Truth and Reconciliation: Mayor Martin J. Walsh on Racism as a Public Health Crisis
On June 24, 2020, the Voices in Leadership discussion between Mayor Marty Walsh and Dr. Michelle Williams spotlighted the role of leadership during a global pandemic and national reckoning with systemic racism. Mayor Walsh, the 54th Mayor of the City of Boston, declared racism to be an emergency and public health crisis in early June. Dr. Williams is Dean of the Faculty and Angelopoulos Professor in Public Health and International Development at the Harvard T.H. Chan School of Public Health and has authored multiple articles on racism as a public health issue. Their conversation explored the impact of data, discrepancies between individual and collective perspectives, power of conversation, transitioning from a moment to a movement, and connection between truth and reconciliation.
The Impact of Data
In the declaration naming racism as an emergency and public health crisis, Mayor Walsh recognized the need for accurate data collection and careful analysis. Dean Williams brought up the importance of using that data to 1) inform specific policy changes and 2) evaluate the impact of those policy changes on the overall goal of dismantling racism. Mayor Walsh provided examples of using such data for forming an equity task force; creating a city-funded housing voucher program; distributing small business equity funds; divesting US$12 million from the City’s police department and redistributing the funds to public health; and funding the Boston Emergency Services Team (B.E.S.T.), a collaboration between police officers and social workers in responding to calls related to crisis evaluation and treatment services.
Data clearly reveal the need for those interventions, yet evaluating their effects on equity and efficacy can be complex. Many factors influence whether a policy has its intended effect(s). Mayor Walsh illustrated this while describing how racism-driven health inequities are inherently tied to the social determinants of health — i.e. the conditions where people live, learn, work, and play. Research on these conditions highlights the stark inequities between people in the United States. For example, Black Americans are more likely than white Americans to experience food insecurity, reduced income, fewer economic opportunities, lessened generational wealth, heightened risk for drug-related arrests, greater likelihood of being verbally abused or assaulted by a police officer, increased incarceration, reduced access to health care, and worsened health outcomes.
A major contributing factor to this is “weathering”, a hypothesis proposed by Dr. Arline T. Geronimus that addresses health disparities. Her theory explains: “stressors that impact people of color are chronic and repeated through their whole life course… and that increases a general health vulnerability”. This vulnerability is clearly reflected in adverse health events — holding all other factors constant besides race — such as diabetes, hypertension, and increased maternal mortality rates. Mayor Walsh additionally described the creation of a city-funded housing voucher program as a way to address inequities. Housing insecurity and lack of affordable housing is not a new phenomenon but rather can be traced to the 1930s when redlining in Boston began with a color-coded mapping system that labeled areas with immigrants and Black American residents as dangerous and undesirable for bank loans.
Given that evaluating the impact on equity is not always straightforward, how can Boston measure the effects of housing vouchers? Such measurement is important because the impact of redlining can still be felt today. Black and Latinx households are more likely to live in neighborhoods with greater exposure to poverty, increased unemployment, reduced air quality, and decreased access to green spaces. Recent data show how Boston’s Black renters face severe discrimination. Clearly, there are other factors besides economic circumstances that reduce access to safe, affordable housing.
Mayor Walsh also discussed how his office is “backing up the declaration of racism as an emergency and public health crisis with eight strategies focused on addressing the impacts that racism has had on the lives of residents and their overall health”. Those strategies address factors ranging from community-level prevention to state-and-federal-level policies and funding. Beyond these, political and public health leaders need to address the people responsible for implementing and enforcing those policies. Mayor Walsh explained: “It’s really important for us to have these conversations with police. Because police officers, and firefighters, and EMS, and our first responders need to understand that when they show up at a house […disparities…] have real impacts. And then on top of that, the racism that exists, and all of that stuff, adds up”.
In 2017, the Boston Globe Spotlight Team published a series investigating racism in Boston. Among their findings, Black residents — comprising about seven percent of the Greater Boston region population — have a median net worth of US$8, compared to US$247,500 for white households. In addition, the team found fewer than 5% of managers and officials in public office are Black Bostonians, and there is a major unemployment gap between Black people and white people. Other investigations have noted a pattern of resegregation within the Boston public school system and over-policing of Black riders by the Massachusetts Bay Transport Authority. Those inequities ultimately take a major toll on health.
