Hundreds of communities declared racism a public health crisis. What's happened since?

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Last year, dozens of communities rushed to declare racism a public health crisis amid the COVID-19 pandemic and nationwide protests against police brutality, both of which disproportionately affect people of color.

More than 200 cities, counties, local governments, public health and educational entities made such declarations since 2020, according to the American Public Health Association – up from just seven in 2019. (At least one city, Holyoke, Massachusetts, has rescinded its declaration.)

And the trend has continued as leaders in Chicago, Salt Lake City and the U.S. Centers for Disease Control and Prevention made similar declarations.

Public health experts and local leaders heralded these declarations as important first steps in addressing the role racism plays in public health but warned that they required action. Although many of the declarations look similar, what steps communities took to address the systemic inequalities vary widely.

From 2020: Racism is a declared public health issue in 145 cities and counties across 27 states

In Wisconsin, for example, Gov. Tony Evers called racism a public health crisis during a news conference last June, but he did not issue a formal declaration like Michigan Gov. Gretchen Whitmer or Nevada Gov. Steve Sisolak did.

Though Sisolak’s declaration did not include specific proposals, Whitmer’s executive order required implicit-bias training for all state employees and created an advisory council to examine problems affecting Black residents.

Most of the resolutions are statements of intent that aren’t legally binding, but many include proposed strategies, said Dawn Hunter, a public health lawyer who has analyzed the declarations.

Hunter said the most common commitments fall into six categories: policy and practice; accountability; funding and infrastructure; partnerships and collaborations; specific issues; or a call to action to other leaders.

Some communities have made progress on those commitments, but many are still early in the process of determining how to take action, said Hunter, deputy director of the Network for Public Health Law's Southeastern Region Office.

"For the most part, there is not yet a lot of really concrete follow-up," she said.

Some task forces, councils and commissions 'only scratched the surface'

Centuries of racist policies and practices created barriers to housing, education, wealth and employment – called the social determinants of health – that continue to drive disparities in health outcomes for minorities, according to the CDC.

Racial and ethnic minority groups have significantly lower life expectancies and experience higher rates of illness and death from conditions such as diabetes, hypertension, obesity, asthma and heart disease. The coronavirus pandemic highlighted and exacerbated those disparities as people of color experienced higher rates of infection, hospitalization and death and lower vaccination rates.

"Public health crises affect a large number of people, impact health over the long term and require the adoption of large-scale solutions," said Regina Davis Moss, associate executive director at the American Public Health Association. "When you frame it like that, its clear why (racism) is a public health emergency."

More: CDC declares racism a 'serious public health threat' as COVID-19 puts a spotlight on disparities

What is systemic racism? Here's what it means and how you can help dismantle it

Many resolutions created councils or tasks forces to oversee racial equity work or required officials to produce annual reports as a means of holding the government entity accountable, Hunter said.

She pointed to Ohio's Cuyahoga County, where leaders established a Citizens Advisory Council on Equity in July 2020 and a County Equity Commission in September. The council issued a report that with dozens of recommendations, including establishing an equity fund and implementing countywide racial equity training.

In response, the county executive created a department of equity and inclusion, issued executive orders to address racial inequities in county contracting and is implementing diversity training for all county employees, said Cuyahoga County Clerk of Courts Nailah Byrd.

San Bernardino County in California created an “equity element group” composed of prominent Black community members who were tasked with identifying racial disparities and solutions in areas such as education, transportation and public safety.

The group began meeting and training in August 2020, and it’s “too soon to say” which policies the group will prioritize, said Diana Alexander, an assistant executive officer for the county who is coordinating the group. The county is now also looking to hire an equity consultant.

“We just celebrated a year. In some people’s mind that may seem like a long time, but it really wasn’t,” Alexander said. “I’m very proud of the work we’ve done so far, but we’ve only scratched the surface.”

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Funding, infrastructure commitments stand out

Most declarations don't specifically address funding, so when they do it stands out, Hunter said.

She pointed to Fayetteville, Arkansas, which committed a grant to fund “small business development, affordable housing and community-based infrastructure serving lower income and minority citizens." Minneapolis, where George Floyd was murdered by a police officer in May 2020, also pledged to allocate money from the city's budget toward the same issues and create a long-term sustainable source of funding for youth development programming.

