Improving Population Health Will Require Confronting Racism

Delivery System Reform Population Health Social Determinants of Health

In 1969 when Jack Geiger and John Hatch, with support from the Milbank Memorial Fund, were running one of the earliest community health centers in the country in Mound Bayou, Mississippi, 43 of every 1,000 black infants in the state died before their first birthday—1.9 times more frequently than white infants.

By 2017, the black infant mortality rate in the state had fallen to 12 per 1,000, but black infants were still 70 percent more likely than white infants to die in their first year.

Nationally, the gap worsened in those five decades. Black infants are now more than twice as likely as white infants to die in their first year.

Such well-documented and morally unacceptable racial disparities are rife in health care. Their persistence can only be attributed to racism in our society—deeply rooted attitudes that cause people to be treated differently because of their skin color. These biases manifest themselves in acts of violence and neglect, small and large, in all sectors of society. The deaths in the hands of civil authorities that have wracked the country, like George Floyd’s and Eric Garner’s, are only the most egregious.

The acts of violence accumulate to differences in health outcomes like disparate infant mortality rates. In the COVID-19 pandemic, black people have died at greater rates than white people. The infection is not prejudiced, merely opportunistic. Less able to socially isolate, discriminated against in the health care system, and sicker from an accretion of stresses (or “weathering”), black populations are epidemiologically more vulnerable. Whether a life is cut short in infancy or old age, each of these deaths is as tragic and unfair as the knee on George Floyd’s neck.

Addressing racism involves looking at not just racist systems and institutions but our own conscious and unconscious racism. Those of us who have benefited from our racist society, with increased opportunities and decreased fear and suspicion, bear a particular responsibility to examine our own attitudes, relationships, and actions.

Addressing racism also requires collective action. Attending the largest rally in decades in Rhode Island, organized by youths in the wake of the deaths of Floyd, Breonna Taylor, and Ahmaud Arbery, I was struck by the diversity in age and ethnicity of attendees.  I was moved by the opportunity we now have to channel passion and energy into change; to overcome the inertia of privilege and power that is racist, if not in intent than in effect; to expand Medicaid eligibility; to register and vote to change who determines policy; to institute meaningful criminal justice and policing reforms; and to build trusting relationships between communities and safety officers.

The Milbank Memorial Fund exists to work with leaders to improve the health of populations. Being committed to improving population health requires a commitment to building a more just society. A more just society requires, among other things, eliminating racism and its effects.  It will not happen without paying attention to what we, as individuals, as organizations and as institutions, do and how we do it. It requires relentless examination of ourselves, and our current and past interactions with others, our communities, and our society. It requires paying attention to privilege and sharing power. It requires protest as well as a spirit of honesty, humility, peace, and love. We at Milbank are committed to this systemic and individual work.