As the city of Rochester grapples with the killing of an unarmed Black man at the hands of police officers, and the nation continues to deal with the COVID-19 outbreak, the Greater Rochester Black Agenda Group is leading the charge in declaring racism a public health crisis.
“COVID-19 has really shone a spotlight on inequity and injustice and specifically systemic and structural racism, how the pandemic has disproportionately impacted people of color and even more so people who are poor,” said Jerome Underwood, president and CEO of Action for a Better Community and one of the 11 members of the Black Agenda Group.
Underwood noted that groups most affected by the pandemic were those with pre-existing conditions, people who live in multi-dwelling apartments, people with high blood pressure and diabetes.
“In Monroe County, all of us who work in human services knew that hey, you’re talking about large numbers of Black and Brown people,” Underwood said. “It took seven weeks for testing to be available at Jordan Health and Trillium. Why did we let that happen? That, I think, is Exhibit No. 1 in the impact of systemic racism. It just didn’t matter to anyone.”
Underwood is a board member of Common Ground Health, Rochester’s nonprofit community health planning organization, as well as Highland Hospital.
“Myself and my colleagues are asking these types of questions and nobody had a good answer. Everybody’s looking at everybody else,” he recalled. “The answer is us. The systems that are in place do not have the level of consideration for the poor. And that’s our Black Agenda work.”
A declaration put forth by the Black Agenda Group in late April enumerates nine attributes of racism that make it a health crisis. Those attributes include:
Race is a social construct with no biological basis.
Racism is a system that creates structures of opportunity and assigns value based on the social interpretation of how one looks, that unfairly disadvantages some individuals and communities, while unfairly providing advantages to other individuals and communities and saps the strength of the whole society through the waste of human resources.
Racism causes persistent racial discrimination in housing, education, health care, employment, criminal justice, business and economic mobility. There is an emerging body of research that demonstrates racism as a social determinant of health.
Racial health disparities in the Black Community have existed since racial health data has been collected and analyzed. Racial health disparities in diabetes, hypertension, heart disease and mental health are prevalent and growing.
Moreover, in Rochester and Monroe County, the persistent toxic stress of racism expressed as racial and ethnic discrimination impacts health through a combination of social-emotional and physiological effects. Researchers have found higher levels of stress hormones (allostatic loads) as an indicator of premature aging and death.
Of all the ways racial health disparities impact our life course and trajectory (path) the most profound is in infant mortality. African American babies in Monroe County die at three to four times the rate of white babies. This is a statistic that has not changed in many years and is trending in the wrong direction.
Public health’s responsibilities to address racism include reshaping our discourse and agenda so that we all actively engage in anti-racist and racial justice work.
While there is no epidemiological definition of “crisis,” the health impact of racism clearly rises to the definition proposed by (epidemiologist, Sandro) Galea: “The problem must affect large numbers of people, it must threaten health over the long-term, and it must require the adoption of large-scale solutions.”
“No one is born racist; it is modeled, learned and passed along through generations where it poisons and paralyzes its victims and corrupts its perpetrators. If we are to eradicate this persistent evil we must see to its structural and institutional roots. And with swift and collective action hold those that govern and that are governed accountable for its elimination.” – Joy DeGruy
The Greater Rochester Black Agenda Group is asking the community, including individuals, nonprofit and for-profit organizations, to sign on to its Declaration, promising to take additional steps towards becoming and remaining anti-racist.
For organizations, some of those actions include publicly asserting that racism is a public health crisis affecting our entire society; conducting an assessment of internal policy, practices, procedures, reporting relationships and organizational structures to ensure racial equity is a core element of its work; and advocating for relevant policies that improve health in Black and Brown communities, and support local, state and federal initiatives that advance social and economic justice, while also encouraging individual advocacy to dismantle structural and systematic racism; among others.
By early June, more than 700 individuals and 65 organizations had signed on to the Declaration.
“There have been a number of organizations and individuals that have endorsed the pledge, but endorsing the pledge is a transaction. It’s very easy to say ‘I endorse the pledge,’” Underwood said. “What we’re looking for is transformational activities where organizations and individuals will look internally to say what actions can I take as an individual and as an institution that will be anti-racist. In other words, it’s not good enough to be a non-racist; we have to take action that is anti-racist because there’s no more standing at the fence.”
Among those who have endorsed the Declaration are the Rochester-Monroe Anti-Poverty Initiative, Rochester Downtown Development Corp., Willow Domestic Violence Center, Reconnect Rochester, the Breast Cancer Coalition of Rochester, the Legal Aid Society of Rochester and dozens more.