In Boston, then-Mayor Marty Walsh’s declaration outlined eight strategies to address the effect of racism on the city’s residents and redirected $3 million from the police overtime budget, less than 1% of the department’s annual $414 million budget, to fund the effort.

Some of the money went to projects that focused on data collection, translation and workforce development for people who were incarcerated or struggling with substance abuse, said Triniese Polk, director of the Office of Racial Equity and Community Engagement at the Boston Public Health Commission.

The commission also will create a racial equity tool, update staff training, review the amount budgeted to reduce racial inequities and develop strategies to increase the number of people of color in the commission's leadership, steps outlined in its first anti-racism action plan released last week.

"It was exciting to have the declaration, but for BPHC we’ve been doing this for quite some time," Polk said. "I wouldn’t particularly say the declaration sparked anything new."

Tanisha Sullivan, president of Boston’s NAACP chapter, was initially “very optimistic” about the declaration but said not enough has been done.

“I do not believe that there has been the type of focus placed on operationalizing this declaration that could actually lead to it having the type of impact that it would otherwise have,” she said.

Declarations provide a framework for policies and practices

Nearly all of the 21 resolutions in the Southeast that Hunter reviewed included a commitment to changing culture within organizations by identifying and adopting anti-racist policies and practices.

Less than a year after leaders in Buncombe County, North Carolina, declared racism a public health and safety crisis, the county passed an ordinance banning discrimination based on race, natural hair or hairstyles, ethnicity and multiple other characteristics.

In June, elected officials passed a racial equity plan to reduce disparities in 18 areas. Among them: reducing Black infant mortality rates and minority arrest rates and increasing representation on county boards and commissions.

Racism a public health crisis: Buncombe County officials grapple with equity amid pandemic

The Indianapolis City-County Council approved a resolution declaring racism a public health crisis last June, but community and faith groups said the council's resolution had “no true depth” and failed to direct resources to the city’s African American community.

Vop Osili, president of the council, said the declaration provided a framework for it to decide where to direct PPE and federal relief funds during the pandemic as well as crime prevention grants. Municipal departments are now also required to answer questions about their budgets, including how compensation compares between white and minority employees.

"The one place we knew would have the most impact was within our budget," Osili said. "The declaration was the start of it."

Earlier declarations may provide road map

Hunter emphasized that many communities have been working to achieve racial health equity and made declarations well before Floyd's death.

She noted that Pittsburgh created an Office of Equity in early 2019 and declared racism a public health issue later that year. Its city departments use a toolkit to collect data to help departments understand how to use their budgets to address racial equity.

She also pointed to Cook County, Illinois, which declared racism a public health crisis in 2019. The county included an equity fund in its budget in November 2020 and created a task force of community partners to advise on how to invest it.

Wisconsin’s Milwaukee County became one of the first to declare racism a public health crisis in May 2019, citing disparities in employment, low birth weight and incarceration. More than 3,500 county employees have since undergone racial equity training, and the county also created a “racial budgeting tool” that requires departments to analyze how their budgets affect communities of color, according to Jeff Roman, head of the county’s Office on African American Affairs.

The county is trying to be "more intentional of how we’re evaluating the impact of the training as part of our strategic plan,” Roman said.

In April 2020, the county passed an ordinance committing to eliminating racial health disparities, outlining areas for improvement including in data collection, funding, and diversity and inclusion. Milwaukee was one of the first places to track and publicly share demographic data related to the COVID-19 pandemic, which was used to help determine where testing and vaccination resources would be directed.

There are still racial and ethnic gaps in the county’s vaccine rollout, but the city and county are building relationships with and investing in communities hit hardest by inequity, said Paula Tran Inzeo, a program director at the University of Wisconsin’s Population Health Institute

"There's always more that can be done," Inzeo said. "We’re not eliminating disparities."

Contributing: The Associated Press

More: Milwaukee put race front and center as it tracks COVID-19's toll, helping shape a national conversation on racism as a public health crisis

This article originally appeared on USA TODAY: How US cities are tackling the public health crisis of racism

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