Numerous Ohio cities declare racism a public health crisis, but does it mean anything?

Ideastream Public Media’s health team is connecting the dots on how racism contributes to poor health outcomes in the Cleveland area. 

Politicians in nearly 30 communities across Ohio and in Cuyahoga County are taking a stand against a public health threat that many believe put Black and brown residents at risk for serious health problems: Racism.  

“Our health…is determined in part by the social and economic opportunities and the lack of resources in our communities, in our homes, in our neighborhoods,” said Natoya Walker Minor, Cleveland’s Chief of Public Affairs, while addressing Cleveland City Council’s Health and Human Services Committee on June 1, 2020. “Disparity reigns.”

As of Feb. 2022, at least 27 cities and counties in Ohio - including Cleveland and Cuyahoga County - have declared racism a public health crisis. Ohio boasts the second-highest number of municipalities that have passed declarations, according to the American Public Health Association (APHA).

Of the 60 municipalities in Cuyahoga County, 10 towns and cities, which together include roughly 45% of the county’s population, have declared racism a public health crisis since 2020, according to an analysis by The Land.

Although Ohio has a large number of cities declaring the crisis, that does not mean the state is necessarily a standout in addressing the issue, said Kierra Barnett, who holds a doctorate in public health and works as a research scientist for health disparities at Nationwide Children’s Hospital in Columbus.

“There are folks in this state that are moving toward trying to understand what’s happening among Black and minority populations and trying to fix the health disparities that’s happening, but as a collective... We haven’t got there yet, as a state," she said.

Most resolutions were proposed in the summer of 2020 as a wave of racial justice awareness swept across the globe in the months after the murder of George Floyd, a Black man in Minneapolis. At the same time, Black Americans were also disproportionately getting sick and dying from COVID-19.

Some of the declarations formally acknowledge that racism has overtly and covertly infiltrated systems of society, such as health care, and continues to cause disparate health outcomes in the present day. Many declarations also propose action steps for the communities to take such as creating task forces to focus on racial equity.

Social determinants of health are at the root of health disparities

The declarations also recognize the primary reasons for many racial disparities are what health experts call “social determinants of health,” such as whether someone has a safe place to live, a job and access to transportation, Barnett said. 

Social determinants can account for 80 percent of a person’s health, according to the Robert Wood Johnson Foundation.

While many people have been focusing on social determinants in Ohio, others, including some in positions of power, misattribute the racial disparities to individual behavior, rather than systemic causes, Barnett said.

For example, when some Ohio legislators were considering declaring racism a public health crisis in the state,  State Sen. Steve Huffman (R-Tipp City) during a June 2020 hearing askedmedical experts testifying whether Black Ohioans might be contracting COVID-19 at higher rates because they were not washing their hands, Barnett said.

“Equating the disparity to individual behavior and not the system that has left most of our essential workers Black and minority, which puts them at risk, while some folks … have been able to work from home during this pandemic,” Barnett said. “We’re not thinking about that inequity.”

Huffman later apologized but was fired from his job as an emergency room physician. The resolution has not passed as of Feb. 2022.

Other systemic reasons for the racial differences in COVID-19 outcomes, Barnett added, are that minority populations are more likely to live close together in cities due to historical policies like redlining, where banks prevented non-white residents from buying homes in communities with better housing and investment, Barnett said.

Many are also more likely to rely on public transportation, which puts them at risk of contracting the virus in close quarters, she said.

“We don’t think about any of those things, and immediately when we see disparities in something like COVID, we blame individuals. ‘Well, they must not be social distancing. They must not be washing their hands. They must not be wearing their masks,’” she said. “But we’re not thinking about the systemic things that also [place] these populations at a greater risk.”

Ohio does gather data and create reports on racial disparities in health outcomes such as infant mortality, she added. Black babies are more than twice as likely to die in their first year of life than white babies in the state, according to the Health Policy Institute of Ohio.

In Cleveland, the disparity in infant mortality rates along racial lines is startling. In 2020, the Cuyahoga County infant mortality rate for Black babies was 1.46%. For white babies, meanwhile, the rate was 0.2 percent, a 30-year low.

Barnett said people might also attribute this to individual behavior, such as Black mothers not seeking out proper prenatal care compared to their white counterparts. But, Black mothers with a high socioeconomic status and college degree actually experience higher infant mortality rates than white mothers with high school education, she said.

“That should be the level playing field – that if I have an education, I should have a better income that can provide me better access to all these different resources, and the bottom line we come back to is: there is also this added stress of being Black that can cause different health disparities,” Barnett said.

It is not genetic differences, Barnett added – it is the exposure to racism in everyday life, whether, on a personal or systemic level, that accounts for the health disparities, she said.

What happens next

The majority of Ohio localities that declared racism a public health crisis are in the three biggest metropolitan areas: Cleveland, Columbus and Cincinnati, where more Black people reside than in predominantly white rural or suburban areas.

The APHA map is not completely up to date, as the organization missed several small cities in Cuyahoga County that issued declarations.

“Even before this map, before these declarations, a lot of folks in those cities have been doing the work to address health equity and health disparities,” Barnett said. 

In Cleveland, for example, several nonprofits like the NAACP and YWCA had been working to declare racism a public health crisis for months before the resolution passed in June 2020, officials said.

They differ from other anti-racism declarations passed in the wake of George Floyd’s murder, like those of Bay Village City Council and North Olmsted City Council, which generally denounce discrimination without acknowledging specifically that it’s a systemic issue impacting public health.

While declaring the crisis is a good start, organizations must be held accountable for their proposed action items, Barnett added.

“We have to pay close attention to what policies have come out of these jurisdictions since the declaration was made,” she said. “Where do we see racial equity occurring in the policies that come out?”

For example, cities can form task forces to advise elected officials on where to allocate resources to promote equity, Barnett said. Officials in Milwaukee, which was the first major city to declare racism a public health crisis, made sure every budget item went through a racial equity task force first to try to prevent systemic racism from occurring in the future, Barnett said.

Cleveland City Council created a working groupto advise them on how to allocate funds to causes that address disparities, such as lead abatement, but the group does not have funds on its own to make change.

Reporter for The Land, Michael Indriolo, contributed to this story. The Land is one of the partner organizations working with Ideastream Public Media on the Connecting the Dots between Race and Health project.