Warning: Racism is Hazardous to Your Health in Columbus
Franklin County and the city of Columbus have declared racism a public health threat for good reason. Just look at the statistics. What’s being done to attack the inequities?
Talk about a racial divide. Consider this:
There’s Bexley, which is 87 percent white. Compare it to the Near East Side of Columbus, which is 59 percent Black. They are essentially next-door neighbors. The average lifespan of residents in the wealthy suburb? A little more than 85 years. In the minority community? Try 67 years.
Think about that. A difference of more than 18 years based on where you live.
Might as well put up a warning sign: Living while Black in Central Ohio can be dangerous to your health.
Perhaps it is a foggy memory for many after a year when a pandemic ripped through the world and killed millions and racial tensions skyrocketed after a white Minneapolis police officer held down a Black man until he suffocated. Many people feel they’re just waking up from a long, bad dream. But about a year ago, Franklin County commissioners and Columbus City Council separately issued proclamations declaring racism a public health crisis. Elected officials urgently called for action.
Sure, battling racial inequities is no easy fix, but what do these declarations mean and how will they improve the health of African Americans in Central Ohio?
As Franklin County Commissioner Marilyn Brown told reporters at the time, “People are talking about race in this community. But talking isn’t enough.”
From Declarations to Action
The recognition of the harsh impact of race on health actually took place prior to last year. In 2019, Franklin County commissioners laid out their plans in “Rise Together: A Blueprint to Reduce Poverty in Franklin County,” which includes changing long-standing racial inequities as a major goal.
One result has been the hiring of Lisa Dent as associate director of equity and inclusion at Franklin County Public Health. She’s setting up a program to train all health department staff about equity, including ways to communicate with other employees and the community at large that are sensitive to different cultures.
That’s meant, for example, listening to community members about how health department messages encouraging masks to combat COVID-19 are perceived and how they can be tailored to specific groups such as African American males, she says.
“We came to realize we weren’t the experts in that, and that we needed boots on the ground to help,” says Dent. The Equity Advisory Council, made up of representatives of more than 20 community organizations, meets monthly to help provide some of those insights.
“We wanted to start looking at how we can address poverty in the broader spectrum and how racism fits in,” says Franklin County Commissioner Kevin Boyce. That means looking at factors in lower-income neighborhoods such as adequate grocery stores, health care facilities and transportation links—all things that can improve the health of a community.
The city of Columbus is working on reducing racism as a public health threat in several arenas. One is the Center for Public Health Innovation, created after Mayor Andy Ginther called out the issue in his February 2020 State of the City speech. Dr. Mysheika Roberts, Columbus health commissioner, heads up the effort; she says its purpose is to improve health by increasing life expectancy and quality of life for all residents with a variety of programs that promote physical activity, losing weight and health screenings.
Another city effort is CelebrateOne, a program created in 2014 to reduce the high rate of infant mortality in the area, particularly among Blacks. The rate is calculated as the number of babies who die before the age of 1 per 1,000 live births. In Franklin County, that rate was 11.4 for non-Hispanic Black babies compared with 4.3 for non-Hispanic white babies in 2019. Statewide, the 2019 rates are even worse—14.3 for Black babies and 5.1 for white babies, according to the Ohio Department of Health.
Those statistics capture the reality of racism as a public health threat, says Dr. Deena Chisolm, director of the Center for Child Health Equity and Outcomes Research at Nationwide Children’s Hospital. “It’s kind of the canary in the coal mine,” she says. “It’s a big red indicator of a lot of health-related social factors and an indicator of access to health care, safety in homes and nutrition, to name a few things.”
CelebrateOne’s efforts have reduced Franklin County’s overall infant mortality rate, from 8.1 in 2012 to 6.6 in 2020, but the racial disparity in that rate hasn’t gone down. That’s the No. 1 goal now, says Maureen Stapleton, executive director of the program. “A society is judged based on how it cares for its most vulnerable citizens, so if we can’t keep babies safe, what does that say about our community?”
Stapleton says data shows the high rate of infant mortality among Black babies isn’t limited to those who live in poverty. “A Black mother who is college-educated with a good job still has worse birth outcomes than a high-school-educated white woman,” she says. “So when you peel away the layers of the onion, the two things that make that [Black] mother different are the color of her skin and how she is treated in her medical care. Somehow the Black woman is getting different medical treatment than someone who is not Black.”
CelebrateOne’s partners, which include area hospital systems, have reached the same conclusion, Stapleton says. So the program’s push going forward is to reduce implicit bias among doctors, nurses and other medical staff.
Addressing Implicit Bias at Hospitals
Consider the case of Chisholm, who is Black. She suspects she experienced racism as a child during many visits to doctors and hospitals because of her asthma. “I’d go to an emergency room, they’d give me a breathing treatment and send me home,” she says. “Then I’d go to another hospital and they’d admit me.”
Once during a hospitalization for asthma, nurses refused to answer when she pushed the call button. Finally, as Chisolm was turning blue because she couldn’t breathe, a doctor noticed and treated her. “Did the nurses not respond because I was a teenaged Black girl? I don’t know. But when you see that over and over again, you wonder.”
