To fix the health crisis caused by racism Americans need to talk about its history, Northeast Ohio African American leaders say

In 2020, Cleveland was among many cities across the country to declare racism a public health threat. As municipalities have grappled with the implications of their declaration, leaders in Northeast Ohio’s African American community are urging residents, health care administrators, civic leaders and public policy experts to look back at the history of racism to understand better its impact on the health of Northeast Ohioan’s today.

“With the advent of slavery, and chattel slavery in particular, what we saw was race being associated with how you look, and so it created this cast system with African Americans or people who are dark-skinned always on the bottom,” said Yvonka Hall, executive director of the Northeast Ohio Black Health Coalition. “When you look at how these systems are built, these systems were built off the backs of slaves. They were people who were never looked at as having the opportunity to rise because they were always looked at as property.”

Racism and white supremacy are so embedded in American society that those with a privileged status often don’t even recognize it, said Mwatabu S. Okantah Kent State University’s Interim Chair of Africana studies.

“Enslaved African people were redefined as something other than being a human being, and that legacy is still with us... and it's difficult because the country has never really acknowledged that,” Okantah said.

In order to address the public health crisis created by racism, it’s essential that the community as a whole understand and develop policies that account for the 400 years that African Americans suffered under slavery, oppression or discrimination, said Greg Brown, the executive director of Policy Bridge, a Cleveland-based think-tank that studies public policy issues affecting African Americans.

“It is very, very important that the community start to understand and develop policies practices and procedures and have accountability measures that start to hold our community responsible and accountable for how we deal with all of the people in the community — especially those people from communities of color,” he said.

First, said Hall, of the Northeast Ohio Black Health Coalition, society has to be clear-eyed about the problem.

“I think that when you look at inequities and how the African American community is disproportionally impacted here, we have to look at the cause of the inequities and the key culprit is racism,” Hall said.

Once racism was officially named a public health crisis, the next step is to look at the social determinants of health, things like access to green space, good schools and reliable transportation that feed racial health disparities in Cleveland, said Alan K. Nevel, MetroHealth’s Chief Equity Officer.

“If you look at it just in terms of zip codes across Greater Cleveland, there are some areas in our community where four out of ten people don’t know where their dinner is going to come from this evening,” he said. “That will naturally cause someone to be unhealthy.”

When you think about health as dependent on a person’s economic viability, mobility, housing and environmental conditions in addition to their access to transportation, good schools and healthy food, what you’re looking at is a large societal system that must also be evaluated in terms of race, said Brown, of Policy Bridge.

"When you think about all of those things, you have to think about them not just in how a community is dealing with it, but whether there are structural barriers based on racism and long-term discrimination that impedes the progress of certain populations reaching their maximum and ultimate potential,” he said.

That means that solutions to racism as a public health crisis can be practical in nature.

“So individuals are having a tough time coming over to receive their medical care whether that’s because of public transportation or personal transportation,” said Dr. Claude Jones, president and CEO of Care Alliance, Federally Qualified Health Center in Cleveland. “So can we change policy to increase bus routes into those areas where there may be a shortage of routes?”

Hall said her group is looking at more than just health outcomes as it tries to address health disparities.

“Our team has been working to make sure we address those issues and also many things that disproportionally affect our community,” she said. “We’re looking at the air, we’re looking at the land, we're looking at the water. We're looking at every single system and how it impacts our community and how we can work to educate the community about those systems.”

That includes understanding how those systems were built — even decades or centuries ago.

Redlining was a practice by banks, insurance companies and federal housing programs that denied Black neighborhoods access to loans during the mid-20^th century. But today, the term has come to be understood as any practice that denies resources to Black communities.

Through that lens, Hall said today she sees a continuation of the redlining that existed in the 1930s and 40s playing out in Northeast Ohio’s health care system.

“We have hospitals that are closing in urban areas, and we have suburban areas that were once non-African American that are changing over in those communities,” she said. “What we’ve seen is hospital systems pulling out of these areas.”

The epicenter of redlining is not just central cities and urban areas, but now includes formerly white suburbs that now have sizeable Black populations, she said.

Too perceptions of treatment can be affected by one's race. Some Care Alliances patients say they feel overwhelmed and poorly treated by large hospital systems, said Jones.

“Many of our patients are lower socioeconomic status, they have lower education levels so when they go to any one of the major hospitals they may feel overwhelmed,” he said. “So many of them do come back and feel like they were treated differently because of their insurance status or they didn't have insurance or they may have a chronic pain condition where they were seen as seeking meds, so they felt like they were put into a category automatically.”

Nevel, of MetroHealth, said his system has reviewed its policies to make sure they’re treating people of all races and ethnicities with respect.

“I shouldn’t have to wear my badge to go into one of our facilities to be treated with a level of dignity and respect,” said Nevel, who is Black. “I shouldn’t have to walk in wearing a suit and tie.”

Nevel also stressed the importance of working with organizations outside the health care sector and having community discussions to serve the most vulnerable better.

Okantah, of Kent State, has another recommendation.

“In this historical moment, this reckoning, that’s happening in this post-George-Floyd-Breonna-Taylor world, there’s a need for white people to sit down with each other and talk about the negative impact that living in a white supremacy system has had on them,” he said.

Hall, of the Northeast Ohio Black Health Coalition, said that although racism and the public health crisis it has created are affecting people’s well-being, it’s important to remember that it’s unacceptable.

“Racism should not follow me into the doctor’s office, into an education setting, it shouldn't follow me into a job, it shouldn't follow me anywhere,” she said, “because racism should not exist.”