States are calling racism a public health crisis. Here's what that means

Protesters gather in downtown Portland, Oregon, on July 25.

(CNN)With Covid-19, the US is experiencing its worst public health crisis in a generation. But that same crisis is prompting leaders to take note of another emergency, one that has been ongoing for centuries:

Racism.
Michigan and Nevada became the latest states to declare racism a public health crisis earlier this month, joining Wisconsin and local governments in California, Ohio and other states following the killing of George Floyd in Minneapolis.
Treating racism as a public health issue isn't a new idea. A handful of local governments declared it a crisis last year, and health professionals have identified racism as a public health issue for well over a decade.
    These latest declarations and resolutions, though, come as the country remains in the midst of a national reckoning on race. Both the Covid-19 pandemic and the recent killings of Black people at the hands of police have brought renewed attention to the ways that systems and institutions disadvantage people of color, especially Black Americans.
    Now as communities call on their leaders to address systemic racism, more governments are considering similar declarations.
    "What we're hoping will happen is that by thinking of this through a public health lens, it will help people recognize that racism actually hurts people -- it impacts their health in a negative way," Georges Benjamin, executive director of the American Public Health Association, told CNN. "Then we're hoping that once people recognize that and they take the next step, they will begin to do things to unravel that."
    Here's what it means to treat racism as a public health crisis, and why officials believe it's necessary.

    How racism and health are tied

    When health experts talk about racism as a public health issue, they are referring to the ways that racism affects where people live, where they go to school, the quality of the air they breathe, their income and wealth, their access to food and healthcare and more.
    "How does that relate to public health? Because you are where you live," Jeffrey Sánchez, a public health advocate and former Massachusetts state representative, told CNN.
    Racism helps explain why Black and brown patients experience worse health outcomes than their White counterparts in nearly every category, even as they move up the socioeconomic ladder.
    Black women are nearly four times as likely to die of pregnancy-related causes than White women. Black men are more than twice as likely to be killed by police as White men. Black people are more likely than White people to experience high blood pressure, diabetes and stroke. And they're more likely to die at early ages of all causes.
    The Covid-19 pandemic perfectly encapsulates how racism manifests in public health.
    Black and Latino Americans who get infected are more likely to have pre-existing conditions that increase their risk of severe illness, according to a report from Johns Hopkins. Because they are more likely to be uninsured, they tend to put off seeking treatment and are sicker when they do receive care. On top of that, they tend to receive less aggressive treatment than White Americans, the report states.
    At home, crowded housing conditions make it harder for Black and Latino Americans to practice physical distancing, and many of them work in essential jobs that can't be performed remotely.
    "Racism has been killing people for a long time, either through benign neglect, aggressive policing, gentrification, or through a healthcare system that doesn't know how to take care of people of color," Sánchez said.
    The ongoing protests and national outcry over systemic racism that erupted after the death of George Floyd has put increased pressure on leaders and institutions to address racism in their communities.
    The American Public Health Association, the American Medical Association, the American Academy of Pediatrics and the American College of Emergency Physicians are among the organizations calling racism a public health crisis.
    Increasingly, more state and local leaders are doing the same.

    What the declarations do -- and don't -- entail

    That states, counties and cities are recognizing the extent to which racism affects people's lives is an encouraging first step, public health experts said.
    "They help us define that there is a problem," Benjamin said. "The first part of trying to solve a problem is to identify that it exists.
    But many of the declarations are just that -- statements that name the issue and pledge to do better but stop short of outlining a clear plan of action or allocating funds for the problem.
    These states say racism is a public health crisis

    • Michigan: Gov. Gretchen Whitmer issued an executive order on August 5.
    • Nevada: Gov. Steve Sisolak issued a proclamation on August 5.
    • Wisconsin: Gov. Tony Evers called racism a public health crisis at a news conference on June 4.
    • Colorado: The state plans to make a public declaration, the Denver Post reported in late July.

    "Ultimately what does it mean?" asked Sánchez. "Is the state going to figure out how to put more resources into the public health infrastructure that deals with the social determinants of health? Are they going to stratify data on where people are and how they're doing and how sick they are and target them with public health messages?"
    Wisconsin Gov. Tony Evers, a Democrat, called racism a public health crisis at a news conference in June, though the state has not issued a formal declaration.
    "Just like we cannot look away from police brutality and the killing of Black men and Black women, we cannot look away from the reality that inaction, indifference and institutional racism has harmed generations of Black and brown Wisconsinites," Evers said in June.