Some hospitals have begun programs to address implicit bias, and the statewide activist organization, UHCAN Ohio, has offered to help hospital systems set up anti-racism initiatives in conjunction with their communities.
“Hospitals grew up in a racist environment and they have to be explicit in examining the processes they have set up,” says Steven Wagner, executive director of UHCAN Ohio. “They have to try to change their belief systems and their implicit biases if they’re really going to grow and eliminate racism.” That work needs to help hospital staff understand their biases, increase staff diversity and root out practices that perpetuate institutional racism, he says.
One organization that has embraced the moment is the Ohio State University Wexner Medical Center. Although the system, which includes the university’s seven health sciences colleges, has long had programs to address racism, the killing of George Floyd last year prompted a massive attempt to face the issue and make changes, says Autumn Glover, co-chair of the center’s anti-racism initiatives that began last summer. “Only when we address the real issues of racism are we able to develop sustainable solutions to transform the health of our communities and support our trainees, staff and faculty while doing so,” the initiative’s web page explains.
Through its Anti-Racism Action Plan, Glover says the medical center is examining how to erase racism “in every fiber of our work.” That includes how physicians, nurses, dentists and veterinarians are taught, how much diversity is in the hospital staff and how staff can examine and understand their implicit biases.
She knows changes won’t come easily or quickly. “We’re not fooling ourselves into thinking that everyone’s having this great awakening,” says Glover. “Some are ready for the stretch and some aren’t.” The biggest hurdle, she says, is systemic—the country’s history of slavery and all that has resulted from it. But, Glover adds, addressing racism is the only way to move toward health equity.
Health equity for Blacks isn’t a zero-sum game, says Kyle Strickland, senior legal analyst at the Kirwan Institute for the Study of Race and Ethnicity at Ohio State University; the changes needed to make it happen will help whites as well as Blacks. “Racism costs all of us and hurts all of us,” he says. “It’s not as if when Blacks win, whites lose.”
Racism and COVID-19
The pandemic has spotlighted both historic Black mistrust of health care and how ongoing structural racism impairs Black health.Communities of color have been disproportionally affected in myriad ways, ranging from a higher incidence of contracting COVID-19 to greater economic fallout.
“COVID-19 has really put this right in front of us,” says the Rev. Dan Clark, Ohio director of Faith in Public Life, a coalition of activist faith leaders. “There are people who deny that systemic racism exists in America, but we know that Black and brown and indigenous people have less access to health care and economic opportunity in this country.”
The Centers for Disease Control and Prevention estimates that Black Americans are nearly twice as likely to die of COVID-19 and nearly three times more likely to be hospitalized with the disease than whites. In part, that stems from higher incidences of underlying health conditions that can contribute to poor outcomes from COVID: hypertension, cardiovascular disease and obesity, to name a few, says Joe Mazzola, Franklin County health commissioner.
With that in mind, Franklin County and Columbus Public Health have reached into communities of color in a variety of ways during the past year. Franklin County Public Health has worked with minority community organizations such as the African American Male Wellness Agency to make sure its messages surrounding COVID-19 are culturally sensitive, Mazzola says. It also has partnered with faith and other community leaders to provide better testing and vaccination opportunities, including easier ways to sign up for vaccinations and vaccination sites on public transportation lines.
“For those who have certain barriers, we try to eliminate those to the best of our ability,” Mazzola says. “It’s the right thing to do, and that’s what guides us as a public agency.”
The department also is putting together mobile vaccination units to go to churches, recreation centers and other public places where there are pockets of poverty, Mazzola says.
Columbus Public Health has set aside 20 percent of its vaccine allotment for vulnerable populations, says Roberts, the Columbus health commissioner. “It’s imperative that we as an urban health department value our vulnerable community and say: ‘We’re going to make special efforts to make sure you get vaccinated,’” Roberts says. To do that, the department has sent mobile teams to places such as senior centers and homeless shelters to get shots in arms of those eligible and has plans to set up a mobile vaccine van that can go to vulnerable neighborhoods.
Columbus Public Health also has offered vaccines at Opportunity Clinics at its headquarters on Parsons Avenue for vaccine-eligible residents of certain ZIP codes with high unemployment, high infant mortality, access-to-care issues and low graduation rates.
Efforts also are being made to reduce African American mistrust of health care and, in this instance, vaccines. Roberts, who is Black, addresses the issue almost daily in talks to groups large and small, explaining how the vaccines were developed and reassuring residents that, despite racism surrounding health care in the past, the vaccines are safe. The efforts may be paying off.
“A few weeks ago one of the vaccine providers told me that an elderly Black woman walked into their site … and said she had had no intention of getting the vaccine until she listened to Dr. Fauci and Dr. Roberts and then became convinced it was safe,” Roberts says.
The Lack of Black Doctors
Health care inequities for Blacks also can’t be adequately understood—or addressed—without examining how prevalent racism has been within the medical community. Books have been written on the subject, but a few examples are revealing.
