Michelle A. Williams, SM ’88, ScD ’91, Dean of the Faculty at the Harvard T.H. Chan School of Public Health and Angelopoulos Professor in Public Health and International Development (Left), and Jeffrey R. Sánchez, former Massachusetts state representative and lecturer at Harvard Chan (Right).

Enough is Enough: Dean Michelle Williams and Representative Jeffrey Sánchez on the Need for a Public Health Lens in Addressing Systemic Racism

By Mahaa M. Ahmed

The COVID-19 pandemic has claimed the lives of nearly 180,000 people in the United States. As the pandemic rages on, it has magnified the vast inequities that exist in our world. Early observations coupled with narratives from healthcare workers indicated that Black and Latinx individuals were being affected by COVID-19 at alarmingly higher rates. An overview of the racial inequities of the pandemic only further echoes this and finds that Black and Latinx people are at greater risk of contracting coronavirus than white people due to systemic conditions that have created environments where COVID-19 can spread. In the midst of the present pandemic, the public consciousness of those in the United States and around the world has been captured by the murders of Black people by the police. The combination of the disproportionate impacts of COVID-19 and anti-Black police brutality has recently rekindled a broader reckoning about systemic racism.

On June 11, 2020, Dean Michelle Williams and Representative Jeffrey Sánchez engaged in a solutions-driven discussion exploring the intersections between COVID-19, systemic racism, and public health, moderated by Dr. Sara Bleich, Professor of Public Health Policy and Management at the Harvard T.H. Chan School of Public Health and Carol K. Pforzheimer Professor at the Radcliffe Institute for Advanced Study. Dr. Michelle Williams is currently Dean of the Faculty at the Harvard T.H. Chan School of Public Health and Angelopoulos Professor in Public Health and International Development. Jeffrey Sánchez is a former Massachusetts State Representative and lecturer at the Harvard T.H. Chan School of Public Health.

Together, Dean Williams and Representative Sánchez co-authored an op-ed, “Racism is killing black people. It’s sickening them, too” in The Washington Post on June 4, 2020, in response to the murder of George Floyd and the ways in which racism permeates our society across every sector.

Incomplete Celebrations

Both Dean Williams and Representative Sánchez admitted that their initial impulse upon being invited to Voices in Leadership was to decline. The difficulty of discussing their thoughts about events and rhetoric that so personally affect them and their communities, coupled with being conditioned to have these invaluable conversations away from the table in favor of doing what has to be done to succeed, proved difficult to ignore. Yet, their personal anecdotes and reflections shared over the course of their conversation with Dr. Bleich illustrate how their proposed solutions to moving forward to address systemic racism from a public health lens are informed by their own lived experiences.

Representative Sánchez recounted growing up in the Mission Hill community. He recalled the unjust impacts felt after the 1989 murder of Carol DiMaiti Stuart when her husband accused a Black man of jumping into their car and shooting him and his pregnant wife. Sensational news reporting and Mayor Raymond Flynn’s call for a far-reaching manhunt to identify the perpetrator led to the Boston police force’s too-frequent use of stop-and-frisk searches, which terrorized countless young Black people. Among them, Representative Sánchez remembered being “treated in a way that demeaned us, degraded us”. He further shared how he could “remember being thrown up in the hallways in [his] housing project”. Although the husband was ultimately identified as the murderer, the cruel and inhumane tactics used by the Boston police force and the media’s harmful framing of Black communities have persisted and led to far too many wrongful arrests and convictions of Black individuals beyond the city of Boston.

Representative Sánchez’s accomplishments are numerous and impressive; he was the first Latinx chair of the Ways and Means Committee and has introduced numerous criminal justice laws. He attributed feeling lucky about all that he has accomplished to date due to witnessing firsthand the work and advocacy of a powerful woman in his life — his mother. She worked to uphold the rights of residents in the Mission Hill community and was a fierce proponent for improving living conditions. Similarly, Representative Sánchez continues to work to improve access to education, affordable housing, marriage equality, and many other public health issues. Representative Sánchez shared:

“But one thing that I learned is, from my mother and from so many other people, like Dean Williams, [is that] you have to keep yourself at the table. And most of the time, you’re going to be at the table with people that you don’t normally agree with. And one thing I’ve learned is that you can call people out, but you also have to find solutions now that people are at that table.”

Dean Williams also stuck to the notion of feeling lucky. She explored how although she feels lucky to have achieved all that she has, she also feels somewhat ashamed. She explained how she is haunted by the thought that so many Black and Latinx individuals are conditioned to work twice as hard simply in order to be seen, yet are still overlooked. Dean Williams shared that since elementary school, she has been cognizant of having to “work twice as hard for half the recognition”.

