In 2018, the CDC found a 16% difference in the mortality rates of Blacks versus whites across all ages and causes of death. This means that white Americans can sometimes live more than a decade longer than Blacks.
In 2020, due to the COVID-19 pandemic, the discrepancy in health outcomes has only grown. Michigan’s population, for instance, is 14% Black, yet near the start of the pandemic, African Americans made up 35% of cases and 40% of deaths.
Because of this discrepancy in health outcomes, many scientists and government officials, including former American Public Health Association President Camara Jones, MD, PhD, MPH; more than 50 municipalities nationwide; and a handful of legislators are attempting to root out this inequality and call it what it is: A public health crisis.
Dr. Jones, a nationally sought-after speaker and the college’s 2020 Bray Health Leadership Lecturer, has been engaged in this work for decades and says the time to act is now.
Synergies editor Kathryn Stroppel talked with Dr. Jones about this unique time in history, her work, racism’s effects on health and well-being, and what we can all do about it.
Let’s start with definitions. What is racism and why is important to acknowledge ‘systemic’ racism in particular?
“Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks, which is what we call race, that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities and saps the strength of the whole society through the waste of human resources.
“The reason that people are using those words ‘systemic’ or ‘structural racism’ is that sometimes if you say the word racism, people think you’re talking about an individual character flaw, or a personal moral failing, when in fact racism is a system.
“It’s not about trying to divide the room into who’s racist and who’s not. I am clear that the most profound impacts of racism happen without bias.
“The most profound impacts of racism are because structural racism has been institutionalized in our laws, customs and background norms. It does not require an identifiable perpetrator. And it most often manifests as inaction in the face of need.”
Why did you want to give the 2020 Bray Lecture?
“I’ve been doing this work for decades, and all of a sudden, now that we are recognizing the disproportionate impact of COVID-19 on communities of color, and after the murder of George Floyd and all of the other highly publicized murders that have been happening, more and more people are interested in naming racism and asking how is racism is operating here and organizing and strategizing to act. I wish I could accept every invitation.”
What do you hope people take away from your lecture?
“When I was president of the American Public Health Association in 2016, I launched a national campaign against racism with three tasks: To name racism; to ask, ‘how is racism operating here?’; and then to organize and strategize to act.
“Naming racism is urgently important, especially in the context of widespread denial that racism exists. We have to say the word ‘racism’ to acknowledge that it exists, that it’s real and that it has profoundly negative impacts on the health and well-being of the nation.
“We have to be able to put together the words ‘systemic racism’ and ‘structural racism’ to able to be able to affirm that Black lives matter. That’s important and necessary, but insufficient.
“I then equip people with tools to address how racism operates by looking at the elements of decision making, which are in our structures, policies, practices, norms and values, and the who, what, when and where of decision making, especially who’s at the table and who’s not.
“After you have acknowledged that the problem exists, after you have some kind of understanding of what piece of it is in your wheelhouse and what lever you can pull, or who you know, you organize, strategize and collectively act.”
You’re known for using allegory to explain racism. Why is that?
“I use allegory because that’s how I see the world. There are two parts to it. One is that I’m observant. If I see something and if it makes me go, ‘Hmm,’ I just sort of store that away. And the second part is that I am a teacher. I’ve been telling a gardening allegory since before I started teaching at Harvard, but I later expanded that in order to help people understand how to contextualize the three levels of racism.
“As an assistant professor at the Harvard T.H. Chan School of Public Health, I developed its first course on race and racism. As I’m teaching students and trying to help them understand different elements, different aspects of race, racism and anti-racism, I found myself using these images naturally just to explain things, and then I recognized that allegory is sort of a superpower.
“It makes conversations that might be otherwise difficult more accessible because we’re not talking about racism between you and me, we’re talking about these two flower pots and the pink and red seed, or we’re talking about an open or closed sign, or we’re talking about a conveyor belt or a cement factory. And so I put the image out there to suggest the ways that it can help us understand issues of race and racism. And then other people add to it or question certain parts and it becomes our collective image and our tool, not just mine.”
What should white people in particular see as their role and responsibility in this system?
“All of us need to recognize that racism exists, that it’s a system, that it saps the strength of the whole society through the waste of human resources, and that we can do something about it. White people in particular have to recognize that acknowledging their privilege is important – that your very being gives you the benefit of the doubt.
“An example: About six years ago now, in McKinney, Texas, outside of Dallas, we came to know that there was a group of pre-teens who wanted to celebrate a birthday at a neighborhood swimming pool. The people who were at the pool objected to them being there and called the police. And what we saw was a white police officer dragging a young Black girl by her hair, and then he sat on her, and the young Black boys were handcuffed sitting on the curb.
“The next day on TV, I heard a young white boy who was part of the friend group saying it was almost as if he were invisible to the police. He saw what was happening to his friends and he could have run home for safety, but instead, he recognized his white skin privilege. He stood up and videotaped all that was going on.
“So, the thing is not to deny your white skin privilege or try to shed it, the thing is to recognize it and use it. Then as you’re using it, don’t think of yourself as an ally. Think of yourself as a compatriot in the struggle to dismantle racism. We have to recognize that if you’re white, your anti-racist struggle is not for ‘them.’ It’s for all of us.”
Why did you transition from medicine to public health?
“Because there’s a difference between a narrow focus on the individual and a population-based approach. I started as a family physician, but then wanted to do public health because it made me sad to fix my patients up and then send them back out into the conditions that made them sick.
“I wanted to broaden my approach and really understand those conditions that make people sick or keep them well. From there, the data doesn’t necessarily turn into policy. So, I sort of went into the policy aspect of things. And then you recognize that you can have all the policy you want, but sometimes the policy is not enacted by politicians. So now I am considering maybe moving into politics.”
Speaking of politics, when engaging in discussions around racism and privilege, people will sometimes try to shut down the conversation for being ‘political.’ Is racism political?
“Racism exists. It’s foundational in our nation’s history. It continues to have profoundly negative impacts on the health and well-being of the nation. To describe what is happening is not political. If people want to deny what exists, then maybe they have political reasons for doing that.”
What are your thoughts on COVID-19 and our country’s approach to dealing with the virus?
“The way we’ve dealt with COVID-19 is a very medical care approach. We need to have a population view where you do random samples of people you identify as asymptomatic as well as symptomatic.
“When you have a narrow medical approach to testing, you can document the course of the pandemic, but you can’t do anything to change it.
“With a population-based approach we already know how to stop this pandemic: It’s stay-at-home orders, mask wearing, hand washing and social distancing.
“This very seductive, narrow focus on the individual is making us scoff at public health strategies that we could put in place and is hamstringing us in terms of appropriate responses to the COVID-19 pandemic.
“In terms of race, COVID-19 is unmasking the deep disinvestment in our communities, the historical injustices and the impact of residential segregation. This is the time to name racism as the cause of those things. The overrepresentation of people of color in poverty and white people in wealth is not happenstance.”
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