Opinion | Virginia’s top health official needs an education on racism

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Stephen A. Haering and Charles Konigsberg are board certified physicians in general preventive medicine and public health and former directors of the Alexandria Health Department, part of the Virginia Department of Health. Konigsberg also served as the state health official for Kansas and Delaware.

Racism is a public health crisis.

Virginia State Health Commissioner Colin Greene said recently that he associates the word “racism” with “fire hoses, police dogs and Alabama sheriffs.” Greene misunderstands the issue. Those are overt symptoms of racism. Such overt symptoms are only the tip of the iceberg of symptoms of racism — and other forms of oppression, including sexism, classism, ableism and oppressions based on sexual orientation and gender/gender identity.

There are many more symptoms of racism than “fire hoses and police dogs.” They are more deceptive but no less shameful. They are, longitudinally, evidence of the harm that racism exacts on an entire subset of society: our Black neighbors.

These symptoms include well-documented, pronounced and pervasive health inequities: higher rates of chronic diseases and premature death for Black Americans compared with White Americans. For example, National Center for Health Statistics 2020 data reveal that the maternal mortality for Whites is 19.1 per 100,000 live births compared with an alarming 55.3 for Black Americans. For children with asthma, it is worse: Black children have a death rate from asthma that is seven times greater than White children. How does this happen?

“Social determinants of health” are those factors that create, protect and promote health or, on the flip side, allow and/or cause illness. Well-known, traditional social determinants of health include education, housing, food security, transportation, economic stability and health care. The causes of health inequities are complex, diverse, dynamic and interrelated. And racism is an insidious web that works at multiple levels.

Racism negatively affects each of the social determinants of health by disadvantaging people of color through policies, practices, beliefs, attitudes and behaviors. What, precisely, is racism? And how does it negatively impact the social determinants of health?

Racism, as defined by the Centers for Disease Control and Prevention, “is a system – consisting of structures, policies, practices, and norms – that assigns value and determines opportunity based on the way people look or the color of their skin. This results in conditions that unfairly advantage some and disadvantage others throughout society.”

The Post’s View: The racial ignorance of Virginia’s health czar

Racism is ideologically rooted in White supremacy’s premise of racial superiority. An article in The Post reporting on Greene’s comments indicated that Greene is concerned that White people will be alienated if the word “racism” is used; this is tantamount to a doctor concerned of alienating his patient when presented with the diagnosis of cancer.

Though Black Americans suffer the burden (the symptoms), the disease of racism is that of our society as a whole, and particularly of those in power who deny its reality, actively choose to remain ignorant or do not use their power to act to identify , correct and prevent it. Racism exists insidiously at multiple levels, intentionally and unintentionally, consciously and unconsciously.

Historically, racist policies redlined Blacks from obtaining credit. Currently, at the systemic/societal level, reverse-redlining practices create food deserts in poor, predominantly Black areas; and Black neighborhoods often have the double burden of proximate industrial and/or highway development (with subsequent increased negative environmental exposures) along with lower property values ​​(with a lower tax base for schools). Racism also exists at the community, interpersonal and intrapersonal levels. And all of these levels affect our Black neighbors.

Additionally, there is an increasing body of evidence that racism itself — independent of its impact on the traditional social determinants of health — is, itself a determinant of health. This occurs through the cumulative burden of chronic stress and explains why Blacks with similar socioeconomic status and behaviors as White counterparts suffer more diseases and die earlier.

We all have much to learn more about racism’s impact on public health, including how to identify, reverse and prevent racism at all levels.

As part of this, we call on Greene to, first and foremost, follow the Hippocratic oath to “do no harm or injustice”; to seek out, listen to and learn from public health experts who have researched and worked in this field as well as to learn from Virginia’s Black leaders at state and local levels; and to encourage — even to require — that all public health workers at the Virginia Department of Health become anti-racists through formal training programs. And Greene should lead this endeavor by being the first to take such training.

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