She further echoed Representative Sánchez’s sentiments that their celebrations of success are incomplete, given reflections on not only their own personal adversities but also their renewed fear that future generations will continue to be faced with the same set of challenges. She pointed out how it is difficult to celebrate successes, such as being the first Black Dean of the Faculty at the Harvard T.H. Chan School of Public Health, because she wonders “about all the others who should have been first that didn’t make it because they didn’t get seen, or they weren’t quite as lucky as… [me]”.

Both Dean Williams and Representative Sánchez convey feeling lucky when reflecting on their accomplishments. Still, their successes are attributable to both the opportunities they were fortunate to have and the hard work they have done and continue to do. The lingering notion of luck sometimes gives way to feelings of guilt and shame that can overshadow the feeling of joy and pride they should take in all that they have done to ensure public health and safety.

Looking Upstream

Dean Williams articulated exactly how tenuous the very existence of Black and Latinx individuals is in the U.S., stating that “for this country, Black and Latinx people’s lives are incredibly impacted in complex ways, from birth to death, by a network of racist, anti-Black, anti-Latinx systems that costs us our lives”. Police brutality is only one of the many systemic racism tools used by those in power to abridge and hinder the lives of Black and Latinx individuals. When looking upstream, the myriad social determinants of health that threaten the lengths and qualities of their lives become evident.

George Floyd pleaded that he couldn’t breathe, no less than 20 times, during the final eight minutes and 46 seconds before he lost his life in Minneapolis, Minnesota. In 2014, Eric Garner said those same three words after being wrestled to the ground in a chokehold by a police officer in Staten Island, New York. These three words resonate with those familiar with the reach of public health. Representative Sánchez stated that the concept of “I can’t breathe” is too real in Black and Latinx communities, whether through the young children who have asthma or their parents living with hypertension. In the United States, the burden of asthma disproportionately falls on Black and Latinx populations. They experience increased exposure to allergens and air pollutants and difficulty accessing care, often due to the lack of primary care physicians in these communities.

The health of Black and Latinx communities in the United States is threatened in cross-cutting and complex ways. Flint, Michigan’s water supply was knowingly poisoned with lead, and many in the city still lack access to clean water even in the midst of the COVID-19 pandemic. Black Americans are more likely to live near industries that contribute to air pollution than white Americans regardless of their income level, which jeopardizes their respiratory health. And Black pregnant people face a disproportionately high mortality risk due to decreased quality of care and/or susceptibility to the impacts of climate change.

Discriminatory housing and permitting policies subject Black neighborhoods to extreme heat and ecosystem disruption, and the corresponding adverse health effects will only be amplified by the impacts of the climate crisis. Residents in Black neighborhoods face an increased risk of financial loss due to living in areas with the highest flood exposure. A recent study reports that Black and Latinx populations in the United States have lost a greater number of years of potential life lost due to COVID-19 compared to white Americans. The health of Black and Latinx populations is undermined by systemic and racist barriers across all sectors. The recent calls to defund and abolish the police should include broader conversations and consideration for social determinants of health as well since health begins in homes, schools, work offices, communities, and neighborhoods. Dean Williams asserted, “we have to be truthful about the problem that we’re trying to solve, how pernicious and pervasive it is. And then we have to structure solutions in proportion to the size of the problem”.

Michelle A. Williams, SM ’88, ScD ’91, Dean of the Faculty at the Harvard T.H. Chan School of Public Health and Angelopoulos Professor in Public Health and International Development (Top Left), and Jeffrey R. Sánchez, former Massachusetts state representative and lecturer at Harvard Chan (Top Right) were virtually interviewed by Dr. Sara Bleich, Professor of Public Health Policy in Department of Health Policy and Management and Carol K. Pforzheimer Professor at the Radcliffe Institute for Advanced Study (Bottom Center) for the Voices in Leadership web series for the Harvard T.H. Chan School of Public Health.

Fixing the Ratio

Clinical care and services provided by the healthcare system only account for approximately 10–20% of our health, whereas social determinants of health overwhelmingly account for the rest. Our health is determined by our physical and built environments, social and economic factors, health behaviors, and clinical care. Our health status is predominantly determined by the quality of the air we breathe and water we drink, housing in which we reside and its affordability, modes of transportation we use to commute, education systems accessible to us, jobs we work and income we receive, social and familial support networks we have, types of nutritious food to which we have access, the parks and green spaces we can frequent, and far more. The lengths and qualities of our lives are far more influenced by these social determinants of health than they are by access to clinical care.

