It’s become commonplace for government leaders to consider a community’s social factors -- such as poverty, housing, the quality of its schools and its racial breakdown -- in efforts to make lasting improvements in health equity. But this spring, Milwaukee County, Wis., leaders went a step further, approving what is believed to be a first-in-the-nation local government resolution declaring racism itself a public health crisis.
When the County Board of Supervisors, County Executive Chris Abele and the Office on African American Affairs rolled out the declaration in May, they pointed to troubling statistics. A ZIP code in the city of Milwaukee has been cited, for example, as having the nation’s highest rate of incarceration of black males. And Wisconsin’s black infant mortality rate is the highest in the nation, according to the latest data.
For some county leaders, the racial disparities that affect health reflect personal experiences. “Growing up in the public school system, I experienced systemic cuts in public education,” says Marcelia Nicholson, the county board’s vice chairwoman, who is African-American. “I was surrounded by family members battling addiction and a lack of stable housing. I experienced gun violence and saw drug deals happen. I saw how all of that impacted our community.”
For now, the declaration doesn’t involve redirecting or increasing county spending. Rather, it’s an effort to bring racial equity to the forefront in every decision county leaders and administrators make. It promises to assess all internal county government policies for racial biases, and it mandates training for all county employees to “expand understanding of how racism affects people.”
Milwaukee County’s declaration is by no means the first time that racism has been linked directly to health equity. When she was Baltimore’s health commissioner, following the riots that erupted in the city in 2015 after the death of a black man prosecutors said was injured while being transported by police, Leana Wen launched initiatives to confront wide racial disparities in health outcomes and life expectancy. There has also been an emergence of new studies documenting how racial discrimination impedes equal access to stable housing, health care and other social services that have an impact on health. And a survey by National Public Radio, the Robert Wood Johnson Foundation and Harvard University found that even common day-to-day experiences of racial bias increase African-Americans’ stress levels.
Declaring a local emergency isn’t necessarily the only way to make health equity a priority, but it is seen as one way to force local leaders to think more holistically about all of the ways, big and small, that their decisions impact disadvantaged communities. “If, for example, you want to fix alcoholism in a community, you don’t just provide alcohol-related services,” says Georges Benjamin, executive director of the American Public Health Association. “You have to fix the boarded-up housing. You have to fix the lights and roads.”
For government leaders who want to tackle racial equity as a public health issue, Benjamin suggests doing “an audit of your policies and see who is being impacted.” If, say, “the place to sign up for health insurance is only open on weekdays during the day, you might need to make those services available at night or on the weekends.” These sorts of program and policy changes, he says, need to be addressed on top of more obvious issues such as police violence, residential segregation and drug addiction. “It requires a thoughtful approach.”