One year later, George Floyd’s murder requires reflection from public health. The epidemic of police violence and the criminalization of Black lives have existed for generations. The murder of George Floyd on May 25, 2020 was not new information. It was the same suffering and struggle of one fifth of the population of the United States set against the backdrop of American life: the militarization of that life and of our police, the privatization of our prisons, the debasement of our journalism and our media, the corporatization of our professions, and the commercialization of our culture.
Americans made our biases about race known in the US Constitution, where slaves were counted as three fifths of a person. Racial disparities in health have never been a secret to any public health practitioner or any American. But our biases are so ingrained that too many Americans did not and do not see what is right in front of us. However, departments of health have critical tools we can use to help end racial disparities in health so that we, as a nation, provide optimal health to all Americans.
Boards of all health care organizations and institutions regulated by departments of health should be at least 51% people of color, at least until health disparities are eliminated in each community. The current self-selected boards have failed to achieve equal treatment and equal outcomes. Now is the time to try another approach. Targets and timelines can be used to hold institutions accountable for achieving these goals, with fines and de-licensure the consequences for failure.
Departments of health should also measure, track, and report disparities in access to care and disparities in treatment. Fines and de-licensure should be the consequences for allowing disparities in access and disparities in treatment.
Health professions and health care organizations should have equal employment by race and culture. Public money, via Medicare, Medicaid, the Health Resources and Services Administration, the National Institutes of Health, and the Centers for Disease Control and Prevention, provides most of the revenue for nonprofit health care organizations in the United States. These health care organizations should be held accountable for equal employment, equal treatment, and equal outcomes.
It is long past time to replace spending on unnecessary and for-profit medical care with spending on education, housing, the environment, and community development. Departments of health can use measured health outcomes to confront policymakers with the health impacts of this irrational spending—and help provide optimal health to all Americans in the process.
We cannot bring back George Floyd or the thousands of people who were murdered or lynched by our police or our fellow citizens. We cannot reverse the impact of personal and institutional racism on the health of so many of our fellow citizens. We cannot bring back the hundreds of thousands who died unnecessarily from COVID-19.
But we can change and make the future better than the past.
9 Years Ago
Social Justice in Pandemic Preparedness
Social justice requires the use of fair procedures, but fair procedures do not suffice to promote social justice, despite hopes that they will. Unless supplemented by a substantive understanding of justice and injustice, procedural notions of justice tend to rely on neutral decision-making. In other words, fairness is associated with lack of bias: decision-making strives to be blind to race, ethnicity, class, gender, and other social categories. . . . Ironically, when applied in a systematically unequal social context – one rife with health disparities – this approach disproportionately affects the already disadvantaged, perpetuating and exacerbating existing disparities. . . . Those who will suffer disparate effects of pandemics or other public health disasters should receive preference in the distribution or rationing of resources, so that they may be protected from further harm.
From AJPH, April 2012, pp. 587–590, passim
12 Years Ago
Pandemic Influenza and Screening in Jail Facilities and Populations
The data on morbidity in jails indicate that jail inmate populations contain many individuals with a compromised immune system. This factor may facilitate the spread of infection. Although jails are able to provide limited medical care, their capacity for screening for medical and mental health problems appears to be greater than their capacity to provide care. Planning for a pandemic outbreak should consider the health screening role for jails. One approach would be to develop new instruments for screening and to use public health resources to assist in training and implementing screening procedures. But implementing strategies to prevent the possible spread of infection may be difficult to put into practice unless a jail facility is able to screen and group its inmates according to infection status.
From AJPH, Supplement 2, October 2009, pp. S339-S344
Biography
