Want to Improve Public Health? Address Systemic Racism

Any meaningful conversation about public health disparities in the United States has to acknowledge the destructive impact of systemic racism. For generations, the public policies and institutional structures that have advantaged White Americans have also contributed to inequities in education, housing, and economic advancement for communities of color—inequities that have led these communities to experience worse health outcomes than their White neighbors.

In early December, EDC’s Center for Strategic Prevention Support (CSPS) and the Massachusetts Department of Public Health’s Bureau of Substance Addiction Services (BSAS) attempted to tackle this issue head on with a three-day statewide conference on systemic racism and community health. The BSAS virtual conference hosted 290 public health and prevention specialists. The event was organized by EDC’s Ben Spooner, associate project director, and Gisela Rots, project director, for CSPS in collaboration with BSAS.

In this roundtable, Spooner spoke with two prevention practitioners who attended the conference: Chelsea Orefice, a substance misuse prevention professional in Springfield, and Jennifer Kimball, the principal planner for public health at Berkshire Regional Planning Commission. The three discussed the intersection of systemic racism and public health, as well as what they took away from the conference.

Spooner: You’re both coordinators in western Massachusetts, but the communities and regions you serve are very different. How have you seen systemic racism affect public health outcomes and substance misuse issues where you live and work?

Kimball: I don’t think there’s one way that systemic racism—or what I call White supremacy culture—hasn’t affected substance misuse outcomes. I live in the city of Pittsfield, which is Berkshire County’s largest city, around 42,000 people. I do a lot of work around hepatitis C and HIV prevention in my community. And when I look at specific data, the outcomes associated with injection drug related diseases are by far poorer in the neighborhoods that have the highest concentration of persons of color than the rest of Pittsfield. And when you pull all the data apart, there is no other way to explain what is happening besides systemic racism.

Orefice: And so we ask, why do we still have these issues? In Springfield, where I work, a lot of the kids who we consider high risk—those who are already using drugs and involved in risky activities—have similar backgrounds. They have single mothers and their fathers are in jail. It’s a recurring cycle. And there’s not a lot of room to help pull some of these children out of that cycle. So to me, the question is, how do we create programs to help youth like this, who are stuck in that cycle of oppression, and help them break free?

Spooner: BSAS and EDC just held a statewide conference specifically about addressing racism in substance misuse, prevention, and public health. What did it mean to you to be able to have conversations about systemic racism with other prevention practitioners and coordinators from across the state?

Orefice: I am glad that BSAS is addressing racial equity and injustice. I’ve had these conversations with my counterparts during regional coordinator meetings. But I’m the only individual of color in those meetings. So I already know these things need to happen. I already know that we need to address this in our work. However, I also need concrete examples of how to make it work. I need to know what programs have worked in communities very similar to mine.

Kimball: I thought it was important that racial equity was not the side note to the conference. It was the conference. It was great just to hold the space and have an opportunity to start practicing the work, because I think a lot of us are like Chelsea—we want examples of people who have reorganized around this power dynamic, and we want to know how it’s working.

Spooner: What have you already done to incorporate racial equity and racial justice into your prevention work?

Kimball: For me, as a coordinator, I have to find some ways to put my words and beliefs into action. One way is to invite—and pay—more people who are directly affected by inequitable health policies—more people of color, more active drug users—to come and do this important community work. We’re trying to find ways to bring these people into grants from the start, so that they can drive the policies.

Orefice: We’ve done a lot of racial justice work in our coalition meetings. For example, we’ve incorporated videos from the truth initiative® to help individuals understand how tobacco companies have always targeted Black populations. We’ve also asked youth to think about questions like, how many package stores are in your neighborhood in comparison to healthy food markets? And it’s really bringing up the conversation, especially given the events from last summer.

Spooner: I’m glad that you brought up tobacco, because in Massachusetts, you still see racial and socioeconomic disparities in smoking rates, even though the overall rate of smoking has fallen considerably. But thinking beyond tobacco, what state or local policy changes would you like to see in order to address racial disparities in health?

Orefice: We’ve been working with the Hampden County District Attorney’s office to start the process of expunging cases for petty crimes and charges. Because if you have a minor delinquency when you are young, it really does impact your opportunities moving forward. We’re pushing for youth to get the help they need rather than just having them shipped off to juvenile detention.

Kimball: Rates of incarceration are of interest to us too. Berkshire County is trying to integrate community justice practices, which aim to prevent people from ending up in jail after having multiple interactions with law enforcement. There are clear patterns of systemic racism in incarceration practices, and this has to be addressed at the policy level.

Spooner: What gives you hope that we are actually going to be able to move forward and make some progress on the systemic issues that we have been discussing?

Kimball: The fact that BSAS, a statewide department, chose racial equity as the central theme to a three-day annual conference gives me hope. I feel OK talking about these issues within my community, and these conversations are not as hard as they were even last year. We have so much work to do, but we have a lot more people willing to do the work.

Orefice: Before last year, people didn’t really seem to care about issues of systemic racism. They would acknowledge that it was bad, but they wouldn’t challenge it. Now, people are saying, this is bad, and we have to do something about it. People are also educating themselves more. That means more to me than anything, because it takes a lot for somebody to realize their part in upholding White supremacy and systemic racism—especially people who didn’t know or care about it much before—and say, how can I be part of the solution? Seeing people take that step forward gives me hope.