PROVIDENCE, R.I. [Brown University] — Before coming to the Brown University School of Public Health to join a panel discussion addressing the impact of racial bias on public health Feb. 25, Ana Novais, executive director of community, family health and equity for the Rhode Island Department of Health, had spent the afternoon working on a strategy to address the state’s serious racial disparity in infant mortality.
Statewide the infant mortality rate is 4.4 per 1,000. Among whites it’s 4 per 1,000. Among blacks it's 11.1 per 1,000. Even when officials statistically control to exclude factors such as differences in income, education and access to care and insurance, a disparity remains.
“That’s associated with the things we’ve been talking about today, with the level of racism [and] with the level of discrimination that black women have suffered in this society,” Novais said. “It will take us over 60 years if we continue to do what we’ve done so far to bridge that gap.”
The influence of racial bias on public health is particularly strong, panelists said, because systemic racial bias has such a pervasive influence on many aspects of life and so many aspects of life – like income, education, access to healthy food and living environments – affect health. Social disparities become health disparities.
“When we talk about these things we talk about them as if they happened by accident, but there is an architecture to our society,” said panelist Joshua Segui, interim director for the Brown Center for Students of Color. “Where people live, where resources are allocated, where environmental hazards are placed, what building materials are used, all of this – there is intentionality behind it.”
“When people say Black Lives Matter, it’s not really specific to policing,” he said.
In analyzing health outcomes, the life experience and socioeconomic disadvantages –-or privilege—that can come with race can be much more meaningful than race itself, said panelist Akilah Dulin-Keita, assistant professor of behavior and social sciences. She has studied the health effects of racism between children ages 7 to 12 in the South and found that it not only impacts self-esteem, but also that racism among children was a better predictor of high blood pressure than any marker of race.
“It means we really need to be cautious and consider what race is a marker of,” she said. “It’s a marker of lifetime accumulation of disadvantages. I’m cautious about the use of race in research.”
All six panelists came from minority or mixed-race backgrounds, and many shared personal exposures to hurtful racial bias. Mae-Richelle Verano, a junior studying public health and ethnic studies, for example, told the audience how she felt that some dorm mates during freshman year had stereotyped her as an “accommodating” Asian woman who “will sit in the corner and do what you say.” She made some food once as a friendly gesture, she said, and the dorm mates assumed that she’d continue to serve them upon request.
But the panelists didn’t absolve themselves of responsibility to watch out for their own potential biases.
“Even though we can probably speak from the perspective of being a target of racial bias, we are not exempt from being perpetrators of racial bias,” said Don Operario, associate professor of behavior and social sciences.
Several panelists said recognizing bias, both in oneself and in one’s academic field, is part of the solution to reducing its impact. They also called for public health research to more readily translate to direct public advocacy and to policy. Novais noted that because health has so many non-medical social determinants, the department has sought collaborators in the community that go beyond traditional health sectors, such as in transportation and housing.
Dulin-Keita called for researchers to not merely analyze the statistics on the communities they study, but to expose themselves to life in them.
She also said she has been studying not just what negatively affects people, but also how some people manage to be resilient even amid racial bias and its effects.
“If we can just bottle this up and turn these into public health interventions, then we can adjust a lot of things,” she said.
Omar Galárraga, assistant professor of health services, policy and practice, said that doing good public health research can also help combat racial harms because it can benefit everyone.
“It’s about access, it’s about opportunity, not just race,” he said. “When we do public health, I think we do the right work. If we do it right, we raise everybody, we provide better health for everybody. When we do that we all gain.”
Public Health graduate students Rachel Denlinger and Anisha Gill and postdoc Jennifer Nazareno moderated the panel.