By Brian Skinner, Esq.
On October 6, 2020, the Wheeling city council and mayor unanimously approved a resolution declaring racism a public health crisis. The resolution cites several national institutions, such as the American Public Health Association, the American Medical Association, the American Association of Pediatrics, the National Partnership for Women and Families, and the American College of Emergency Physicians, who have recognized racism as an urgent threat to public health in the United States.
The resolution directs the city manager to review all city policies and procedures for the purposes of eradicating any implicit and explicit racial bias, and promote policies and procedures that advance racial equity; require all municipal employees to complete implicit bias training; work towards building a more diverse and inclusive workforce; incorporate inclusion and equity by offering educational training for employees; and work with the city council to build alliances and partnerships with other organizations that are confronting racism.
Wheeling’s declaration is important because it recognizes that many issues affecting Black communities, in education, employment, healthcare, housing, and law enforcement, have a common root – structural and institutional racism. Because systemic and institutional racism drives the racial inequalities that cause racial health disparities, policymakers around the country are moving to define and respond to racism as a public health crisis.
Wheeling joins more than 130 cities, counties, and states have declared racism a public health crisis, with many of those declarations occurring following the police killing of George Floyd in Minneapolis and the subsequent nationwide protests calling for governments to address the legacies of racism and discrimination. Like Wheeling, many cities have not only set specific policy goals, but also committed funding to achieve those goals.
In addition to the cities and counties that have declared racism as a public health crisis, governors in Michigan, Nevada and Wisconsin have issued their own declarations. Wisconsin Gov. Tony Evers declared racism a public health crisis without including any new requirements for state agencies or legislative suggestions to remedy the crisis.
Michigan Gov. Gretchen Whitmer, went further and issued an executive directive that mandates the formation of advisory groups, training of government employees in implicit bias and the review of state laws that perpetuate inequities.
But, even declarations that do not include new requirements or enforcement mechanisms should be viewed with optimism since they demonstrate a recognition of this issue after so many years of people saying racism doesn’t exist or doesn’t affect us.
The concept of “racism is a public health crisis” is not new and has gained momentum to recent events, including the Covid-19 pandemic. Public health researchers have been talking about the social determinants of health since the 1990s, connecting racist practices in housing, health care, employment, and other areas to worse health outcomes for Black Americans.
Unfortunately, health issues impacting Black Americans are often discussed in isolation -- the maternal mortality crisis, high rates of asthma, mass incarceration and over-policing are all over represented in Black communities.
And, previous public health and legal responses have been inadequate to fully address the impact of the racism embedded in our institutions because they focus only on a specific action or perpetrator rather than the system of racism.
The result? Legitimization of the existing social system of racism, leaving in place a racial hierarchy that is reinforced by social norms and institutional practices.
But before you dismiss the idea that systemic racism exists in West Virginia, consider that although Blacks make up just 3.6% of the state’s population, infant mortality rates for Blacks are almost twice those of Whites, Black West Virginians make up 5% of all Covid-19 cases, and Black men and women make up 12.48% of the prison population and 10.74% of jail admissions. And, according to the 2007 Minority Health in West Virginia report -- the last time the state issued by the state on the subject – Black West Virginians die of cancer, diabetes, heart disease and stroke at higher rates than white residents.
Despite these statistics, West Virginia has done little to acknowledge the impact racism has had on the health of the state’s small minority community.
In 2014, the Office of Minority Health was created in the Bureau for Public Health with the mission of eliminating health disparities for vulnerable populations as defined by race or ethnicity, socio-economic status, geography, age, disability status, risk status related to sex and gender and other populations identified to be at-risk for health disparities. Four years later, the office was moved from the Bureau for Public Health to Marshall University’s Minority Health Institute which has now been designated as the state’s primary contact with the federal Office of Minority Health. Consequently, state government does not have an office devoted to addressing health disparities that impact the state minority population.
One effort to correct this omission occurred during the 2020 legislative session when Senators Jeffries, Baldwin, Lindsay, and Facemire introduced a bill to establish a Minority Health Advisory Team to advise the Commissioner of the Bureau for Public Health on providing adequate public health services for the state’s minority population. The bill included the establishment of a Community Health Equity Initiative Demonstration Project to develop a model government program to promote public health and general welfare through comprehensive community development for communities across West Virginia. Unfortunately, the bill was never taken up by the Senate Committee on Health.
In response to the impact the Covid-19 pandemic has had on the state’s Black population, Gov. Justice established the COVID-19 Advisory Commission on African American Disparities to investigate the effect of COVID-19 on Black communities across the state. After meeting regularly during the months of May and June, the commission hasn’t met since July 16.
Because these efforts have been inadequate to address the serious health disparities impacting the state’s Black citizens, the time is right for West Virginia to be more proactive in its efforts to achieve racial justice by establishing proactive reinforcement of policies, practices, attitudes, and actions that produce equitable power, access, opportunity, treatment, and outcomes for all people regardless of race.
To that end, the legislature should first ensure that data documenting differences in health outcomes among racial and ethnic groups in the state is collected, analyzed, and made publicly available to drive equitable policy and practice development. Data is critical to our understanding of how racial disparities in societal, economic, environmental, and behavioral factors intersect to affect access to resources that promote good health, access to healthy and affordable food and housing, equitable transportation options and a first-rate public education.
In addition to identifying racial inequities, it is vitally important that the state develop a plan for how it will eliminate the root causes of the inequities that cause disparities in health outcomes for its citizens. Such a plan must include programs and services to address the negative impact that racial inequities have had on specific populations as well as programs that empower communities to tackle these systemic barriers.
Finally, the state must take steps to build a more diverse and inclusive government workforce by requiring a review all state policies and procedures to eradicate implicit and explicit racial bias and promote the advancement of racial equity, including requiring all state employees to complete implicit bias training.
It is critical that West Virginia follow Wheeling’s lead by taking the important first step of acknowledging that the state has a responsibility to put an end to systemic and institutional racism. But acknowledgement alone will not eradicate the effects 400 years of racism. What is needed to achieve racial health equity is an aggressive long-term effort by governments at all levels - federal, state, and local - to implement policies and provide necessary funding to improve the health and wellbeing of racial and ethnic minorities.
Brian is the former counsel to the West Virginia House of Delegates Judiciary Committee and counsel to the West Virginia Senate Minority Caucus. He was also general counsel to the West Virginia State Health Officer and Commissioner for the Bureau for Public Health. He has almost two-decades of experience as a strategic advisor and chief legal counsel to both executive and legislative branch public officials.