Racism Is Causing a Health Crisis. What Are We Doing About It?

little boy being carried by mom

Living with racism is like carrying around a 20-pound bag of cat litter all day, every day. That’s the unusual analogy presented by attorney and novelist Adam Smyer, who is African American, in a 2019 essay:

It occupies all of one arm, but you still have the other arm free to carry more groceries or unlock the door or whatever. It’s doable. You can live your whole entire life carrying that bag. … If you are really good, you can almost make it seem like you are not carrying anything at all. Of course, most people aren’t going to be able to do that.

Certainly, that burden takes a physical toll.

The health disparities in the U.S. between whites and people of color — in heart disease, obesity, pregnancy complications, infant mortality, life expectancy, and other conditions — cannot be explained entirely by socioeconomic factors like education and income. Instead, modern research is focusing on the stress brought on by racial inequity.

One clinician told NPR why he took a close look in particular at the link between stress and racism. Dr. Roberto Montenegro, Chief Fellow at Seattle Children’s Hospital at the University of Washington, shared this anecdote. After earning his Ph.D. at UCLA, Montenegro went out for a celebration dinner with colleagues. While leaving the restaurant, patrons mistook him for a valet. Twice. “I vividly remember turning red,” he recalled. “And I remember my heart pounding.” These, of course, are stress responses.

“Individually these incidents seem benign,” Montenegro continued. “But cumulatively I believe that they act like sort of low-grade micro-traumas that can that end up hurting you and your biology. It’s not just having your feelings hurt. It’s having your biology hurt as well.”

Racism, Stress and Mental Health

Arline Geronimus, a professor at the University of Michigan School of Public Health, calls this process weathering. Because of the way stress wears away at the body, she explained to Pro Publica, it “causes a lot of different health vulnerabilities and increases susceptibility to infection, but also early onset of chronic diseases, in particular, hypertension and diabetes.”

Likewise, mental health suffers. Between 2001 and 2017, “the rate of death by suicide for black boys ages 13 to 19 rose 60 percent, while the rate for black girls skyrocketed an astounding 182 percent,” according to clinical psychologist Dr. Inger Burnett-Zeigler, writing in The New York Times in 2019.

“Many black youths are often fighting for their lives in a system actively working against them,” Burnett-Zeigl added, “which can be exhausting and feel like a pointless, uphill battle.”

For women of color, sexism adds another layer of stress. This especially is true in the Rust Belt, according to research by CityLab and urban sociologist Junia Howell. In an in-depth review of data on health, education and economic outcomes for black women in 42 metro areas, Cleveland (and Pittsburgh) ranked at or near the bottom in each category. Cincinnati and Columbus fell below median scores as well, though Columbus was above the median for health. (WCPN’s The Sound of Ideas discussed this study in detail.)

Racism Even Effects the Health of Infants

Perhaps the most stark and tragic effect of inequity on health appears in babies. In Cuyahoga County, the African-American infant mortality rate is three and a half times higher than that of white babies. Margaret Mitchell, CEO and president of the Greater Cleveland YWCA, told Cleveland.com that statistics such as this represent “normalization of the 400 years of the impact of slavery.”

We look at infant mortality and we nod our heads. It’s a sign of normalization. That we are not all jumping up, screaming, demanding to do something. We can go down the list: the justice system, thinking about housing, lead, infant mortality, the wage gap, gun violence. We have reached crisis levels and yet somehow we can only whisper, “Is it time to declare racism a public health crisis?”

In 2019, the YWCA and First Year Cleveland, which focuses on infant mortality, organized 400 Years of Inequity: A Call To Action. This summit commemorated the 400th anniversary of the arrival of slaves in North America. Significantly, it connected that history to current racial disparities.

Health and Race in Cuyahoga County

Other organizations are speaking up as well and taking action as well. Health Improvement Partnership-Cuyahoga, a broad coalition of healthcare, education and community-service providers and other partners, counts among its goals “help[ing] eliminate structural racism as a root cause of health inequity.”

Meanwhile, Birthing Beautiful Communities is a “Village” of doulas that “holistically supports pregnant women to deliver full-term healthy babies, and in achieving equitable birth outcomes.” The organization plans to open a birthing center later this year. In addition, a Cleveland Clinic surgeon is leading the healthcare giant’s efforts to address health disparities through its new Multicultural Health Center of Excellence.

In a City Club speech last June, MetroHealth CEO Dr. Akram Boutros advocated for Open Tables, a community volunteering initiative organized by Community of Hope, and lamented how many are underserved, or not served at all, by “a society that has invested billions in medical care, and little in health care.”

“Look, if I have offended you, I am not sorry,” he said, according to Cleveland.com. “I hope I have offended you into action. I hope every person who listens to this goes out there and proves me wrong. If you or your organization are doing your part to end this health-outcome crisis, I beg you to yell it from the rooftops. Let all those who want to join you know.”

In 2019, Milwaukee County, Wisconsin, declared racism a public health crisis. Perhaps it’s time for Cuyahoga County to do the same.


The Institute of Family & Community Impact is a initiative of OhioGuidestone, one of Ohio’s largest behavioral health agencies. From research to products to clinical innovations, we provide tools for mental health treatment. For questions or more info, email us at IFCI@ohioguidestone.org.

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