In 1886, at a celebration of the 24th anniversary of emancipation in the District of Columbia, Frederick Douglass gave a speech in which he described the basic contributing factors to systemic racism in the United States.
“Where justice is denied, where poverty is enforced, where ignorance prevails, and where any one class is made to feel that society is an organized conspiracy to oppress, rob and degrade them, neither persons nor property will be safe.”
For over 400 years this country has been infected with a pernicious and persistent pathogen that has sought to destroy the core of liberal democracy and subject millions of citizens to a conspiracy of oppression and degradation. That pathogen is racism. Racism is hatred employed against individuals of racial and national identity as well as class membership, through overt acts of violence and structured depravation of basic equality and human rights.
A primary outcome of that hatred has been reduced health status and increased vulnerability to chronic and acute illness. As a determinate of poor health, racism has its greatest impact when it generates inequities in the fabric of our society that severely disadvantage individuals in areas such as housing, access to health care, nutrition, employment, education, income security, safety, opportunity and political participation. Racism infects what should be fair and objective social and economic structures serving the basic needs of all citizens and instead skews their performance in a manner that severely inhibits the wellbeing of some citizens while favoring others. The outcome is measured in premature morbidity and mortality.
The obligation of public health to measure, track and intervene in this process of altering health status by racial identity and class membership has always been clear, however, not always been followed. Public health has too many times failed to explore and embrace adequate social paradigms that would explain the inequities leading to unequal health status because of racism. In fact, higher educational institutions have in the past, collaborated with racism by promoting pseudoscience such as ethnology and polygenism to account for the perceived variation of performance outcomes by race. This racist thinking, or some variation of it, remains in much of the white supremacist ideology of today.
It is, however, the obligation of public health to move beyond this primitive and abhorrent thinking and include in its work clear and legitimate explanations for the consequence of systemic racist behavior and the resultant social inequities and their health impact. This process needs to be embedded in every aspect of epidemiological investigation and public health intervention. Furthermore, this paradigm needs to focus its explanatory reasoning on the behavior of the social pathogen – racism - and the conduct of the institutions which practice it, not its victims. As Douglass said in an address at the Chicago Columbian Exposition in 1893:
“The true problem is a national problem. There is no Negro problem. The problem is whether the American people have honesty enough, loyalty enough, honor enough, patriotism enough to live up to their own Constitution.”
Public health must adopt the spirit of this statement and use the tools it possesses to bring an honest and honorable examination to every health matter it confronts. That means bringing a multidisciplinary approach that can inform every aspect of the environment in which the health problem exists. It means placing the problem in its historical, economic, cultural and political context. It means having the bravery to define the issue regardless of the consequences and the wisdom to see the impact of proposed interventions from multiple perspectives.
Until public health seriously examines itself and how it defines health, it cannot defeat the pathogen of racism.
Richard Murray Trostle, M.P.H. ’78, Dr.PH., is the former director of the Childhood Immunization Unit, U.S Agency for International Development (USAID) Office of Health.
This is part of a series of essays by Yale School of Public Health faculty, alumni and students on the issues of race and racism in the United States following the killing of George Floyd and the ensuing protests against police brutality throughout the United States. We remember, too, Ahmaud Arbery, Breonna Taylor, Rayshard Brooks and countless Americans who came before.
See other essays in this series and related material in the Public Health Crisis of Racism section on the YSPH website.