Sept 2021: Local public health agencies


Structural racism has an impact on health. Structural racism is a system in which public policies, institutional practices, cultural representations, and other norms help perpetuate the inequity of racial groups. It is rooted in a hierarchy that favors one race over another, influencing the institutions that govern daily life, from housing policies to police profiling and incarceration. It is closely linked to the social determinants of health (SDoH) and health disparities.

Health disparities are particularly evident in the area of ​​maternal and child health. Black, Native American, and Alaska Native (AI / AN) women are 2-3 times more likely to die from pregnancy-related causes than white women. The infant mortality rate of black infants is twice that of whites. Minorities also face higher rates of morbidity and mortality from chronic diseases, including cardiovascular problems, diabetes, cancer and some infectious diseases. COVID-19 incidence and death rates are the latest examples of racial disparities.

Public health professionals from local, state, and federal public health agencies and academic institutions are in a unique position to address the challenges of structural racism because it contributes to poor health. In the main article of this issue, Olivas and co-authors Emphasize that local public health services (LHDs) can and should address health disparities through community partnerships and multisectoral collaboration. Racial disparities in health are associated with socioeconomic status, health-related behaviors, and access to health care. Racial segregation is also a cause of these health disparities. This study examined the extent of racial segregation in relation to the activities of LHDs to address health disparities. LHDs with higher segregation measures were found to engage in more activities to address disparities. These LDHs were aware of the impact of SDoH on their communities. The increased responsiveness of LHDs to this challenge, by providing public health services and focusing on SDoH, can make a measurable difference.

Other articles in this issue delve deeper into this theme. Shiman and co-authors from the New York City Department of Health and Mental Hygiene describe the Tremont neighborhood in the Bronx. In 1937, this neighborhood was designated as “dangerous” by the Home Owners Loan Corporation through a process known as redlining. This has led to a divestment in this community and similar communities across the country. The housing stock has deteriorated. Schools received insufficient funding and small businesses struggled without loans. The local economy and the parks have deteriorated. Currently, the neighborhood is experiencing poor health outcomes today, with higher rates of diabetes and obesity and lower life expectancy than the predominantly white Upper East Side neighborhood. of Manhattan.

Bronx Health Department staff developed an exhibit Undo red line design. Visitors included youth groups, community organizations and municipal agency teams including the health department, planners, religious leaders, health service providers, educators and residents of the Bronx. The goal was not only education, but also the design and ownership of new systems to “negate the design” of the consequences of redlining. The Undo red line design The exhibition offers a concrete example of the fight against structural racism. The exhibit has now moved to other neighborhood locations, and the health data profiles for each community district show the impact of structural racism and public health.

Kovach writes, in an article on public health accreditation, that all communities deserve high quality public health services. In particular, LHDs serving disadvantaged communities should be accredited so as not to exacerbate health inequalities. This applies to jurisdictions serving more diverse populations because of the large health inequalities between racial groups. PHAB accreditation has the potential to reduce health inequalities in jurisdictions where health outcomes are worse.

In early 2022, the Journal of Public Health Management and Practice will publish an additional issue: Public health interventions to address health disparities associated with structural racism. This issue is sponsored by the WK Kellogg Foundation. Mary T. Bassett, MD, MPH, director of the FXB Center for Health and Human Rights and FXB Professor of Health Practice and Human Rights at Harvard School of Public Health, agreed to ‘be the guest editor of this important issue. Articles from nationwide research will describe how local, state, or federal public health agencies or academic institutions engage with communities of color to address racism-related health disparities. structural.

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Author profile

Lloyd F. Novick

Lloyd F. Novick, MD, MPH, is Professor Emeritus in the Department of Public Health, Brody School of Medicine, East Carolina University. Previously, he was chairman of this department. He was the Vermont Health Commissioner and Secretary of Human Services, Arizona Director of Health Services, and Director of the New York State Bureau of Public Health. Previous academic positions include Professor and Director of the Preventive Medicine Program at SUNY Upstate Medical University, Professor and Chair of Epidemiology at the School of Public Health at the University of Albany, and Clinical Professor and Program Director of teaching in epidemiology and public health at the University of Vermont, College of Medicine. He is the founding editor and editor of the Journal of Public Health Management and Practice. He is also editor of five books, including Public Health Administration: Principles for Population-Based Management; Public health issues in disaster preparedness; community-based prevention programs that work; Public health leaders tell their stories; and health problems in prisons. He is former president of the Association of Teachers of Prevention and Research (APTR) and of the Association of State and Territory Health Workers (ASTHO). He has received a number of national awards, including a Special Recognition Award, American College of Preventive Medicine (2005); Duncan Clark Prize, Association of Teachers of Preventive Medicine (2003); Yale University Distinguished Service Award (2003); Excellence in Health Administration, American Public Health Association (2001); and the Arthur T. McCormack Award, Association of State and Territorial Health Officials (1992). He is a graduate of Colgate University (BA), New York University (MD) and Yale University (MPH).