“Racism is a crisis that has plagued our country and community for centuries,” Legal Aid Society officials said in their endorsement. “LASROC is resolved to continue advancing and protecting the legal rights of the disenfranchised, and therefore we’re taking this opportunity to again denounce hate and racial injustice. The Legal Aid Society of Rochester stands with the Greater Rochester Black Agenda Group to affirm that racism is a public health crisis affecting our entire society.”
In a letter to the community in June, RDDC Chairman Joel Frater and President Heidi Zimmer-Meyer said it is time to speak up and act.
“As Black Lives Matter protests continue in communities across our region and the nation, the silence in much of the business community has been deafening,” they wrote. “But, systemic racism is everyone’s problem, and RDDC will not be silent.”
In addition to endorsing the Black Agenda Group Declaration, RDDC will commit to becoming a more actively anti-racist organization. Specific actions include opening the door to its boardroom by broadening and diversifying the voices that influence its growth strategies; making downtown open and welcoming to everyone by “celebrating the diversity” and cultures of Rochester’s citizens; and building alliances and partnerships with organizations confronting racism by encouraging its members and stakeholders to recognize racism as a public health crisis; among other things.
According to a 2019 report from Common Ground Health, poverty is the Finger Lakes region’s number one health concern, and it drives health inequities that undermine wellness and cut lives short more than any other single cause of illness, more than cancer or diabetes or opioid overdose. It also costs the region more than $1 billion annually.
The report, “Overloaded: The Heavy Toll of Poverty on Our Region’s Health,” found that:
Residents of areas with a 30 percent or higher rate of poverty die eight years earlier than residents in areas with poverty rates below 5 percent;
Diabetes is 154 percent more likely among those with incomes under $20,000 per year;
In the Finger Lakes region, more than half of adults over the age of 35 with household incomes under $25,000 per year suffer from hypertension, a 38 percent higher prevalence than found among the high-income population; and
The rate of asthma-driven emergency department visits by those living in areas with the highest rates of health-related housing violations was nearly nine times the rate in suburbs.
To be sure, Rochester is not the first community to make such a declaration. Paula Tran Inzeo, the Mobilizing Action Toward Community Health (MATCH) Group Director of the University of Wisconsin Population Health Institute, has worked with community-based and governmental organizations for some time related to racial equity. In 2017, she and her colleagues began convening a group called the Healthiest State Initiative. The group’s hope was to identify shared priorities across the state to support health equity.
During that two-day convening, the group came up with six priorities, and declaring racism a public health crisis was one of them.
“There was also another group being convened out of the Wisconsin Public Health Association. One of the efforts we worked on together was drafting with the leadership of the Wisconsin Public Health Association a resolution for them to adopt as a member-based organization, and they really reflected a lot of the writing for that resolution from the American Public Health Association,” Tran Inzeo explained of how the declaration got its start.
The WPHA passed a resolution declaring that racism is a public health crisis in Wisconsin in May 2018, which was then modified to create a broader sign-on for other organizations, Tran Inzeo said. It was that declaration that the Rochester Black Agenda Group used as a base for its own Declaration.
“There are a set of actions people can identify,” she said of the University of Wisconsin’s Declaration. “For example, as an organization we have committed to assessing our organization and have committed to ongoing education and training for our staff, and now are beginning the process to set up work groups to identify processes and policies that we want to change more systematically within our organization.”
Other groups such as the Milwaukee County Executive’s Office use the model to define its strategic plan, Tran Inzeo noted.
Tran Inzeo said when the Declaration was first published there was a good deal of public pushback.
“What we’ve seen in the last three years is a lot more public will and support for this kind of language,” she said. “I would say there’s been a pretty big sea change around the language itself, which is definitely not enough. Yet we see it as a signal of some things making some progress, including our governor using this language and many key organizations and institutions using the language, which I think creates an entry point for more action.”
Back in Rochester, Underwood said just talking about the issue of racism and its effect on health outcomes is not enough. He said we must call people out.
“From an individual point of view I would encourage people to query the organizations where they live, work and play,” Underwood said. “There’s an investment that some organizations are going to have to make to come to grips with where they are and improve their status as an anti-racist, culturally competent, culturally responsive institution.”
The Greater Rochester Black Agenda Group encourages organizations to reach out for help in areas in which they are unfamiliar. The group is offering a plethora of resources and referrals for help in succeeding with the endorsement.
“Luckily for me this is my vocation, and I think that’s why I’m given oxygen, to work on issues of equity and justice,” Underwood said. “Hard work alone is not enough. We’re optimistic, but cautiously so, because racism is a very resilient thing.”
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