The blog of the Urban Institute
November 11, 2020

It’s Time to Declare Racism a Public Health Issue

November 11, 2020

The police killings of George Floyd, Breonna Taylor, Ahmaud Arbery, Tony McDade, and countless others this year underscore systemic racism’s detrimental role in our criminal justice system. And consistent with the pattern of long-existing health disparities, COVID-19 has disproportionately affected Black Americans. And last year, about 76 percent of Black Americans experienced racial discrimination.

Systemic racism has been baked into United States institutions, such as the criminal justice and health care systems, for years. To combat racism within our culture, many leaders are now arguing that to create meaningful change, society must view and address racism as a public health issue. What does the evidence suggest?

How is racism a public health issue?

The American Public Health Association names racism as a driving force behind social determinants of health—including housing, education, employment—and a barrier to attaining health equity. Evidence shows racism is the main determinant of disparities in death and disease between Black and white people. Further, Black people ages 18 to 34 have higher mortality rates for 8 of the 10 leading causes of death. And since 2014, research has shown that the life expectancy for Black Americans is four years shorter than the expectancy for white Americans. Health disparities cut across socioeconomic lines in Black communities, suggesting that even wealthy Black Americans experience worse health outcomes.

Violent victimization associated with racism has negative health consequences for Black people

Victimization can be especially traumatic for Black people because it is commonly associated with racism and related violence. The Center for Victim Research found that Black people are 1.5 to 2 times more likely to be victims of serious violence than white people.

Racial bias in the application of policies and procedures, such as overpolicing and use of excessive force, pose health and safety hazards for people in communities of color. One study found that between 2010 and 2014, Black males older than 10 were found to be nearly three times more likely to die as a result of police violence than white males. Another study found that Black people were more than 2.8 times likely to die from the use of force by law enforcement than white people. And in 2018 alone, police killed more than 300 Black people, a quarter of whom were unarmed at the time. In addition to increased violence, law enforcement is often protected by policies that allow them to avoid accountability.

In addition to physical violence, victimization can include traumatizing events that damage emotional and mental well-being. Black people report stress as a result of police encounters, and inappropriate stops by law enforcement have been shown to result in anxiety, depression, and posttraumatic stress disorder. A 2018 study reported that Black adults, in general, experienced adverse mental health effects in response to law-enforcement-involved deaths of unarmed Black people. And in some neighborhoods, communities with high law enforcement use-of-force rates were shown to have increased risk for diabetes, obesity, and high-blood pressure.

The evidence described above shows that targeted violence in Black neighborhoods results in community-wide deaths, trauma, and stress. This violence and victimization, perpetuated by police against Black people, shows that racism is systemic, and its public health consequences are too.

What can be done?

There is no single method or solution to heal the trauma caused by centuries of a systemically racist society. But declaring racism a public health issue is an important step to bringing systemic disparities to the forefront. Broader recognition would further highlight the need to allocate and direct funding to the resources necessary to combat these issues. It would signal to society that although racism very much exists, it will no longer be tolerated.

Cities and counties in many states—including California, Colorado, Connecticut, Georgia, Illinois, Indiana, Massachusetts, Maryland, Michigan, Minnesota, Missouri, Nevada, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Vermont, Washington, and Wisconsin—have now officially named racism a public health issue. Others can consider following suit. There is also an opportunity for recognition and change at the federal level.

If Americans want to combat racism within their society, they can start by calling out racism for what evidence shows it is: a public health issue running rampant throughout the United States. Black voices interested in leading the conversations about what it would take for their community to feel safe and protected in society need to be respected. We must listen and take action—now is the time to declare racism a public health issue.

Protesters gather at Times Square to march uptown via the Henry Hudson Parkway on August 9, 2020 in New York City. Protesters took to the streets to demand the arrest of the officer responsible for the death of Breonna Taylor. (Photo by David Dee Delgado/Getty Images)

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As an organization, the Urban Institute does not take positions on issues. Experts are independent and empowered to share their evidence-based views and recommendations shaped by research.