impact it will have on policy,” said Dawn Hunter, a Florida public health attorney who analyzed the declaration.
Why is racism a public health crisis?
According to the U.S. Centers for Disease Control and Prevention, centuries of racist policies and practices have created barriers to housing, education, wealth and employment — known as social determinants of health — that continue to drive disparities in health outcomes for minorities.
Racial and ethnic minority groups have significantly shorter life expectancies and higher rates of disease and deaths, including diabetes, high blood pressure, obesity, asthma, and heart disease. Recognition of the public health impact of racism is not new: the American Public Health Association first resolved to consider race a public health issue in the 1960s, and a handful of communities, including Pittsburgh, Cook County, Illinois, and Milwaukee County, Wisconsin, were among the first to declare racism a public health crisis and begin addressing it in 2019.
But the COVID-19 pandemic has highlighted and exacerbated those disparities, with people of color experiencing higher infection, hospitalization and death rates, as well as lower vaccination rates. Minneapolis Mayor Jacob Frey said Floyd's killing in Minneapolis served as a guidepost to draw attention to the racism that permeates society.
“I think Floyd's murder has sparked a global acknowledgment that racism is everywhere,” Frey told USA Today.
Further declarations followed in 2020 and 2021. By 2022, more than 300 local and state officials had acknowledged the crisis, according to a report from the Healing Justice and Equity Institute, a research institute based at Saint Louis University in Missouri that focuses on systemic oppression. Experts say the pace of such declarations has slowed considerably, but the trend continues. In March, for example, the Sonoma County Board of Supervisors in California unanimously approved a county health department resolution declaring racism a public health crisis.
“For a long time, racism wasn't recognized as having a direct impact on health,” said Tia Williams, director of the American Public Health Association's Center for Public Health Policy, which tracks declarations. “So by making these declarations, communities and leaders are acknowledging that racism is a driver of disparities in health and overall life outcomes.”
What did the Declaration bring about?
Williams said the declarations were an “important first step” to addressing disparities, but the promises they made vary widely.
In APHA's 2021 analysis of 209 of these declarations, 21 included more than 10 specific actions, such as enhancing diversity in leadership, personnel and contractors, and partnering with grassroots organizations. 145 included fewer than 10 actions, and 32 included no actions other than declaring racism a public health crisis. Williams said the proposed actions typically fell into four categories: data and accountability, policies and programs, and community engagement and funding.
In Minneapolis, Frey said the declaration means ensuring that access to mental health care is equitable across the city and recognizing the impact gun violence has on minority communities and how it creates intergenerational trauma.
“This is about finding a way to prevent the trauma these communities have faced for so many years,” Frey said.
One data-focused effort is San Bernardino County's Equity Factors Group, a group of 16 Black people from various community groups that Alexander said is researching the inequities facing African-Americans in the county. She advised other local governments to take a similar approach and start by using data to address inequities. Now, Alexander's group is placing paid internships with community organizations, holding workshops on grant applications and tapping consultants to bridge communication gaps.
“We've worked really hard to put together and develop this team to understand how to confront racism,” Alexander said. “We can't just declare this a public health crisis, but also bring people together at the table.”
Collecting data was also an important step for Buncombe County, North Carolina, according to Norial Armstrong, chief equity and human rights officer for the county, who serves as the county's project lead for the county's long-standing Community Reparations Commission, which was formed in July 2020 after Asheville's City Council became one of the first areas to pass a resolution supporting community reparations for Black residents.
One of the first actions taken by the group, which makes recommendations to local elected officials including guaranteed income, was to commission an audit to assess the harm caused to Black residents of the city and county by existing policies, practices and programs.
“I think a lot of people in the community felt like, 'Yes, we know what's going on, we know what's going on with all the harm that's been done, because we experience it every day,' and the 'Cease the Harm' audit was able to put that in a data format and organize it,” Armstrong said.
In King County, Washington, fundraising was one of the first short-term goals for a committee tasked with addressing racism as a public health crisis, says Abigail Echohawk, director of the Urban Indian Health Institute. She said she was nervous when asked to join the group, because she had seen so little “symbolic work” done across the country.
Confident that things would be different in King County, Echo Hawk helped form the Gathering Collaborative, a fluid group made up of mostly Black and Indigenous community members dedicated to eradicating the harms of systemic racism. In 2023, the group was able to award $25 million in grants to 123 nonprofits, community organizations and small businesses to address the crisis.
“$25 million is a good step, a good first step, but it's also what we at the Gathering Collaborative call a 'budget bust,'” she said. “It's a tiny fraction of King County's overall budget, and we need more investments to eliminate racism.”
The declaration “has become a truly polarizing issue.”
A shift in leadership within communities that have declared racism a public health crisis has led to the reversal or backtracking of some pledges and other controversies, said Rukaija Yearby, a health law professor at Ohio State University, who pointed to Virginia as an example.
In 2021, Virginia became the first Southern state to declare racism a public health crisis, according to APHA's declaration map. The following year, then-state Health Commissioner Collin Green told The Washington Post he opposed the declaration, saying, “When you say 'racism,' you're blaming white people.” Green apologized, but was later removed from his position by the Virginia Senate, according to the Post. The Virginia Department of Health did not immediately respond to USA Today's request for comment.
“Racism as a public health crisis is truly a polarizing issue because while we tend to focus on people feeling blamed, we also need to understand that racism is part of the fabric of our system and it negatively impacts all of us,” Yearby said.
In Holyoke, Massachusetts, former acting mayor Terrence Murphy issued an executive order in June 2021 rescinding the city's declaration because no action had been taken on the plan, according to city documents. Murphy, a former city council member, became acting mayor after former Mayor Alex Morse resigned to take another town job, according to city council minutes.
Stephen Fahy, an aide to current Mayor Joshua Garcia, sent USA Today a 2021 news article about the city of Holyoke rescinding the declaration in response to a request for an interview with current Mayor Joshua Garcia.
Experts say the backlash against the declaration is similar to the growing backlash against diversity, equity and inclusion in higher education and the private sector ahead of the 2024 presidential election. But Hunter, the public health attorney and leader of the Anti-Racism and Equity Collaborative, said communities that haven't made an official declaration or oppose it can still do racial equity work.
“It's useful to have done it; it helps prompt action,” she said, “but it's not a prerequisite for continuing to work on health equity.”
What more do I need to do?
The CDC declared racism a public health threat in April 2021, and President Joe Biden has issued several executive orders aimed at eliminating racial disparities, but more legislative action is needed, Yearby said.
As House and Senate Democrats continue to reintroduce resolutions to declare racism a public health crisis, Yearby said he hopes federal legislation goes beyond a symbolic statement and provides funding to state and local agencies to address the issue, allowing people to challenge the ongoing impacts of racism on their health.
“If implemented correctly, this could be used as another civil rights law,” she said.
Ultimately, King County's Echo Hawk said her long-term goal is not just to eliminate disparities in public health but to eradicate racism altogether. She doesn't want her grandchildren to have to deal with the same crisis, but she knows the work will take time.
“These systems of oppression have been built up over 500 years, and it's going to take time to undo them,” she said.
Contributors: Sarah Honosky, Asheville Citizen-Times, Sam Woodward, USA TODAY.
