Racism and Public Health – A New Announcement, A Growing Understanding

On June 12th, Mayor Walsh declared racism a public health crisis in Boston and announced that he would reallocate $12 million of the Police Department’s overtime budget to fund programs to reduce racial disparities, including $3 million on public health initiatives. This $3 million was reallocated to the Boston Public Health Commission in the Mayor’s final budget, which passed on June 26th.

Declaring racism as a public health crisis is a bold statement. It echoes growing awareness in the public health community that racism itself is a major social determinant of health. At the same time, I wonder what exactly this declaration can do to accelerate change since others in the city and the state have previously established the connection between racism and public health.

The Boston Public Health Commission (BPHC) is an independent public health agency which is governed by a board appointed by the Mayor of Boston. According to their website, “BPHC has been committed to racial justice & health equity in Boston since 2000.” In 2019 BPHC made ‘Racial Justice and Health Equity’ its priority in its strategic plan.

Massachusetts has additionally recognized racism as a public health issue in several ways. In 2017 as part of the Massachusetts Department of Public Health’s (DPH) revisions to their Determination of Need regulations, DPH created a Statewide fund of which the intersection of racism and public health as a defining characteristic. MACDC served on the fund’s advisory task force that recommended this focus on racial equity. Applicants to the fund were required to articulate how their project works to dismantle “policies, systems, and social/physical environments that are historically based in structural and institutional racism and other forms of oppression.” According to the Department of Public Health, “these forms of oppression need to be understood and disrupted to eliminate health inequities.”

Building on the Department of Public Health’s Determination of Need updates, the Massachusetts Attorney General clearly identified racism as a public health issue in her updated Community Benefits Guidelines for hospital in 2018 (MACDC also served on this Advisory Task Force!). Citing the BPHC (again – which has a board appointed by the Mayor of Boston), the Attorney General declared that racism both has an independent impact and also impacts other social determinants of health. The Guidelines recommend that “hospitals and HMOs should consider this framework and continue to recognize and address the role that racism and institutional bias play in impacting health outcomes in their communities.”

So, what is new about the Mayor’s announcement? First of all, an announcement from the top City official is an important statement – even if it’s one that reiterates something that’s been said before. It’s also important the Mayor’s term “Public Health Emergency” connotes appropriate seriousness and urgency. This is particularly noteworthy in the midst of another public health crisis – the COVID-19 pandemic. By using terminology that evokes this international crisis, the Mayor is signaling the importance of acknowledging the profound impact of racism on population and individual health. Lastly, it is important that this is a statement that is coming from a non-public health entity nor from explicit public health guidance. Mayor Walsh’s announcement makes clear that it is not just the people who think day-in and day-out about population health who are making the connection between racism and health. I hope that the Mayor’s declaration will influence people at all levels of government, across all industries and sectors, and across demographics to recognize this connection. Additionally, all levels of government, as well as hospitals and other healthcare institutions should follow Mayor Walsh’s lead and invest money in racial equity work. In addition to being the right thing to do, investing in racial equity work will lead to improved health outcomes and a reduction in health disparities.