Discussing the data on how COVID-19 disproportionately affects Black Americans, State Representative Dr. Jonathan Santiago, an emergency room physician, stated: “what we see right now, is what we expected. It’s really an exacerbation of the disparities that already exist”. Echoing this, Mayor Walsh opined: “When COVID hit, we saw a real spotlight, which we already knew existed, on these disparities and racial disparities in a big way, whether it’s been small businesses or employment or whatever the issue is”.
Individual vs. Collective Perspectives
Individualism has been a core value in the U.S. since its founding. Many white Americans, recalling anecdotes of European ancestors migrating over a century ago, use history as “proof” that every person has the ability to work hard and “pull themselves up by their bootstraps”. Despite being largely false, this narrative is ingrained in U.S. culture. Mayor Walsh described his understanding of his own family’s history in the context of the experiences of people from other backgrounds:
“As… white [people], we don’t have the answers. We don’t walk in the shoes of a Black person. We might think we feel it… My parents are immigrants… Their family had nothing, literally nothing. But when [my father] came to America, he was given, by somebody, an opportunity. And that can’t be said for the Black community in a lot of different ways.”
He took care not to equate personal experiences with adversity with collective experiences. Unfortunately, many white Americans continue to liken their individual experiences with the collective experience of Black Americans. This is reflected in the 45th U.S. president’s twisting of statistics in stating that “more white people, by the way” are killed by police than Black people. This assertion misleads and misses important context. White people are not disproportionately represented in police brutality statistics; Black Americans are shot and killed by police at twice the rate as white Americans. Related to this is the concept of “rootedness”, described by historian and law professor Kenneth Mack, referring to each individual’s unique development in a particular set of circumstances. That “rootedness, such a basic human necessity, can have a distorting effect on what one sees”. People’s perceptions are subjective, shaped by their experiences. Without acknowledging that bias, people in the U.S. risk skewing reality through a distorted individual lens.
The Power of Conversation
Even as more white Americans acknowledge the injustice in ignoring the perniciousness of structural racism, it is important to acknowledge the barrier between conversation and action. For example, as journalists Amy Harmon and Audra D.S. Burch described: “some of the same communities where white liberals have been marching with ‘Black Lives Matter’ signs have seen steep resistance to efforts to integrate public schools and neighborhoods”.
Mayor Walsh recognized this disconnect, stating: “we think that because we’re elected officials, we’re professionals. That we have our hands on the pulse on all these different issues. I think we usually do, but are we missing something here? And I think the answer to the question is, yes we are”. Voices in leadership too frequently belong to those who are hoarding power and leveraging privilege for their individual agendas. Among Boston’s leadership — in politics, law firms, businesses, and hospitals — Black Americans have been historically excluded.
Bostonians are rightfully voicing their frustration, reminding the community that conversations about racism have been happening for decades without tangible improvements. Segun Iodwu, Executive Director of the Black Economic Council of Massachusetts, expressed his discontent with the Walsh administration in a virtual roundtable, asserting that “people are done with talk, and done with ‘reform’. People are looking for a new world”. His words reflect the fact that while headline-making declarations and novel task forces are an initial step towards equitable policies, concrete actions are desperately needed to impact change.
Other community leaders have vocalized that the Walsh administration’s actions were not reflective of the conversation that Mayor Walsh described. In an article in The Bay State Banner, senior editor Yawu Miller wrote: “in view of the more radical demands coming from activists and Black and Latino city councilors, many of Walsh’s proposals appear as half-measures that generate headlines but often leave substantive reforms off the table”, indicating an impression that these measures were self-serving. Student advocate Vikiana Petit-Homme agreed that there are discrepancies between the demands of Black Americans and the response of the Walsh administration. In response to Mayor Walsh’s 2.4% reduction in police funding, Petit noted: “It was just US$12 million of the overtime budget, which they’re free to overspend anyway. It was performative, to get the media off his back”.
