Pro-Protests: A public health perspective

Amid widespread protests and demonstrations, many political commentators have called social distancing orders into question. Their antagonism is not directed at the policing system responsible for the deaths of George Floyd or Breonna Taylor, nor the economic system that has disparaged minorities communities for generations. Instead, it is pointed at public health experts and health care professionals.  These commentators claim an apparent hypocrisy between condemning protests of social distancing while condoning Black Lives Matter protests.

In early June, hundreds of healthcare workers marched in solidarity with protestors. Over 1,200 public-health experts signed a letter addressing the counter-narrative stating:

“Instead, we wanted to present a narrative that prioritizes opposition to racism as vital to the public health, including the epidemic response. We believe that the way forward is not to suppress protests in the name of public health but to respond to protesters demands in the name of public health, thereby addressing multiple public health crises.”

It is warranted to ask: How is racism a public health crisis? Here, we will attempt to briefly explain. 

For context, it is important to know health care quality is associated with socioeconomic status . Socioeconomic status (SES) is defined by education, income, occupation, and social status and refers to an individual’s social standing relative to other members of a society.. It is well documented that those with  lower socioeconomic status have less health care access. Furthermore, observational studies have pointed to increased obesity prevalence as family socioeconomic status decreases. Similar relationships with lower socioeconomic status have been accentuated with asthma, lead-poisoning, and sexually transmitted infections (STIs). Some factors that are related to these outcomes include food deserts (lower access to nutritious foods), poorly built infrastructure of communities, higher exposure to environmental toxins, and less preventative health care access. This outlines an end-to-end public health issue among lower socioeconomic groups – a situation where people are at higher risk of developing conditions that they may not have equitable access to care for. Herein lies the connection to systemic racism as a public health issue. While white Americans have the highest population of people living in poverty, low income communities are disproportionately represented by people of color in America, especially Black and African Americans. In 2018, the Kaiser Family Foundation noted that 22% of Blacks lived in poverty as compared to 9% of whites. This means that if there were equal number Black Americans as whites, then the total number of Black or African Americans living in poverty would dwarf that of whites. This does not describe a lack of aptitude – it outlines an economic system that does not provide equitable opportunity (e.g., through education, higher paying jobs, or safety net programs) to those who need it most and therefore jeopardizing the health and wellbeing of Black Americans. For example, we can look at disproportionate access to GI Bill funding.  The post-World War II meant to advance veterans into middle-class America neglected 1.2 million Black veterans by allowing states to provide the benefits rather than the federal government.

Consequently, these benefits were restricted by small technicalities made predominantly by Jim Crowe era southern states. Then, there is the subject of redlining — the discriminatory mortgage lending process that ranged from the 1930’s to 1968 that shaped wealth and demographic patterns across the country. Redlining was a means to ascribe value, and usually devalue, properties for investment. Properties that were owned by minorities and low-income people were often devalued, therefore lowering wealth accumulation in these groups as compared to white, affluent properties. The effects of these policies live on today. They serve as quantifiable examples of systemic racism in America.  Public health professionals are obligated to understand that outcomes are determined by these long-standing social determinants of health, including systemic racism.The pandemic has only exasperated these issues. As widespread unemployment and higher rates of mortality related to COVID-19 further disenfranchised Black communities nationwide, the public was awarded with $1,200 and Donald Trump publicly diminished the pandemic’s impact. George Floyd survived COVID-19 only to be murdered on May 25th. His experience highlights dually lethal circumstances that systemic racism invokes on Black and African Americans presently, and serves as a small sample of their plight for generations. For anyone concerned about the public’s health, the luxury of complicity does not exist. For public health professionals, complicity is to assist systemic racism and neglect the health of many members of our society.

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