Empty classroom.

School Discipline is a Public Health Crisis

By Thalia González, Alexis Etow, and Cesar De La Vega

Education is well-accepted as a key social determinant of health. It serves as a strong predictor of chronic disease, social and economic instability, incarceration, and even life expectancy. For example, by age 25, individuals with a high school degree can expect to live 11 to 15 years longer than those without one. Despite such evidence, education policies and practices have not been public health priorities. Too often, policies and practices in schools that create and compound health inequities are narrated and re-narrated as falling outside health law and policy. This is a missed opportunity for collective action to positively impact the future health pathways of children and communities.

In the wake of national protests against racialized police violence and COVID-19’s disproportionate impact on communities of color, the time has come for the health community — from researchers, to public health organizations, to advocates, to health care professionals — to move from simply affirming that racism is a public health crisis, to actively exposing how structural discrimination in education has fueled disparities and deepened the persistence of health inequities.

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Climate protest sign that reads "no nature no future."

Climate Change and Pregnancy: Policies for Impact

By Cydney Murray

The ongoing, worsening environmental crisis is exacerbating negative pregnancy outcomes associated with climate change.

Exposure to air pollutants, such as smog (ozone) and PM2.5 (another type of air pollution), is linked to impaired fetal growth, increased likelihood of cancer, autism spectrum disorder, stillbirth, and low birth weight. These health consequences have the potential to impact children’s overall quality of life by affecting their brain development, and their susceptibility to disease.

Climate change is worsening this established association, particularly for those living in urban environments with high air pollutant exposure. This disproportionately affects women of color, since they are more likely to live in more highly polluted areas, and already suffer a higher risk of negative pregnancy outcomes.

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Sign that reads "Racism is a pandemic too."

The Two Pandemics Facing Asian Americans: COVID-19 and Xenophobia  

By Seema Mohapatra, JD, MPH

When there is an outbreak or emergency, reports of racism and xenophobia often follow.

But in recent pandemics, there have been concerted governmental efforts to thwart nativist attitudes and prejudice, using law as a tool.

During the COVID-19 pandemic, however, instead of trying to extinguish racist attitudes, the Trump administration has actually spearheaded ways to “other” Asian Americans.

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redlined map of Los Angeles.

A Critical Race Perspective on Housing and Health

Image from “Mapping Inequality,” American Panorama, ed. Robert K. Nelson and Edward L. Ayers.

By Courtney Anderson

Only 10-20% of health outcomes are attributed to health care. Social, economic, and environmental factors thus account for the vast majority of population and individual health outcomes. And housing encompasses many of these factors, as it largely determines the built environment and exposure to stressors.

Section 801 of the Fair Housing Act declares, “It is the policy of the United States to provide, within constitutional limitations, for fair housing throughout the United States.” This Act was the culmination of racial justice protests, resistance to discrimination and violence, and other aspects of the civil rights movement. Despite the stated intention of this Act, housing remains unequal across the nation.

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A protester holds a sign with a quote that reads: "Pf all the forms of inequality injustice in health care is the most shocking and inhumane."

Structural Racism, Social Determinants, and the Contested Scope of Public Health Law

By Lindsay F. Wiley

For centuries, public health advocates have understood that our health is shaped by the conditions in which we live and work — conditions public health researchers now refer to as the social determinants of health. Law itself is a social determinant of health. Structural racism and other forms of socioeconomic subordination, which are embedded in our laws and public and private policies, are social determinants of health.

Unfortunately, these statements are not uncontroversial. Commentators have debated whether structural racism and other forms of subordination are social determinants of health, and whether dismantling these forms of subordination is within the legitimate scope of public health law and policy. Critiques run along at least three main lines—semantic, civil libertarian, and progressive.

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Medicine law concept. Gavel and stethoscope on book close up

Addressing Racism through Medical-Legal Partnerships

By Medha D. Makhlouf

Numerous studies have documented that racism is a social determinant of health (SDoH) that negatively impacts Black, Indigenous, and people of color (BIPOC). As such, racism is one of “the conditions in which people are born, grow, live, work, and age” that are “mostly responsible for unfair and avoidable differences in health statuses.”

The U.S. health care system was not designed to respond to SDoH, much less to address racial health disparities. In fact, U.S. health care institutions have racist legacies that continue to influence the way they operate today. When health care providers fail to confront racism within and outside their walls, they perpetuate the racial health disparities that have plagued our nation since before its founding.

Medical-Legal Partnership (MLP) is a model of collaboration and joint advocacy between lawyers and health care providers who seek to improve social conditions that affect health and well-being. MLPs aim to address SDoH on three levels: direct representation in civil legal matters, institutional change, and systemic advocacy. They typically employ legal interventions to ensure that people’s basic needs are met, such as nutritious food, health care, income, safe and stable housing, and uninterrupted energy and water utilities. Improving access to such resources is an important way of engaging with the work of health equity.