Dean Williams cited science journalist and author Laurie Garrett to illustrate her point that the majority of the determinants of health are situated outside of healthcare, yet we invest far more in medical care than social services. She shed light on the need for public health practitioners to work to rectify this imbalance that jeopardizes health, especially that of Black and Latinx individuals. She highlighted how essential it is to engage across all sectors to achieve health:

“And I think we at the Harvard Chan School of Public Health, and we all across academia have to realize that public health is so important that it can’t be left just to academia and to government. We need all sectors. And this is where we have a moment, because COVID brought to everyone’s attention the primacy of public health in the securing of our economic and civil society.”

Dean Williams further stressed that those working within public health must take ownership of the crucial role social determinants of health play in determining our health status. She pressed: “We in public health are positioned and prepared to understand that our public safety framework and our policing framework needs to be examined and reimagined and implemented in a different way”.

The onus to work beyond the comfortable confines of public health lay with those who understand that to meaningfully work to secure healthy lives for Black and Latinx children and adults, we must build partnerships and relationships with those working in other sectors. The current COVID-19 crisis exemplifies how we must consider how health begins from the environmental conditions where we are born, live, learn, and work.

Action-based, Outcome-based

Representative Sánchez expressed that he remains hopeful. He shared that he feels encouraged by the mobilization we have seen in recent weeks. Protests centering the Movement for Black Lives have occurred in major cities and rural towns across the United States as well as in Brazil, Trinidad and Tobago, Germany, and in many other corners of the world. Sánchez shared how the movement to defund and abolish the police is actually rooted in redistribution of resources. Dean Williams concurred and warned that the goal of achieving health for Black and Latinx communities goes beyond defunding the police and fighting against police brutality. She outlined that the defund the police movement should serve as a gateway to reimagining how we secure public health and safety. For example, the BREATHE Act calls for divesting taxpayer dollars from discriminatory police practices and instead investing in solutions that secure public health and safety.

Representative Sánchez and Dean Williams shared the idea that to achieve solutions, we need to pursue individual accountability and get to the inner consciences and hearts of people. Dean Williams pressed the importance of voting and vigorously holding elected officials accountable. Although these notions of individual and institutional accountability are important, they circumvent what truly needs to be addressed: structural and systemic racism. Reliance on personal responsibility rather than dismantling structural and systemic racism may not be the path towards a more equitable future for all.

Representative Sánchez urged that the work to combat police brutality, as well as consideration of the other ways systemic racism hurts Black and Latinx communities, must continue. He encouraged the audience to ask themselves:

“What are we really doing? And how do we catapult our efforts? What do we need? What’s relevant in terms of what we’re doing? And what isn’t? And what is going to keep all these people that we have at the table that are so passionate right now? How do we keep them at the table to dismantle and replace a broken system?”

Despite the indelible heaviness of the COVID-19 crisis and the call to reckon with systemic racism, both Dean Williams and Representative Sánchez remain hopeful for the future. COVID-19 has undeniably brought public health to the forefront of everyone’s minds, while continued police brutality has spurred many to consider individual and collective accountability. Protests in Australia have demanded justice for the deaths of Aboriginal people in police custody, protests in Brazil have demanded attention to the fact that over 75% of people killed by police are Black, and protests in Canada have called for investigations into the deaths of Rodney Levi and Regis Korchinski-Paquet.

Dean Williams and Representative Sánchez rightfully believe that now is a vital moment for public health. The public health lens, which advocates for investing in education, food systems, neighborhoods, environmental protection, and economic stability, in addition to working to abolish the police, must be integrated to ensure that Black and Latinx people are able to live healthy lives.

Story written by Mahaa M. Ahmed. Mahaa is a Master of Science student at the Harvard T.H. Chan School of Public Health. She is studying Environmental Health with a specialization in Environmental Exposure Assessment. Born and raised in New Jersey, she received her BS/BA in biology and philosophy from Rowan University. Her research interests revolve around global environmental health with a focus on children’s health in Bangladesh. She is an aspiring pediatric infectious disease specialist.

Story edited by Sherine Andreine Powerful, MPH, a Doctor of Public Health candidate at the Harvard T.H. Chan School of Public Health. A Diasporic Jamaican, she received her Bachelor’s degree in Latin American and International Studies from Yale University and holds a Master of Public Health degree in Population and Family Health, with a concentration in Global Health, from the Columbia University Mailman School of Public Health. Her interests, centered around the English-speaking Caribbean, include feminist global health and development leadership; gender and sexual health, equity, and justice; and pleasure, healing, and liberation.