Racism and public health: Statement from Dean Julio Frenk

December 17, 2014

Dear Members of the Harvard T.H. Chan School of Public Health Community:

The tragic deaths of Michael Brown, Eric Garner, and Tamir Rice have mobilized large and diverse groups to take action in the service of social justice. As people who work in the public health field, we are all acutely aware of the body of evidence that shows significant inequities in health among racial and ethnic groups.

As a School of Public Health, we must continue to conduct research that can shed a bright light on these inequities and ongoing health disparities. We must recruit, retain and educate students to be leaders in addressing the health challenges posed by racism and all forms of exclusion. We must translate evidence so it can guide the design and implementation of policies to improve the health of all people. And we must continue to mobilize knowledge—the unique and valued product of universities—as the most powerful force for enlightened social transformation. We are committed to this process of educating leaders who understand and can act upon the specific dimensions of social disparities, as outlined below.

As many are aware, African Americans and Native Americans have higher age-specific death rates than whites throughout most of the life course. Pacific Islanders and some economically disadvantaged Hispanic and Asian population groups have elevated rates of illness compared to whites for multiple conditions. Even after controlling for education, socioeconomic status, and other conditions that signal “lack of privilege,” on average African American adults have worse health than whites. Moreover, African Americans have the highest age-adjusted mortality rates among all groups in the U.S. While gaps in life expectancy and adult and infant mortality have narrowed in recent decades, they remain large and persistent. And in some areas, such as maternal mortality, the gaps are actually widening.

Gaps are also widening for some of the socioeconomic factors that drive health inequities. A 2014 report from the U.S. Census Bureau reported that in 2011 for every dollar of wealth that white households had, African American households had 6 cents and Hispanic households had 7 cents – wealth gaps that were wider than those in 2000, and this continues to be of concern in terms of access to equitable health-care.

There is a large body of evidence documenting the persistence of racism in contemporary society and the multiple pathways by which racism contributes to the patterning of racial and ethnic disparities in health. For example, institutional racism such as residential segregation can restrict access to educational and employment opportunities and lead to group differences in socioeconomic status and health. It also creates health-damaging residential environments where minorities face elevated levels of acute and chronic stressors, compounded by less access to resources that promote health such as nutritious food, safe places to exercise, and high-quality medical care.

Studies also show that African Americans are less likely to be offered the latest health care treatments for conditions such as cancer, cardiovascular disease, and depression when compared to whites. Data indicate significant bias in the criminal justice system, which leads to African Americans being arrested, convicted, and incarcerated for similar crimes at much higher rates than whites. In turn, this circumstance can contribute to the feelings of anger and hopelessness and the types of family instability that yield increased stress, decreased access to healthy lifestyles and health care, and ill health.

Public health research has also documented that self-reported experiences of discrimination are a psychosocial stressor that adversely affects physical and mental health and contributes to racial and ethnic disparities in health. Simply stated, racism is a public health problem that contributes to higher levels of stress, greater exposure to risk factors, reduced access to medical and social services, and ultimately to excess levels of disease, disability and death. As leaders in the field of public health these issues are of concern to us all.

As a community dedicated to issues of public health, we must persist in our scholarly and professional work so that we can contribute to the amelioration of ongoing disparities and the improvement of health conditions. As a School, we are committed to educating leaders who will address the health challenges posed by racism and all forms of exclusion. We look forward to working with all members of our community to design, generate, and implement an innovative educational and research agenda that leads to truly enlightened social transformation to advance health for all.

Julio Frenk, M.D., M.P.H., Ph.D.
Dean of the Faculty, Harvard School of Public Health
T & G Angelopoulos Professor of Public Health and International Development,
Harvard School of Public Health and Harvard Kennedy School

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