Racism Declarations Were Made, So What’s Next?
Acknowledging the effects of racism by declaring RPHC is an important first step, but to reduce health disparities it is more important to implement health equity action strategies, practices, and programs.
According to the American Public Health Association (APHA), since June 2020, hundreds of local and state leaders in public health have declared racism as a public health crisis (RPHC). The National Association of County and City Health Officials (NACCHO), the Centers for Disease Control and Prevention (CDC), and the Association of State and Territorial Health Officials (ASTHO) collaborated with the Center for Public Health Systems (CPHS) at the University of Minnesota (UMN) School of Public Health to understand health equity-related practices in health departments across the US. As part of this project, we (CPHS) evaluated the health departments and other public health entities that have declared racism as a public health crisis (RPHC). Our goal was to analyze these declarations to better understand the actions that public health agencies are taking as they aim to achieve health equity.
Declaring RPHC is important because extensive racial health disparities research indicates that racial/ethnic minoritized groups have worse health outcomes compared to White people. Health disparities between White and Black people in the US have been attributed to the fact that Black people are more likely to be poor, have less access to health care, and have lower-quality health care. These preventable differences are historical and ongoing. The murder of George Floyd in May of 2020 alongside the COVID-19 pandemic has ignited national discussions surrounding health equity, social determinants of health (SDoH), and the enduring impact of racism in the US. Race has often been labeled as a predictor or risk factor for health conditions. This is problematic as viewing one’s race or ethnicity, and not racism, as a predictor ignores the historical and systematic policies and beliefs that are in place that oppress certain racial/ethnic minoritized groups. We need to reframe the discussion of race in racial health disparities to situate structural racism, and not one’s ethnic or racial identity, as a fundamental cause. It is racism that is an obstacle to health equity.
Declaring RPHC is the first step in not only raising awareness of the impact of racism on public health but also an initial effort to facilitate legal reforms, resource distribution, and policy changes. However, only a few assessments have been conducted to examine these RPHC declarations and which health equity practices related to race and ethnicity are employed by these agencies. It is important to examine RPHC declarations as they provide greater insight into the actions needed to address health inequities.
Our research team conducted an assessment of 233 RPHC declarations that were made by October 2022. In this assessment, we categorized RPHC declarations’ actions toward achieving health equity. Some of these declarations were very brief and had vague or little to no health equity actions, while others had several or more detailed ones. After conducting our assessment, our research team asked the question: Declarations are made, but what is needed for the declarations to have a real community impact? To answer this, we recently hosted a sharing session and facilitated group activities and focused conversations at the National Association of County and City Health Officials 360 Conference (NACCHO 360) in Denver, Colorado. We were interested in learning about local health officials’ (LHOs) perceptions of RPHC, if their agency has made a declaration, and which, if any, of the action strategies their agency has implemented or planned to implement to achieve health equity.
One major topic that our session illuminated was that these declarations offer a foundation and outline concrete steps taken by agencies that can be utilized to improve the health of those often disenfranchised. However, we also discussed some of the complexities and challenges around moving from just identifying the problem (racism) to trying to fix the crisis. Some agencies have declared RPHC but have not taken any actions toward reducing the effects of racism in public health. This was also observed in our assessment of 233 declarations as 6 agencies mentioned no health equity actions at all while 45 other agencies vaguely mentioned health equity actions. During the sharing session, some agencies shared that the lack of declaring RPHC can be due to contextual issues like the political climate and/or funding conditions that prohibit or hinder them from using terms like “health equity” in their programs/practices.
We discussed the action strategies that NACCHO 360 attendees’ agencies have implemented and learned that several of the action strategies that public health agencies have employed, such as establishing a task force or office for health equity, conducting community engagement and supporting community efforts, and providing diversity, equity, and inclusion (DEI) training/education. One attendee discussed how their agency formed the Central California Public Health Consortium which is a coalition of 12 county health departments in California that focus on health equity work. Additionally, we discussed how there are several other public health agencies that cannot make these declarations for a variety of reasons including political climate and funding conditions but are indeed doing health equity work that aims to combat the effects of racism and historical harm for the people in their community. Lastly, another topic of discussion was reparations and the effect that they would have on reducing the Black-white health gap. Some scholars have suggested that reparations focus on the inequitable distribution of resources which would reduce the Black-white health gap,,.
What became clear was that acknowledging the effects of racism by declaring RPHC is an important first step, but to reduce health disparities it is more important to implement health equity action strategies, practices, and programs. The next step after making declarations, for those who can, is to decide how we are going to address/correct and eliminate the problem in order to actually improve the health of our community in an equitable way. This begs the question, how many of the public health agencies that have declared RPHC actually implemented the action strategies that they mentioned in their declarations and tracked progress towards achieving health equity? APHA has a storytelling map that demonstrates the possibilities for these declarations to have a meaningful impact. On this page, you can take a journey with us from coast to coast to see what 6 different localities across the country have been doing to advance racial and health equity since they passed their declaration. APHA also conducted an assessment of RPHC declarations and outlined actionable steps that agencies indicated that they are committed to.
Furthermore, based on contextual issues like the political climate and/or funding conditions, some agencies cannot declare racism as a public health crisis but are doing the work. This begs the question, how do agencies that can’t make the declarations but are doing work to combat the impacts of racism on health get recognized? Future research needs to collaborate with LHDs to examine the effectiveness of declaring RPHC and implementing action strategies. Lastly, as a next step, research needs to focus on how we implement policies, like reparations laws, that address this crisis.
 Bassett MT, Galea S. Reparations as a public health priority—a strategy for ending Black-White health disparities. N Engl J Med. 2020;383(22):2101-2103. doi:10.1056/NEJMp202617
 Williams DR, Collins C. Reparations: a viable strategy to address the enigma of African American health. Am Behav Sci. 2004;47(7):977-1000. doi:10.1177/0002764203261074
 Paine L, De La Rocha P, Eyssallenne AP, Andrews CA, Loo L, Jones CP, et al. Declaring racism a public health crisis in the United States: cure, poison, or both? Front Public Health. (2021) 9:606. doi:10.3389/fpubh.2021.676784
- Dr. Skky Martin is a researcher at the Center for Public Health Systems. Her research interests include health equity, health disparities, social determinants of health, and the interrelationship between public health and medical education. She has experience in qualitative methods and analysis, writing surveys, and using STATA to create and analyze quantitative datasets. Dr. Martin holds a doctoral degree and master’s degree in sociology and a Certificate in Public Health from Loyola University Chicago.
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Dr. Skky Martin is a researcher at the Center for Public Health Systems. Her research interests include health equity, health disparities, social determinants of health, and the interrelationship between public health and medical education. She has experience in qualitative methods and analysis, writing surveys, and using STATA to create and analyze quantitative datasets. Dr. Martin holds a doctoral degree and master’s degree in sociology and a Certificate in Public Health from Loyola University Chicago.