Rooting out systemic racism in America: Q&A with Gilbert on social change, health determinants — Long-term strategy needed to address race, health inequities

Why have these protests become a national movement across the U.S.?

I think it has something to do with people being exposed to the data that has been presented around COVID-19, of the health disparities between Blacks and whites. I also think that the death of Ahmaud Arbery really started to uncover this idea that Black people and Black communities are hyper-surveilled. Then you have the killing of Breonna Taylor and of George Floyd.

Also, a lot of people have been at home and news of the killings have not been washed away by other news.

And I think in some ways this is also a counter-protest, or counter-movement, to when we saw a lot of people protesting at state capital buildings about the reopening of their states, because people said that they wanted to get back to work.

Where does systemic racism cut the deepest in America?

It’s really hard to say. And the reason why I say that is because it’s embedded in so many systems that work together to produce systemic racism.

I am reminded of a quote from the writer Audre Lorde: “There is no such thing as a single-issue struggle, because we do not live single-issue lives.”

We can do an analysis, an antiracist analysis, for example, within institutions, but it’s very difficult to do that unless you start to look at the overlap or the interconnectedness between one institution and another.

You have to be able to look across systems. And that’s the difficulty of unpacking systemic racism.

How does systemic racism impact the health of Blacks?

We see the onset of the impact or the effect of racism maybe more easily or more readily in physical health, such as in high blood pressure or blood sugar.

Also, there’s a lot of work that’s been done to try to understand not only chronic stress, but also coping mechanisms in terms of how people manage their daily stressors. We do things sometimes to address our mental health that might affect our physical health at a later date.

How can public health workers better take on these issues?

They are doing incredible work, and they’re doing very difficult work, but they don’t always have the resources, the time or the leadership that address the systemic issues.

And so we really need to think about what resources are available to these agencies and to these organizations, so that people can address the social determinants of health in a way that allows us to actually see decline in chronic diseases, whether they be physical health or mental health. I think that’s where a lot of public health practitioners kind of find themselves.

That might allow them to identify interventions or practice-based solutions that they weren’t able to before.

Gilbert

Studies show that many Black men have no primary care physician. How do we involve Black men in the health care system?

Schools start to push Black males out, or show a disregard for them, at a very early age, and then that carries over into adulthood. That suggests to them that schools are not places that care about them, that are concerned about them, that trust them, that respect them. And as a result, they then start to disengage from schools. That carries over into health care.

Also, we can factor in medical distrust, experiences of discrimination and then also even back to the idea of people feeling that they are being surveilled or being policed.

In addition, some of it is related to the types of work that Black men have. One of the primary ways that people get access to health care is through their employer. And so if you don’t have full-time employment, or have an employer that’s offering health care, then you don’t have health care. The Affordable Care Act has helped some of that.

What needs to happen to build on the momentum for social change begun this spring?

We have been relegated to this idea that it’s OK just to document the existence of disparities and inequalities. And it’s OK just to document and articulate only causal factors. But we’ve not made significant investments in interventions and structural changes. And studies have also shown that the investment in interventions and structural changes actually have the greatest benefit.

President Trump signed an executive order on police reform in June. What are your thoughts on the order?

The executive order provides some opportunity for data collection about police excessive use of force and killings, but does not mandate these data be collected. The database allows for tracking of officers who use excessive force and who are reprimanded for misconduct. The executive order does not ban all excessive force tactics.

New York Gov. Andrew Cuomo has taken this idea several steps further and has also written into legislation that false 911 calls that speak to racial profiling or racial bias are no longer allowed.

The order starts to touch the surface of some of the broader changes that a lot of people have been asking for, in terms of police reform, in terms of national tracking, a broader understanding of what happens with police when they commit these types of offenses. But it really does it in a very odd and strange way, in terms of trying to provide incentives for police agencies. It’s not just about bad apples. It’s about cops coming from rotten trees. We should think about the root causes of bad policing behaviors.

What do we need in a long-term strategy for health equity?

One of the things I appreciate about the work of several large nonprofits and foundations is that they’ve taken a different approach in thinking about investing in generational change, recognizing that we can’t fix this problem in a five-year grant, a three-year grant or a two-year grant.

We might need a strategy that looks at this for the next 20 to 30 years. How can we invest now so that in 20 to 30 years we can see a difference, and not just a marginal difference?

One of the challenges that I have as a public health professional, and teaching public health to our MPH students at Saint Louis University, is recognizing that statistics and patterns and trends have not really changed much over time.

That might mean we’re not doing enough in prevention efforts. And not just the prevention efforts in terms of saying you need to get a flu shot, or you need to eat healthier and exercise more. We must also acknowledge social determinants, for example, having a housing problem or education problem in a city.

We get caught up in only addressing the downstream and not the upstream — the root causes of the problems.

To provide an in-depth look at racism as a driving force of social determinants of health and equity, APHA is hosting a new Advancing Racial Equity webinar series. Watch recent webinars and register for upcoming broadcasts at www.apha.org/racial-equity.