Sep 2021: Local Public Health Agencies
Structural Racism Impacts Health. Structural racism is a system in which public policies, institutional practices, cultural representations, and other norms work to perpetuate racial group inequity. It is rooted in a hierarchy that privileges one race over another, influencing institutions that govern daily life from housing policies to police profiling and incarceration. It is closely linked to the social determinants of health (SDoH) and health disparities.
Health disparities are particularly evident in maternal and child health. Black, American Indian, and Alaska Native (AI/AN) women are 2 to 3 times more likely to die from pregnancy-related causes than White women. The infant mortality rate for Black infants is 2 times the rate for Whites. Minorities also face higher rates of morbidity and mortality from chronic diseases, including cardiovascular problems, diabetes, cancer, and certain infectious diseases. The incidence and mortality rates of COVID-19 are the latest examples of racial disparities.
Public health professionals at local, state, and federal public health agencies and at academic institutions are in a unique position to address the challenges of structural racism as it contributes to poor health. In the lead article of this issue, Olivas and coauthors point out local public health departments (LHDs) can and need to address health disparities through community partnerships and multisectoral collaboration. Racial health disparities are associated with socioeconomic status, health behaviors, and health care access. Racial segregation is also a cause of these health disparities. The current study examined the extent of racial segregation in contrast to the activities of LHDs to address health disparities. LHDs with higher measures of segregation were found to engage in more activities to address disparities. These LDHs were aware of the impact of SDoH on their communities. LHDs’ increased responsiveness to this challenge, by providing public health services and focusing on the SDoH, can make a measurable difference.
Other articles in this issue expand on this theme. Shiman and coauthors from the New York City Department of Health and Mental Hygiene describe the Tremont neighborhood in the Bronx. In 1937, this neighborhood was designated as “hazardous” by the Home Owners Loan Corporation through a process known as redlining. This led to disinvestment in this and similar communities throughout the nation. Housing stock deteriorated. Schools received insufficient funding, and small businesses struggled without loans. The local economy and parks deteriorated. Currently, poor health outcomes exist in the neighborhood today with higher rates of diabetes and obesity and lower life expectancy than the predominantly White neighborhood of the Upper East Side of Manhattan.
Health department staff in the Bronx developed an exhibit Undesign the Redline. Visitors included youth groups, community-based organizations, and teams from city agencies including the health department, planners, faith-based leaders, health service providers, educators, and Bronx residents. The purpose was not only education but also the design and ownership of new systems to “undesign” the consequences of redlining. The Undesign the Redline exhibit offers a concrete example of countering structural racism. The exhibit has now moved to other neighborhood venues, and profiles of health data for each community district show the impact of structural racism and public health.
Kovach writes, in an article on public health accreditation, that all communities deserve high-quality public health services. LHDs serving disadvantaged communities especially need to be accredited so as not to exacerbate health inequities. This applies to jurisdictions serving more diverse populations because of the wide health inequities between racial groups. PHAB accreditation has the potential to reduce health inequities in jurisdictions with worse health outcomes.
In early 2022, the Journal of Public Health Management and Practice will publish a supplemental issue: Public Health Interventions to Address Health Disparities Associated with Structural Racism. This issue is sponsored by the W. K. Kellogg Foundation. Mary T. Bassett, MD, MPH, Director of the FXB Center for Health and Human Rights and the FXB Professor of the Practice of Health and Human Rights at the Harvard School of Public Health, has agreed to be guest editor for this important issue. Articles culled from a nationwide search will describe how public health agencies at the local, state, or federal level or academic institutions are engaging with communities of color to address health disparities related to structural racism.
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- Lloyd F. Novick, MD, MPH, is Professor Emeritus of the Department of Public Health at the Brody School of Medicine, East Carolina University. Previously, he was chair of this Department. He has served as the Commissioner of Health and Secretary for Human Services of Vermont, Director of Health Services for Arizona, and Director of the Office of Public Health for New York State. Previous academic positions include Professor and Director of the Preventive Medicine Program for SUNY Upstate Medical University, Professor and Chair of Epidemiology at the University of Albany School of Public Health, and Clinical Professor and Director of the Teaching Program in Epidemiology and Public Health at the University of Vermont, College of Medicine. He is the Founding Editor and Editor-in-Chief of the Journal of Public Health Management and Practice. He is also editor of five books, including Public Health Administration: Principles for Population-Based Management; Public Health Issues in Disaster Preparedness; Community-Based Prevention Programs that Work; Public Health Leaders Tell Their Stories; and Health Problems in the Prison Setting. He is past president of the Association of Teachers of Prevention and Research (APTR) and the Association of State and Territorial Health Officials (ASTHO). He has received a number of national awards, including Special Recognition Award, American College of Preventive Medicine (2005); Duncan Clark Award, Association of Teachers of Preventive Medicine (2003); Yale University Distinguished Service Award (2003); Excellence in Health Administration, American Public Health Association (2001); and the Arthur T. McCormack Award, Association of State and Territorial Health Officials (1992). He is a graduate of Colgate University (BA), New York University (MD), and Yale University (MPH).
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