This year, the focus of Black History Month centers around the theme of Black Health and Wellness, and it could not come at a more appropriate time. Many of the city’s residents look forward after more than two years of the Covid-19 pandemic that has made the gap in health care access and services even more apparent.
“The issues that the pandemic exposed have been there a long time and have never been addressed,” says Dr. Etienne Djevi, an infectious disease specialist, Roseville resident, and member of the Human Rights, Inclusion and Engagement Commission with the City of Roseville. “If you look at the pandemic, it was very clear that people of color were most impacted. That’s because generations of discrimination has pushed black people into low-wage work—they were exposed the earliest when there was no clear understanding of how [the virus] was spread.”
Djevi says there are many things local government can do to intervene to change this trend, and he sees great hope in the steps Roseville has started to take. For instance, in April of 2021, the city banned flavored tobacco within city limits.
“For the city to take a step that tobacco companies can no longer target black and brown kids is a good example of how local government can have an impact on health outcomes,” Djevi says.
Roseville resident Keith Allen is the Senior Manager of Health Programs for a major healthcare organization in the Twin Cities and a Human Rights, Inclusion, and Engagement Commissioner. He grew up in St. Paul and emphasizes that health and wellness for BIPOC communities is about access to services but is also about much more. He sees it play out in social determinants of health in huge ways.
“You realize that there is a science behind it and it's not necessarily always about peoples' DNA; a strong factor is a person’s zip code,” says Allen. “And a majority of people are living in geographic areas where [there is less] access to parks, a high rate of crime, or a high rate of poverty. Those are the same people who are not receiving great access to care or living with more traumatic or chronic diseases. But as you move into places where there's more accessibility to parks, there's more accessibility to grocery stores… those areas often have better health outcomes.”
Researchers at the University of Minnesota Center for Antiracism Research for Health Equity have documented the health equity gap. “These disparities are caused by structural racism which has its roots going back 400 years,” write researchers Keelia Silvis and Miamon Queeglay. “If communities, health professionals, and policymakers hope to address racial health disparities, we must first learn about, understand, and accept the U.S.'s racist roots."1
Some history about Black communities in America which continue to impact medicine today are the:
- Enslavement of Black people in North America stretching back to 1619.
- Black enslavement comprising 60% of the U.S.'s history, with Jim Crow comprising another 20%.
- Racist myths like Black people having thick skin or experiencing less pain were created to prop up slavery and institutional oppression.2 A more recent 2016 study found 58% of white medical students believed Black people have thicker skin than white people.3 With these myths as a justification, doctors like J. Marion Sims performed nonconsensual surgical experiments on slaves like Anarcha Westcott.4
While the City may not be able to address the history of racism in medicine, there is room for improvement in the city to narrow the gap in health care outcomes in other ways, such as employment, homeownership transpiration, and the continued work with the City Police Department to treat everyone fairly and equitably.
“The issue comes down to what can local government do to fight poverty?” says Djevi. "Poverty comes in many flavors from housing discrimination to employment and education discrimination. What can local government do to close that gap? For me, the way I look at it—the changes the city is making to close the gap today hopefully prevent these things from happening again in 30, 50,100 years when the next pandemic comes.”
“The city has an opportunity to recognize the richness of our diversity and making sure that all folks… especially people of color feel welcome in this city, that they can take part in those things that really matter as far as when it comes to social determinants of health, from economics to health to environment,” Allen says.
“All of these things are very important, but it's also important to be intentional about making sure that all communities feel like they see themselves being a part of this community and being welcomed into this community.”
The Center for Antiracism also offers some solutions for improving health outcomes by integrating antiracism into health services.5 The Center for Antiracism encourages health care providers to:
- Center Culture and Relationships in their practice
- Support Desegregating Medicine
- Dismantle Racist Institutions
- Incorporate antiracism as a Core Professional Competency
Allen says he has a lot of hope for the future, especially for people living in the City of Roseville. He says it’s especially important for Black people to know that the health care disparities seen in their communities are not a foregone conclusion. Statistics like higher diabetes rates, high blood pressure, and high cholesterol can be prevented by self-care and reducing risk factors.
“For me, I knew a lot about the disparities in my culture. And assumed that it was a trajectory on what to expect as I get older... [But I realized] I can recreate my future by creating a foundation where that does not have to be my outcome.”
"It’s going to take all of us to be intentional about what we’re trying to achieve, says Djevi. "To keep in mind the wellbeing of those who are most vulnerable [so we can all benefit from] the changes we are trying to make. If we make it a priority, we will get there but we have to be intentional and be willing to factor new information into our decision-making processes.”
With the ongoing COVID-19 pandemic, access to resources are available to people to help people not to become socially isolated.
About the City of Roseville Human Rights Equity and Inclusion Commission:
The Roseville Human Rights, Inclusion and Engagement Commission acts in an advisory capacity to the City Council on matters of human rights, inclusion and engagement. The commission has nine members and currently has one youth member.
About the Center for Antiracism Research for Health Equity:
The Center for Antiracism Research for Health Equity (CARHE) was founded in 2021 by Rachel Hardeman, PhD, MPH to study and confront structural racism through research, community engagement, and narrative change.
- Hardeman RR, Medina EM, & Kozhimannil KB. Structural racism and supporting black lives — The role of health professionals. New England Journal of Medicine, 2016; 375:2113-2115.
- Kendi IX. Stamped from the beginning: The definitive history of racist ideas in America. Nation Books, 2016.
- Hoffman KM, Trawalter S, Axt JR, & Oliver N. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. PNAS, 2016; 113(16): 4296-4301.
- Zhang S. The surgeon who experimented on slaves. The Atlantic, 2018.
- Hardeman RR & Karbeah J. Examining racism in health services research: A disciplinary self-critique. Health Services Research, 2020;55(S2):777-780.