Racial Disparities in Public Health at a Crisis Point

Today, public health is in crisis. This has occurred because of the severe racial and income inequities that were identified, as well as the service failures that were made apparent during the COVID-19 pandemic. Recently, I have written about the need for a set of strategic directions for public health which, if developed and implemented, would begin to create the new public health system for the 21st century.

Simultaneously, a number of states, counties, and cities have begun to step forth to declare racism to be a public health crisis. By any measure, Blacks have worse health status, worse access to health and behavioral health services, and worse longevity than Whites. This is due to the structural and interpersonal racism that persists to the present time in American society.

There are some key values that underlie the public health field and their relationship to racism as a public health crisis. 

Public health developed out of the desire to protect the health of entire communities. This could best be addressed by population-wide approaches that included everyone in a community. From this work, it became apparent that, within communities, members showed great disparities in health status. It also became clear that the less advantaged members, including Blacks, frequently experienced worse health status than others. Thus, over time, the mission of public health became the development and implementation of interventions to address these disparities in health status with a focus on Blacks and other disadvantaged groups. With this focus within a population-wide approach, the health of entire communities can be improved and protected.

If we restate these values in today’s terms, we would say that the essential value driving public health is the need to protect social justice by addressing disparities and promoting equity for the least advantaged within the context of a community-wide approach. Due to systematic and interpersonal racism, the least advantaged persons are almost always Black members of the community. Thus, it is obvious why racism has come to be defined as a public health crisis and why public health has embraced this mission.

So, what are the action items that ensue from this mission?

First, public health needs to foster a national voice to focus laser-like attention on racism as a public health crisis. Yet, today, the national voice of public health is weak to nonexistent. Development of a national voice will require leadership, i.e., courageous persons who are willing to step forward and lead, and it will require advocacy by the entire public health community, i.e., from university researchers to community public health workers, to those in the community adversely affected by racism.

Second, this effort will require the development of projects that engage the voices of affected community members with public health researchers and frontline workers to identify the best community practices for addressing structural and interpersonal racism. Persons with strong backgrounds in social work and social welfare also should be included. These will be spanner projects that bring together people who have not typically worked together in the past. Hence, they will require senior project managers who understand the culture and practices of all the groups who are participating.

Third, policy changes will be necessary at all levels—federal, state, county, city—not only to eradicate any practice that supports structural or interpersonal racism, but also to promote new cultural norms and community practices for a post-racism world.

Solving the public health crisis of racism will neither be easy nor accomplished quickly. That should not deter us, however. The principles of social justice, which are supported by our Declaration of Independence and by our Constitution, demand nothing less.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.