Dismantling Racism in Public Health (and Within Ourselves)
During National Public Health Week, public health practitioners are challenged with the aspiration to create the healthiest nation by 2030. A related “fact of the week” on the NPHW website addresses social justice and health: “Everyone has the right to good health. We must remove barriers so everyone has the same opportunity to improve their lives and their health.”
So how do we start removing those barriers? Confronting the burden of racism may be daunting to most public health professionals, but its effects can be detrimental to the health and well-being of those impacted by it—i.e. people of color. Our very goals as a profession compel us to face these truths, starting with ourselves.
Camara Jones, president of the American Public Health Association, states that all of us are exposed to different levels and layers of racism. It is hubris to imagine that those of us dedicated to the health of the public are somehow immune to the scourge of racial prejudice and implicit bias. And so perhaps our work, our research questions, our approach to problems, and our work with communities are in fact also shaped by our bias. How, then, to begin the work of dismantling prejudice, racism, and inequality in public health?
We know that inequities in health care are more likely to impact Black American communities. In addition, racial discrimination contributes to a spectrum of chronic diseases, including high blood pressure, heart disease, and long-lasting psychological stress that disproportionately affect Black Americans. While these inequities have historical roots, they persist in modern society because of the pervasiveness of bias.
All people hold biases, though much bias is implicit and largely unconscious. Racial bias has been so socioculturally ingrained that its manifestations may not be immediately recognizable without astute self-reflection. Indeed, bias appears even in individuals who view themselves as free of prejudice; however, it has been constructed in a manner that makes it nearly impossible to eliminate from individual consciousness. As individuals, our first task is to recognize, accept, and manage these biases, which can reduce their overall impact.
This requires us to critically examine our own identities and lived experiences, and question how these have shaped us into who we are today. For example, how have the perspectives of masters-level students been shaped by access to education and professional networks? What privileges has a white practitioner been afforded that her colleagues of color have been denied? How is “normalcy” defined for a straight/heterosexual individual compared to a lesbian, gay, bisexual, or trans* (LGBTQIA+) individual?
There are more questions than answers here, and that is intentional. Each person comes to the table equipped with their own experiences and identities—called intersectionality—and there is no applicable blanket response for these introspective questions. We also recognize that these questions may be challenging to address, particularly when the questioners are accustomed to the privilege of ignoring them. Without addressing racism and recognizing biases, the field of public health risks replicating systems of oppression that lead to the very health inequities that we aspire to resist. As individual practitioners, we aim to hold ourselves and each other accountable when bias is present. We cannot, and must not, remain neutral.
Structures of racism and privilege contribute to the disproportionate number of deaths of Black Americans and take a serious toll on the health of all communities of color and non-dominant groups. Historically, the fields of public health and medicine have failed at recognizing or addressing prejudice and bias in research and interventions (such as Tuskegee, Henrietta Lacks, forced sterilization, gay blood bans, and trans* healthcare, to name just a few). In light of the historical trauma inflicted on marginalized groups by research done in the name of public health, public health professionals must reevaluate how to best address health disparities as we move forward in our work, including disparities within the academy itself.
Community organizing and participatory research can be powerful tools in addressing systems of institutionalized racism in our healthcare system. Indeed, engaging community members as experts of their own lived experiences to mobilize change can lead to social action that reduces health disparities. Primarily, this requires the individual researcher to practice cultural humility, which moves beyond cultural competence in acknowledging one’s own implicit bias and making conscious efforts to unpack, self-reflect, and acknowledge how this affects the outcomes of our work. Cultural humility also needs to be the framework by which public health professionals engage with communities. Its main facets are to first have a lifelong commitment to self-reflection and evaluation, to challenge and deconstruct power imbalances where there should be none, and to develop partnerships with those who advocate for others. In doing this, public health professionals can engage with local communities in ways that amend power structures that may impede meaningful interventions, and can begin to successfully dismantle institutionalized racism and implicit bias in healthcare interventions.
As public health professionals, complicity in an unjust, racist system is antithetical to the work we do to improve the health and lives of all. Social justice is integral to effective public health research and practice. We, the Racial Justice Talking Circle, actively work to confront racism and address biases in ourselves and in the field, and implore our colleagues across the field of public health to engage in these difficult dialogues. We unapologetically believe that Black Lives Matter. And until racism has been dismantled, we’ll keep talking.
The Racial Justice Talking Circle invites all SPH/MED/BU/BMC students, staff, and faculty to engage in informal and unstructured conversations about racism, privilege, and inequities across our own identities and backgrounds. During National Public Health Week, the Racial Justice Talking Circle will meet at 1 p.m. on Thursday, April 7, in Talbot 106 East.
Special thanks to the following individuals for their contributions to this Viewpoint: Candice Belanoff, Rachael Bonawitz, Yvette Cozier, Anneke Demmink, Avery Desrosiers, Vanessa Edouard, Sophie Godley, Steve Jang, Faiz Kidwai, Julia Lanham, Jennifer Masdea, Cassandra Osei, and Colbey Ricklefs. Please reach out to Colbey Ricklefs (email@example.com) or Assistant Dean for Diversity and Inclusion Yvette Cozier (firstname.lastname@example.org) for more information or to join the conversation.
Additional resources for anti-racism training:
- Race Forward has lots of resources on racial justice training/institutes, including Moving the Race Conversation Forward and Practice.
- The Interaction Institute for Social Change offers trainings across the US, including “Fundamentals of Facilitation for Racial Justice Work” and “Facilitative Leadership for Social Change.”