Doctors sound off: ‘Racism is a public health issue’

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Oregon health officials, medical associations decry health impacts of systemic racism

PORTLAND, Ore. (KOIN) — Many health organizations in Oregon are coming out in solidarity with the messages of recent protests happening in Portland and across the nation over the death of George Floyd and systemic racism, calling out racism itself as a public health crisis.

The stance that many health professionals have taken manifested in dramatic fashion Friday, June 5, when a “White Coats for Black Lives Matter” demonstration was held in Pioneer Courthouse Square.

Among organizations voicing their concern of racism as a public health crisis are the Oregon Health and Sciences University-Portland State University School of Public Health, Oregon Public Health Association and Oregon Academy of Family Physicians.

A sign held by a medical worker reads ‘stop killing our patients’ at a demonstration in support of Black Lives Matter. June 05, 2020 (photo courtesy Kristyna Wentz-Graff/OHSU)

“It has been a crisis for centuries, but now the wounds have been opened in the public consciousness,” read a statement sent to KOIN 6 News from OHSU-PSU School of Public Health. “The murders of George Floyd, Ahmaud Arbery and Breonna Taylor are the most recent, high-profile illustrations of the countless, tragic human rights and social justice violations against Black Americans over the course of history.”

The school called for health experts across the country to recognize and respond “to the devastating impacts that structural and systemic racism, discrimination, injustice, and state-sanctioned violence have on the safety, security, and health of communities of color, the Black community and other marginalized populations.”

The Oregon Academy of Family Physicians’ President Dr. David Abdun-Nur issued a statement condemning “systems that lead to the unwarranted deaths and marginalization of Black, Indigenous, and People of Color,” which they said manifests in their patients in the form of “chronic trauma, and an increased risk of heart disease, stroke, and diabetes, low birth weight, premature birth, infant mortality.”

The organization in part called “for an end to discriminatory policing, and an end to the use of excessive force which pose particular health and safety hazard to individuals and populations residing in targeted communities, for people of color and other socially marginalized groups.”

Discriminatory policing has certainly been a focal point of the protests, which spurred across the nation nearly two weeks ago after Floyd, a black man, was killed by a Minneapolis police officer who kneeled on his neck for several minutes while handcuffed on the ground (all of which was captured in shocking cell phone footage).

Another recent instance of police violence that protesters point to as evidence of discriminatory killings by police include the death of Breonna Taylor, a black emergency medical worker who was fatally shot by police in Louisville, Kentucky, after a “no-knock” warrant found no drugs in her home in March, in connection with a suspect who did not live there.

The February killing of Ahmaud Arbery, a black man in Georgia, was caught on cell phone video. The suspects, retired police investigator Gregory McMichael and his 34-year-old son Travis McMichael, were charged with murder and aggravated assault in May. McMichael allegedly told police he and his son chased Arbery down in a pickup truck because they suspected him of being a burglar.

A doctor holds a sign in support of Black Lives Matter at Pioneer Courthouse Square June 05, 2020 (photo courtesy Kristyna Wentz-Graff/OHSU).

“Racism is a public health issue. Racism is connected to everything. Because of racism, we have really deep entrenched disparities,” Charlene McGee, Multnomah County Health’s Racial and Ethnic Approaches to Community Health (REACH) Program Manager, told KOIN 6 News.

McGee said the timing of the protests, that they are coinciding with a global pandemic, is “profound.”

“The truth is the issues that folks who are protesting and are exercising their constitutional rights, these are issues that leaders from the black communities and communities of color have talked about for more than decades,” she said.

McGee emphasizing the importance of recognizing violence as a public health issue as well.

“It’s an issue because we know that violence affects both the physical health and mental health,” she said. “We know the toll and the impact of black children and people watching someone literally take their last breath. We know the impacts that it can have on an individual and a community mental health.”

According to a State Health Assessment: Health Equity Analysis from 2018, African Americans, American Indians and Alaska Natives in Oregon had the highest Years of Potential Life Lost (YPLL) rates of deaths from unintentional injuries, homicides, and diabetes. Those groups had higher YPLL overall than did whites. In addition, African Americans had the highest YPLL rate from heart disease.

Health disparities such as these may arise due to differences in the quality of care received within the healthcare system, differences in access to health care like preventive and curative services and differences in life opportunities, exposures, and stresses that result in differences in underlying health status, according to former American Public Health Association President Dr. Camara Jones.

