Doctors, state officials and advocates in Virginia, which was home to the capital of the Confederacy and the birthplace of slavery in the U.S., endorsed legislation Friday that would declare racism a public health crisis.
A quick 13-5 vote along party lines in the House Rules Committee sent HJ537, proposed by Del. Lashrecse Aird, D-Petersburg, to the largely Democratic House floor.
If passed, Virginia would become the sixth state in the country to declare racism as a determinant of health.
“This is the bare minimum,” Aird said in a media briefing Friday. “It took us over 400 years to get here. The circumstances, the structures, the institutions, they took 400 years to build, and they won’t be torn down overnight.”
The legislation calls for expanding the Virginia Department of Health’s Office of Health Equity to analyze policy efforts and offer funding recommendations, making permanent the Commission to Examine Racial Inequity and requiring implicit bias training for elected officials and state employees.
It also pushes to promote community engagement and establish an outline of terms and definitions regarding racism and health equity.
After the police killing of George Floyd and a summer of protests for racial justice, at least 150 cities and counties across the U.S. passed similar resolutions, according to the American Public Health Association.
Both APHA and the American Medical Association, the largest physician organization in the country, have identified racism as a threat to public health and one that affects where people live, go to school and whether they have access to food or healthcare.
Hundreds of research studies have found negative health outcomes rooted in these inequities, including a 2015 report from VCU that showed a 20-year difference in life expectancy between residents in a predominantly white neighborhood and those in Gilpin Court, a majority Black public housing community.
A legacy of racist lending policies from the 1930s detailed in The New York Times soared Richmond’s poverty rates, shortened life spans and fortified food and medical deserts — factors researchers said could be detrimental to health outcomes for decades to come.
And more than 60 years after the Supreme Court’s landmark Brown v. Board of Education decision, Virginia’s school segregation across racial and socioeconomic lines is worsening. More than half in the state’s school systems are students of color.
“When we think about health and health care, I think many of us envision a clinic or a hospital. You think about interacting with a nurse or a doctor,” said Dr. Irène Mathieu, pediatrician and public health researcher at the University of Virginia Children’s Hospital. “What many people don’t realize is that the vast majority of what determines happens outside of those settings, long before we even interact with the health care system.”
Mathieu added that Black women are 3 to 4 times more likely to die during or shortly after childbirth compared to their white counterparts of the same level of education and socioeconomic status. Black children are the least likely to receive pain medication, Mathieu continued, leaving communities with historical mistrust in medical care.
With the pandemic, the disparities have widened — especially in majority Black and Latino cities like Richmond.
Black Richmond residents are being hospitalized with COVID-19 at more than four times the rate of white residents despite accounting for nearly even shares of the population.
The city’s disparity outpaces the nation’s: The Centers for Disease Control and Prevention reported last week that hospitalization rates are three times higher among Black communities.
Nearly half of all of Richmond’s COVID-19 cases were in majority Black and Latino ZIP codes with lower household incomes and lower median rates in September.
The emotional toll of isolation has translated to 1 in 4 young adults seriously considering suicide in the past 30 days, according to a CDC study. Mental health experts have said the lingering effect is deepest for kids already experiencing trauma.
Melissa McGuinn, mental health clinician and state coordinator for Virginia’s Trauma-Informed Community Networks, said children facing racism and discrimination are more likely to report double the average rate of trauma among kids in Virginia. The CDC has linked these events, called adverse childhood experiences, to chronic health problems and substance abuse into adulthood.
While there are opportunities to enact further policies that reduce harm and allocate money to anti-racism work, Dr. Janice Underwood, the state’s chief equity officer, said the first step to addressing a problem is diagnosing it.
“Racism makes all other forms of oppression possible ... so those who want to see inequity continue?” Underwood said. “Get out of our way.”
The legislation is expected to be heard on the House floor next week.