While some MLPs incorporate a racial justice lens in their work, many do not. MLPs are generally more oriented toward addressing the effects of racism as a SDoH, rather than as the cause of poor health. But considering the cross-cutting nature of racism as a SDoH, MLPs can and should address it directly. As Director of the MLP Clinic at Penn State Dickinson Law, whose faculty has resolved to incorporate discussions of racism and inequality in the curriculum, I have begun researching Critical Race Theory (CRT) as a framework to understand how MLPs can build on their core activities to further address racism as a SDoH and make explicit the connections between racism and poor health. This post describes how MLPs can address racism as a SDoH in at least four ways that align with the goals of CRT.

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Man holds up a sign at the Black Lives Matter protest in Washington DC 6/6/2020.

How Social Movements Shape the Law to Address Health Disparities

By Aziza Ahmed

We are facing a health crisis in America. In thinking through the causes of health disparities, a now well-developed body of public health law scholarship focuses in on the central issue of law as a social determinant of health. This scholarship examines the issue of how legal rules can determine health outcomes. Property laws that explicitly or implicitly discriminate against minorities, for example, often result in poor Black communities living in neighborhoods in which they may be more exposed to pollutants, resulting in higher rates of breast cancer or asthma. Or, immigration practices, including ongoing profiling at the border, as well as detention practices, may have mental and physical health impacts.

What is missing from legal scholarship on the social determinants of health is an account of how communities respond to change the legal environments that have the effect of producing poor health outcomes. In other words, how do communities demand a better legal system with regard to health inequality? Here, we must turn to social movements who often drive our national conversation on access to health care by doing the hard work of identifying, naming, and drawing attention to the complexity of issues that people face.

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Syringe and vials of vaccine.

Racial Inclusivity in COVID-19 Vaccine Trials

By Colleen Campbell

Recent calls for racial inclusivity in vaccine trials, which often rely on genetic rationales while emphasizing medical distrust among African Americans, unfortunately lack an equally robust critique of medical racism and the ongoing reasons for this distrust.

Even though race lacks genetic meaning, the COVID-19 discourse is rife with biological notions of race. Because of [g]enetics related to racial differences” African Americans must be involved in clinical trials, said Dr. Larry Graham in an NBC News article. He continued: “We must be sure it works in Black folks.” For this reason, companies like biotech firm Moderna are enlisting Black religious leaders to heavily recruit African American participants. They are also exploiting networks previously used for HIV clinical trials.

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Civil rights march on Washington, D.C. Film negative by photographer Warren K. Leffler, 1963. From the U.S. News & World Report Collection. Library of Congress Prints & Photographs Division. Photograph shows a procession of African Americans carrying signs for equal rights, integrated schools, decent housing, and an end to bias. https://www.loc.gov/item/2003654393/

Structural Racism: The Root Cause of the Social Determinants of Health

By Ruqaiijah Yearby, J.D., M.P.H.

In 1906, W.E.B. DuBois noted that social conditions, not genetics, impacted the health of Blacks, causing racial disparities in mortality rates. In 2010, the federal government formally recognized that social conditions, specifically the social determinants of health (SDOH), were responsible for racial health disparities.

Racial health disparities, estimated to cost the United States $175 billion in lost life years and $135 billion per year in excess health care costs and untapped productivity, persist because of the failure to address their root cause: structural racism.

Structural racism describes the way our systems are structured to produce racial inequalities between whites and racial and ethnic minorities in the SDOH, leading to racial health disparities.

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New York City, New York / USA - June 13 2020 New York City healthcare workers during coronavirus outbreak in America.

COVID-19 and the ‘Essential’ Yet Underappreciated Front-Line Health Care Worker 

By Kimani Paul-Emile

When considering those on the front lines of the coronavirus pandemic response, most people likely envision doctors and nurses. However, there is an often forgotten, front-line workforce comprised of orderlies, nursing facility workers, and nursing assistants (“NAs”) that earns very little money, has few protections, and is largely Black and Brown and female. Many individuals in this group are also subject to a unique form of discrimination: rejection on the basis of their race or ethnicity by some of the very patients they are assigned to aid.

The millions of people who make up this group of essential workers constitute a substantial portion of the health care workforce and earn an average of $13.48 per hour despite the risks they take. Their work, which involves bathing, dressing, and feeding patients; brushing their teeth, and assisting with their use of the toilet, puts these workers at high risk of contracting COVID-19. Nevertheless, early in the pandemic, many of these workers lacked or had inadequate personal protective gear due to the tiered system used for distributing this equipment. Doctors and nurses were first in line for smocks, masks, and other essential gear; last were members of this underappreciated group of front-line health care workers.

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