McGee said on a personal level, as a black woman raising a black son, she’s had to have many conversations with her child about being extra cautious when going out in public alone, such as going to the store to get ice cream with friends, in case he is caught up in an instance of violent racism. It’s the kind of thing she said her white friends with children tell her they don’t often think about.

According to a November 2019 Racial and Ethnic Disparities in Multnomah County report, “people of color continue to be systematically harmed by justice involvement at rates that are disproportionate to their white counterparts.”

The W. Haywood Burns Institute analysis found that black adults in Multnomah County were seven times more likely than white adults to be in jail pretrial during a 2014 snapshot and they were 8.3 times more likely in 2019.

“Black people in our community are living really in constant fear of violence, predominantly from the police, but even from their community every single day,” Oregon Public Health Association Executive Director Jessica Nischik-Long, MPH, told KOIN 6 News.

“Living with this fear and stress, non-stop…think about how your body feels when you feel scared. Your blood pressure goes up and you feel anxious, you might feel shaky, feel ill,” Nischik-Long said. “And now you’ve got this inflammatory response going on long term. And that in turn leads to the development of chronic health problems.”

According to an article from the National Institutes of Health about toxic stress, a child experiencing adversity is at risk of “permanent changes to brain architecture, epigenetic alteration, and modified gene function.” The result may be increased risk for stress-related diseases and experiencing more physical illness.

Some restructuring of city resources have begun to occur as a result of the protests, such as Mayor Ted Wheeler’s announcement last week of the discontinuation of police officers in Portland schools and a proposed plan announced this week to redirect funds to in part put toward the black community and dissolve the Gun Violence Reduction Team and transit officers. Those are changes to the city’s police department long championed by Portland City Commissioner Jo Ann Hardesty, the city’s first African American female commissioner.

Protesters march east on Interstate-84. June 8, 2020 (KOIN)

Nischik-Long said the changes in the city’s funding priority represents “a really great start.”

“My organization, we know about public health, and we really believe that those resources need to be invested in ‘upstream’ and preventive community support that’s going to support or address our mental health, behavioral health […] hunger, domestic violence, education.”

Nischik-Long explained that community reinvestment can be thought of as a way to address the social determinants of health before it ever reaches a primary prevention, safety net program, or medical care intervention.

“When you make investments in a community, like education for example, long term, that community’s ability to being economically viable and to be healthy and less hunger, less mental health traumas, the need for policing goes down,” Nischik-Long said. “So preventing houselessness, hunger and mental health crises in the first place can mean fewer encounters with police altogether.”

The physical reality of the protests pose another public health concern from some: The risk of the spread of novel coronavirus as thousands have taken to the streets in close proximity in Portland each night for almost two weeks straight despite Centers for Disease Control recommendations to socially distance. However many of the protesters can be seen wearing masks.

The former director of the Centers for Disease Control, Dr. Tom Frieden, voiced support for the protests in general, saying the risk of coronavirus transmission from protesting outside is less than the risks posed by the government’s recent actions.

Frieden later remarked in a Tweet that even though crowds outdoors are “less risky” than indoors, and even if the vast majority of people are wearing masks, “crowding and large numbers increase the risk of spread.”

Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Disease also recently spoke on a Washington D.C. based radio program that he was “very concerned” about the congregation of large crowds where active infections are taking place due to protests, though they may have a constitutional right and a good reason to do so.

Nischik-Long said the message to not belittle the profundity of the protests is important, but agreed on a public health front that it’s important for as many people wear masks as possible.

“If not everyone is wearing them, then absolutely the benefit is much less,” she said.

In addition, Nischik-Long said she supported the moratorium on the use of tear gas by Portland police at protests, as a lot of public health professionals, including Fauci, have been worried about the tear gas causing people to cough a lot and propagate the spread even more.

As to whether racial health disparities can be reversed, Charlene McGee, of Multnomah County Health’s REACH program, said there’s been instances in the U.S. where disparities have changed after a proper community investment took place.

“We’ve seen that when policy systems and environmental changes are implemented, we’ve seen asthma rates reversed. We’ve seen that when schools receive the adequate support they need, we see the achievement gap close,” McGee said.

“Addressing racism is naming it. Doing the work that it’s going to take to change is the only way we’ll see these health disparities start to move,” added Nischik-Long.

The stance that many health professionals have taken in support of Black Lives Matter protests manifested in dramatic fashion Friday, June 05, when a ‘White Coats for Black Lives Matter’ demonstration was held in Pioneer Courthouse Square (photo courtesy Kristyna Wentz-Graff/OHSU).

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