Editor’s note: This commentary is by Paul Manganiello, MD, Dana Michalovic, and Craig River-Westling, co-medical director, executive director, and board chair, respectively, of The Good Neighbor Medical and the Red Logan Dental Health Clinic in White River Junction.
Since the beginning of this new year, with the ongoing pandemic, as well as, the ongoing systemic police brutality, Americans cannot ignore the role racism plays in both their tragic outcomes, with people of color suffering disproportionately from both. Health, as defined by the World Health Organization, is not only the absence of physical and or mental illnesses, but also attaining social wellbeing. The public health community has framed the discussion “Your zip code can determine your destiny.”
In 2015, Gee et al., published their Systematic Review and Meta-analysis, of 293 studies reported in 333 articles between 1983 and 2013, Racism as a Determinate of Health. Not unexpectedly, racism was associated with poorer mental health (depression, anxiety, psychological stress as well as other adverse emotional outcomes), and poorer physical health (cardiovascular disease, hypertension, and diabetes, etc.).
The authors defined racism as “organized systems within societies that cause avoidable and unfair inequalities in power, resources, capacities, and opportunities across ethnic groups.” They go on to say that racism can occur at multiple levels, including: the individual’s internalization, incorporating racist attitudes into that individual either consciously or subconsciously, beliefs and or ideologies into one’s worldview; the interpersonal interactions between individuals; and at the systemic level with racist control of access to education, labor and resources within that society. How can racism impact health? There may not be only one factor but multiple factors affecting individuals differently. One huge factor is access to employment, which can affect availability to safe housing and educational opportunities; the lived environment can increase exposure to risk factors such as violence perpetrated by criminal forces, or biased policing. An individual’s health can be impacted through the inability to participate in healthy behaviors such as adequate sleep, exercise, and inability to purchase or prepare healthy food choices and societal exposures to substances with the potential for abuse. Finally, there may be the inability to access health care, or mistrust of the medical community.
Racism has plagued this country since Christopher Columbus, and the effects of racism on both the perpetrators and the recipients have taken its grizzly societal toll over generations. White society has to accept the fact that we are indeed “privileged” by the reality that we are born white, we need to face this fact and start to really address systemic racial inequality. There will be neither peace nor societal progress until it happens.
When this novel virus hit the Upper Valley, the Good Neighbor Health Clinic, like every other health care facility, needed to respond to the threat. We needed to assure the safety of our patients, volunteers and staff. We had to change how we delivered medical and dental care; but we also needed to remain true to our mission of providing free medical and dental care to people in the greater Upper Valley who are in need and do not have the means to pay. We needed to continue to work to achieve our vision of a community where people have access to the health resources they need to reach their potential for mental, physical and social wellbeing.
Recently, the Vermont’s Free and Referral Clinics, formerly the Vermont Coalition of Clinics for the Uninsured, a coalition of nine clinics throughout the state, issued A Statement on Racism and Health Equity: “VFRC and its member clinics commit to working toward health equity and to address the racial, societal, and economic factors that influence people’s health. We commit to combating systemic racism, including racism in the exam room, implicit bias, and violence against communities of color.”
We know that you are all tired of conforming to public health guidelines concerning Covid-19, and that we want to get back to being able to again socialize without physical distancing, but when it comes to racial inequality we can never go back to the “old normal.” Hopefully we all can benefit from these recent shared learned experiences. If we don’t we will never be able to experience a better world whereby we really do have equal opportunities and are able to unlock the full potential of all our neighbors.