In a position of political power, there is a responsibility to amplify constituent voices. Leaders collaborate with stakeholders in efforts to establish equitable systems. Mr. Idowu, of the Black Economic Council of Massachusetts (BECMA), discussed how Mayor Walsh’s announcement of the US$10 million Boston Racial Equity Fund undermined the recent US$20 million New Commonwealth Racial Equity and Social Justice Fund, which was announced by Black executives of the BECMA. “The mayor said two weeks ago that Boston would be a leader in fighting racism and that we should listen to Black people, and then he did the opposite”. Undeniably, Boston has a long history of tensions stemming from racism, which makes it all the more important for leaders to continually check in with community members, utilizing their input to inform impactful policies and actions.
From a Moment to a Movement
The dual crises of the COVID-19 pandemic and police brutality have elevated the harms of structural racism to the national and global levels. Although systemic racism has exposed the façade of the “American Dream” for centuries, having long been experienced by those such oppression impacts, Dean Williams noted: “there’s something very different about what we’re experiencing, where the original sin of racism in our country is being reckoned with, in a way where this moment is becoming a movement”. Acknowledging this, Mayor Walsh shared that he has heard from Black Bostonians that “this isn’t different to [them]. This is just another incident that’s happened”. He shared: “And I can identify with that. But as a person who is white, this feels different where it seems like there’s a lot more support and allies around looking for real change”.
Why do things feel different now to some people? As writer Jesse Washington asked: “Where did all these white people come from?” Journalists Amy Harmon and Audra D.S. Burch bluntly asserted: “It is as though the ability of white people to collectively ignore the everyday experience of Black people has been short-circuited, at least for now”. It seems that the pandemic provided an environment for white Americans to pay more attention to inequities. COVID-19 has played yet another pivotal role in magnifying media coverage of police brutality, and with greater visibility, more white Americans are tuning in to the anti-racism movement.
Washington provided further explanation for the increased participation in anti-racism efforts: “Floyd was killed during the coronavirus lockdown, when there were fewer distractions to national attention and massive pent-up energy to release. And the protests were an avenue for people to express their opposition to a climate of racial hostility stoked by [the 45th president]”. Although COVID-19 has paradoxically created additional space for this moment, it remains to be seen if progress will be made.
Truth and Reconciliation
Near the end of the conversation, Dean Williams quoted Bryan Stevenson, founder and executive director of the Equal Justice Initiative: “You can’t have the reconciliation without the truth”. In the U.S., at the individual and community levels, there has not been widespread acceptance of the truth of the integration of racism in the social determinants of health. However, even though Euro-American belief systems tend to consider “truth” to be objective, in reality, truth is significantly affected by the lens of the individual, as well as historical contexts. Conversations acknowledging individual and collective perspectives will help many to sit with and take action against the fact that Black Americans have been, and continue to be, impacted by structural inequities.
Mayor Walsh’s admittance that “one of the regrets [he has] is…not taking this declaration earlier” is honest, but it does not excuse the decades of racism and systemic discrimination throughout Boston. Ending on a hopeful note, Mayor Walsh recognized: “We can’t go back to normal, the way normal was”. For him, there is a responsibility to create systems change “because of COVID-19 and because of all the unrest, the emotion, the feelings, the anger, the sadness of what George Floyd’s death means to people”.
As family physician and epidemiologist Dr. Camara Jones stated: “racism is not a cloud. It is a system with identifiable and addressable mechanisms, which are in our decision-making processes”. Racism has been an emergency and public health crisis for centuries, and while the data exist, policies have not comprehensively addressed systemic racism. Boston’s past and present are embedded with racism, and the role of leadership in implementing systemic anti-racist policies cannot be understated.
Story written by Elizabeth Alpert, DDS, who is pursuing her MPH in Health Policy at the Harvard T.H. Chan School of Public Health. She is a practicing dentist, and her clinical interests focus on adult special care dentistry and geriatric dentistry. She plans to pursue a path of interdisciplinary research investigating the effects of oral health on systemic health and quality of life. On a broader scale, her interests fall under the umbrella of understanding and addressing disparities in access to health care, as well as underlying social determinants of health.
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.