HARVARD MEDICAL SCHOOL PRIMARY CARE REVIEW

Moving Beyond Empty Promises on Making #BlackLivesMatter (Part 1)

September 1st, 2020

As we seek justice for the deaths of Breonna Taylor, George Floyd, Ahmaud Arbery, and the long list of Black victims of police violence; as we grapple with the disproportionate impact of COVID-19 in Hispanic, Black, and Indigenous communities; and as we acknowledge the tremendous toll of structural racism—we must ask ourselves hard questions about what constitutes meaningful action to make Black lives matter.

Lately, we have seen numerous examples of empty promises and surface-level actions:

  • From municipalities (that declare “racism is a public health issue” but don’t pass antiracist policies);
  • From corporations (that state “Black lives matter” but at most change logos—not wages and benefits, not discriminatory hiring and marketing practices); and 
  • From individuals (who, as Tre Johnson points out, join book clubs, but typically don't dismantle the systems that perpetuate racism at our places of employment, neighborhood associations, or family or social networks; don’t invest in the businesses, education, political representation, power, housing and art of Black people; and don’t reflect on the harm we ourselves have caused in a Black person’s life).

Sometimes, surface-level actions are purely performative and selfishly motivated, and other times, they are important first steps—in learning, in acknowledgement, in representation.  

Either way, what we need to remember is that they are far from sufficient. We must pursue changes to the policies, systems and environments that underpin structural racism. Otherwise, merely stating that “Black lives matter” or “racism is a public health issue” is meaningless.

The truth is, surface-level changes require little to no real work, and often confer immediate benefits to the individuals and entities making them (for example, positive public perception of your brand). But meaningful change to alter the systems perpetuating racism is slower, harder, more nuanced work and often comes at an immediate cost, whether real or perceived. We need to be willing to do the hard work and pay the price—whether monetary or otherwise—that is required to give back what has (knowingly or unknowingly) unjustly been taken from BIPOC (Black, Indigenous, and People of Color) over the course of this nation’s history of being built on stolen lands by stolen labor. Hundreds of years of “progress” on the backs of Indigenous and Black people demands this of us.

I believe antiracist efforts will lead both to a more equitable society and to one that fares better as a whole—in terms of our health, economy, and broader well-being. While such efforts may produce short-term costs to individuals and entities that have been benefiting from unjust systems, it is important to note that racism has a cost for everyone, and we will all be better off for dismantling it.

What policies can help dismantle structural racism?

As Drs. Hardeman, Medina, and Boyd so eloquently write in their New England Journal of Medicine piece, Stolen Breaths: 

Any solution to racial health inequities must be rooted in the material conditions in which those inequities thrive. Therefore, we must insist that for the health of the Black community and, in turn, the health of the nation, we address the social, economic, political, legal, educational, and healthcare systems that maintain structural racism. Because as the COVID-19 pandemic so expeditiously illustrated, all policy is health policy.

The question we should be asking about any policy or system is whether it produces results that are unequal by race—if so, there is need for change. Such change is desperately needed in a number of policy areas, as has been all the more clear in light of the crises currently dominating national headlines: coronavirus and police violence.

We are finally getting a better, though far from complete, picture of the racial inequality of coronavirus in the U.S. (side note: just getting this information took suing the CDC). And it’s not a pretty picture. Black and Latino people have been three times as likely to become infected with coronavirus and twice as likely to die from it as white people. Just-released data from the CDC suggests disparities are widespread, with 96% of hotspot counties having disparities in COVID-19 cases in one or more minority racial/ethnic groups.

Underlying health problems—often caused by unequal conditions in the places we live, work, and play, including lack of access to healthy food options, clean air, safe housing, and healthcare—contribute to inequalities in COVID-19 deaths. But the reasons for inequalities in cases are even broader—Black and Latino people are more likely to have frontline jobs where telework is not an option, depend on public transportation, and live in cramped or crowded apartments and homes. All these issues are reflective of structural racism.

Police violence also poses a disproportionately high threat to the lives of Black people. One in 1,000 Black men will be killed by police, and Black men in the U.S. are up to 3.5 times more likely than whites to be killed by police. Police homicide rates are also higher for Black women and American Indian and Alaska Native women and men than their white counterparts. Contributors to such disparities include the organizational culture of police departments (including the way police officers are trained and how their performance is evaluated, as well as how decisions are driven by implicit and explicit racial bias) and laws around qualified immunity and the “objective reasonableness” standard under which use of force cases are adjudicated. Again, these issues are reflective of structural racism.

But disparities in health outcomes and police violence are only the tip of the iceberg of structural racism. A huge range of policies are implicated in creating and sustaining inequitable systems. Exclusionary zoning policies, especially single-family zoning, disproportionately keep Black individuals and families out of better-resourced neighborhoods with fewer pollutants and higher-performing schools.

Under-resourced schools, zero-tolerance and other school disciplinary policies, school-based arrests, and juvenile detention all disproportionately impact Black students and form a school to prison pipeline. Even though Black imprisonment rates have fallen over the last decade, they are still more than five times as high as rates among whites, with as many as one-in-twenty Black men in certain age groups currently in prison (see this Pew Research data).

The way voting works in this country—with no day off, registration and voter ID requirements, frequent polling site changes, and so on—makes voting “routinely harder” for Black and Latino populations. Effectively understanding or acting to address disparities across a range of topics is inhibited by a woeful lack of data and research, both on health and other outcomes by race, as well as evaluation of policies and other strategies by race.

These are the things we should be focused on changing.

In Part 2 of this blog post, I’ll share some thoughts on what cities, companies, and other institutions can do to move beyond empty promises and surface-level actions and instead contribute meaningfully to dismantling structural racism.

 

Learn about our upcoming Practice Optimization Sprint: A 10-week improvement program for primary care teams in the time of COVID

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Vinu IlakkuvanVinu Ilakkuvan, DrPH, MSPH, is passionate about supporting and strengthening multi-sector community efforts to address the upstream, root drivers of health and health equity. Through her consulting practice, PoP Health, Vinu provides a range of consulting services (including in the areas of community collaboration, research, and communication) in this space. Vinu holds a DrPH in Health Behavior and MS in Health Communications, and teaches and advises thesis students at George Washington University’s Milken Institute School of Public Health.

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