The American Medical Association, the largest nationwide organization of doctors and medical students, has a long history of discrimination against Blacks, particularly in severely limiting the number of Black physicians. For example, the association endorsed the 1910 Flexner Report, which set educational standards for medical schools that most African American schools couldn’t meet for financial reasons. Five of seven African American medical schools closed as a result. Those standards, and continued racist policies at medical schools for decades (few admitted Blacks), created a modern health care system with a dearth of Black doctors.
A 2008 AMA study concluded that one legacy of its racist past was the continued underrepresentation of Black physicians. By 2006, when 12.3 percent of the U.S. population was Black, just 2.2 percent of physicians and medical students were Black, the study found. A 2019 AMA report showed that percentage had grown to 4.2 percent at a time when 13.4 percent of the U.S. population was Black.
History, too, helps explain why mistrust of doctors and hospitals is common among Blacks. A 2020 examination of the impact of structural racism on the Black community by the American Public Health Association noted the 20th century is filled with examples of how scientists and physicians used people of color for research and experimentation. They include sterilizing Black women in welfare programs without their consent and the infamous 40-year Tuskegee Syphilis Study, where, beginning in 1932, Black male participants with syphilis were left untreated for research purposes.
More recently, inequitable and uneven medical care for Blacks has become harder to quantify but, in the minds of many, is still prevalent. That was driven home for Angela Gibbs, 50, of the King-Lincoln Bronzeville neighborhood on the Near East Side, in 2009 after surgery to remove an infected mass from a 2007 cesarean section. Gibbs and her family members felt that she needed a wound VAC—a mechanical device that helps wounds heal—to clear up the infection after her release. Her Medicaid insurance covered the device, but medical staff refused to prescribe it until then-state Rep. Tracy Maxwell Heard asked the president of the insurance company to intervene.
“It wasn’t until pushback and intervention that I received the medical care that kept me alive,” Gibbs says. She doesn’t believe any particular member of the medical staff who treated her was outwardly racist, just that there was “a general apathy” about her treatment because of her race and class.
It Started with Slavery
“It goes back to the original decision to force people to come to America as slaves,” explains Amy Fairchild, dean of the College of Public Health at Ohio State University and a historian who assesses how social, political and ethical factors shape cultures. “How can we undo 400 years of structural racism?”
Long after slaves were emancipated in 1863 and the country appeared to have achieved a kind of egalitarianism, laws were passed that discriminated against Blacks in housing, education, employment, law enforcement and voting rights. Opportunities to change those policies in the 1930s and 1960s were squandered, Fairchild says, and those discriminatory practices continue to hurt the health of black communities.
“We tend to think of racism as a mindset, but what we need to do is think of it as a social policy,” Fairchild says. “The laws, the rules, these historical structures that were created that allow racism to operate without us seeing it. A lot of things seem to be race neutral, but because of the policies built in, they don’t operate in neutral ways. Our systems put obstacles in the way of African Americans, and it’s insidious because we can’t see it. All of that translates into health outcomes.”
One systemic barrier was redlining, Fairchild says. That was when the federal Home Owners’ Loan Corp. in the 1930s labeled neighborhoods according to its view of their loan risk. Mortgage lenders for the most part wouldn’t lend to residents of neighborhoods that were “redlined”—labeled hazardous—so their largely Black and immigrant residents couldn’t build wealth by owning homes. Other racial policies, such as restrictive covenants in property deeds that prohibited owners from selling to Blacks, also worked to keep minorities in specific neighborhoods—often poorer areas with health threats from factory pollution, highways and slum landlords.
The legacy of these practices remains. The National Community Investment Coalition found in a recent study that neighborhoods that were redlined in the 1930s have higher rates of chronic diseases and poverty as well as reduced lifespans today. “Where I live determines whether I’m more likely to have asthma, stress, mental health challenges and higher infant mortality,” Fairchild says. And, according to the U.S. Census Bureau, Blacks were more than twice as likely as whites to live in poverty in 2018.
So, although many tend to think that health is merely the result of lifestyle choices, multiple studies, including some by the Kirwan Institute for the Study of Race and Ethnicity at Ohio State University, have shown that lifestyle choices contribute just 30 percent to an individual’s health outcomes.
Another 20 percent depends on clinical care, while the other 50 percent depends on so-called social determinants of health, which the institute defines as “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.” That includes air and water quality, housing, education, income, community safety, employment and family and social support.
All of those factors equal a stark health outcome: The life expectancy for non-Hispanic Black people in the U.S. in the first half of 2020 was 72 compared with 78 for non-Hispanic white people, according to the National Center for Health Statistics.
That’s why declaring racism a public health threat is so important, explains the Kirwan Institute’s Strickland. Exposing inequities, many of which are the result of years of racist policies, can provide the impetus to invest in at-risk communities to improve housing, education, transportation and safety, which in the long term can improve the health of Black and brown communities, Strickland says.
“We can’t act as if the past doesn’t have an impact on where we are today,” he says. “These are deep, structural problems. This is just a first step, but it’s really important.”
This story was published in the May 2021 edition of Columbus Monthly, a special issue dedicated to exploring the experiences of Black people in Central Ohio. The issue is available on newsstands through May.